Characterizing sexual violence perpetrated by adolescents in South Africa and associations with HIV and STI risk behaviors.

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Objective: Data on sexual violence perpetration among adolescents has not been widely available in South Africa. This paper characterizes sexual violence perpetration and identifies factors associated with perpetration. Method: Data were derived from a secondary analysis of N=879, 14-16 year old adolescents with elevated risk for depression, and recruited via house-to-house community sampling for participation in a randomized controlled trial testing the efficacy of a behavioral intervention for prevention of HIV, STIs, and depression. Data were collected from 2018-2023 in South Africa. Results: Nearly half of participants (45.8%) attempted and/or completed one or more acts of sexual violence perpetration. The most common act of completed perpetration was coerced touching (30.5%), followed by oral sex (18.2%), vaginal sex (12.1%), and anal sex (11.9%). The most common act of attempted perpetration was oral sex (15.5%) followed by vaginal sex (11.2%) and anal sex (10.6%). Boys engaged in more violent perpetration than girls. Regression analysis adjusted for age and gender showed that having more sexual partners (p<0.001), drug use (p<0.001), and less parental monitoring (p=0.057) remained independent risk factors. Conclusions: Public health intervention is urgently needed to address sexual violence perpetration among adolescents. Future interventions should be timed for early adolescence, and should develop adolescents' understanding of rape, assault, and gaining sexual consent for a range of sexual touching, not just penetrative sex. Interventions to address violence should concurrently address sexual and reproductive health risk behaviors as well as substance use.

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