Youths and non-consensual sex: exploring the experiences of rape and attempted rape survivors in a tertiary institution in Ibadan, Nigeria

Summary Background Non-consensual Sex (NCS) is a worldwide problem with far reaching effects on the survivors. This study explored the experiences of rape and attempted rape (AR) survivors in a tertiary institution in Nigeria. Methods In-depth interviews with fourteen survivors of rape and AR were used to explore the context of experience of NCS, its consequences and help-seeking. Interviewees consisted two males and five females for each form of NCS who were identified during the quantitative aspect of the study. Interviews were subjected to content analysis. Results Mean age of the respondents was 22.3±2.5 years. Context of non-consensual sexual experiences varied with sex. Female survivors reported use of physical violence on them by their perpetrators while males reported verbal threats, nudity, forceful hugging and kissing. Means of escape adopted by survivors of AR varied between the sexes. Female AR survivors used physical force as a means of escape while males employed deception/plea. Perpetrators were majorly acquaintances of the survivors. Consequences of the experiences reported include physical injuries and pregnancy among females and psychological disturbances among males. Majority, both males and females did not report, nor seek help due to shame and did not know appropriate methods of preventing future experience. Conclusion Although both males and females reported they have experienced rape and AR, the context of the experiences and consequences reported varied between both sexes and most did not know how to prevent future experience. This call for urgent development of gender sensitive sexual violence prevention programmes to address this phenomenon. Funding The study received grant support from The Gates Institute, John Hopkins University Baltimore, USA through The Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Nigeria.


INTRODUCTION
Non-consensual Sex (NCS) is a worldwide problem often rooted in long-standing societal norms. 1 Definitions of NCS varies, complicating attempts to measure its overall prevalence or to compare its prevalence among various settings. However, all definitions rest on a common foundation: a lack of full and free choice in decisions to engage in sexual relations. Physical force or the threat of it can rob survivors of this choice. But intense psychological, emotional, and financial pressure or a fear of social consequences also can compel individuals to relinquish their right to resist unwanted sexual advances. While rape is one of the most extreme and immediately traumatic forms of NCS, other forms may have great health impact. Other forms of NCS include; attempted rape, unwanted touch or fondling /molestation, non-contact forms of NCS such as verbal harassment and forced viewing of pornography. 2 However, this article focused on the most extreme forms; rape and attempted rape. The experience of forced sexual intercourse is a serious concern because it has far reaching consequences of the reproductive health of survivors including HIV infection. 3 Also, women who have been sexually abused in childhood have greater propensity to participate in risky sexual activities as adolescents or adults thereby increasing the chances of exposure to violence. 4 Studies 5,6 have shown that all young people are at risk of experiencing NCS irrespective of their sex. While young female (unmarried and married) are most at risk, the evidence suggests that young males are also vulnerable to such experiences. For example, a study conducted in Ibadan, Nigeria among secondary school students showed that the overall lifetime prevalence of any type of NCS was 34.9%, this included 30.5% of males and 39.3% of females. 7 A recent study; retrospective study of sexual assault victims in Lagos Nigeria also showed that rape survivors included both females (93.9%) and males (6.1%). 8 Perpetrators of NCS varies depends on the settings where it occurs. Perpetrators of NCS may be a date, an acquaintance, a friend, a family member, an intimate partner or former intimate partner, or a complete stranger, but more often than not, is someone known to the survivor. 8,9 Hence, rape by strangers is less common and also less likely to be repeated than forced sex by known perpetrators. 1 Given the sensitivity surrounding NCS in general, and that perpetrated on young persons in particular, available evidence on NCS remains sparse, particularly in developing country settings. Consequently, several gaps exist in knowledge and understanding of the nature and extent in Nigeria, especially among students of tertiary institutions because majority of the few available studies were conducted among adolescents in secondary schools. We are not aware of any study that has documented the context of the experience of rape, studied males as survivors or gender differences in the situation surrounding the experience, hence the need for this study. Besides, previous effort made to involve male rape survivors in in-depth interview was abortive because not a single of them consented. 10,11 The current study documented the experiences of nonconsensual sex among students in a tertiary institution in Ibadan, Nigeria which was carried out in two phases. The first phase, which is the qualitative aspect, already published elsewhere 12 showed that out of the total respondents (594), 83 (14.0%) and 34 (5.7%) reported they had experienced attempted rape and rape respectively. This included 17 males and 66 females attempted rape survivors and 13 males and 21 female's rape survivors. The second phase of the research reported in this article explored the experience of rape and attempted rape survivors identified in the first phase. The help-seeking behaviours that followed these experiences and the consequences of it in the survivors' lives were also explored. It also highlighted the method employed by the attempted rape survivors in escaping from their perpetrators.

Settings for the study
This article describes the second phase of a cross-sectional study conducted among students of The Polytechnic Ibadan which explored their experiences of NCS. The institution; The Polytechnic Ibadan, being the first Technical Institute in Nigeria, was established in 1970.
The institution offers training in a wide range of specialized short courses not only for the purpose of improving the vocational competence of technical and commercial workers, but also to provide an opportunity for presenting the most recent advances in knowledge and in techniques to specialist groups.
The Polytechnic Ibadan has three campuses located in Ibadan, Eruwa and Saki, Oyo State, Nigeria. The Polytechnic of Ibadan runs mainly National Diploma (ND) and Higher National Diploma (HND). As at 2010 (2009/2010 academic session) when the study was conducted, the students' population in the institution was approximately 11,000 at Ibadan campus alone.
Research that took place before the study described in this article The previous research was a quantitative study conducted among students of The Polytechnic Ibadan, Nigeria which involved 594 students who were selected from the four halls of residence in the institution. Respondents were asked questions on whether they had experienced any of the incidents from a list of forms of NCS which included unwanted touch of breast or back side, unwanted kiss, forced viewing of pornography, exchange of money, mark or gift for sex, attempted rape and rape. Results of this study have been published elsewhere. 12

The current study: In-depth interview
The second phase of the study (reported in this article) was conducted among those who experienced rape and attempted rape identified during the first phase of this research. This second phase (qualitative aspect) consisted of in-depth interview (IDI) with 7 rape and 7 attempted rape survivors; two males and five females for each form of NCS. The instrument used was a pre-tested in-depth interview guide. The IDIs were conducted by the first author and trained research assistants using the IDI guide. Fourteen survivors of rape and it attempt (7 for each form of NCS) were randomly selected among those who indicated they have these forms of NCS during the first phase of the research. Females survivors were interviewed by the female research assistants. The IDI explored the context in which the incidents occurred, the help-seeking behaviour that followed and the consequences of the experience on survivors' lives. Respondents were also asked how they could prevent/avoid such occurrences in the near future. The IDI sessions were recorded on audio tapes and transcribed. Alongside, notes were also taken together with the audio tape recording. However comprehensive notes were taken for a male respondent who did not consent to the audio tape recording. The transcripts were subjected to content analysis.

Ethical Considerations
The study was approved by University of Ibadan/University College Hospital (UCH) Ibadan, Ethics Review Committee (UI/EC/10/0074). Consent of the participants was sought on when and where the interviews were to be conducted to ensure absolute confidentiality. All the interviews were conducted immediately after the completion of the questionnaire except for a male who experienced rape which was conducted a week after.

Socio-demographic Information, perpetrators and settings of the experience
Mean age of the respondents interviewed was 22.3 ± 2.5 years. Most perpetrators were persons known to the survivors and it included male friends for female survivors, and female friends for male survivors. Most of incidents occurred either at the survivor's or the perpetrators' residence. See Table 1 and 2 for summary data on attempted rape and rape respectively.

Context of rape and attempted rape
Narratives of interviewees suggested some common themes such that situational context in which rape or attempted rape occurred varied between the sexes. Firstly, female's survivors reported the use of physical violence on them by their perpetrators. Secondly, a male could succumb to female's threat for sex if he feels that she could implicate him in case he refused. Thirdly, rape has serious impacts on the survivors; this may be physical, psychological, spiritual or social (Table 2). Lastly, means of escape adopted by survivors of attempted rape varied between the sexes.

Help-seeking behaviour
In-depth interviews also explored the extent to which rape and attempted rape survivors sought help/reported the incident. Findings from this study showed that helpseeking was a rare practice. Out of the female rape survivors, only one person sought help among them. The help she sought was not appropriate because she only visited a patent medicine seller to get emergency contraception despite she reported that she knew well that she was not safe. She only protected herself from unintended pregnancy. She said: "After the incident, I went to chemist to buy Postinor (emergency contraception); because I knew I was not safe; that was all I did" Likewise, only one of the two male rape survivors interviewed sought medical help, the second person later sought spiritual help because he was having nightmares. He said:

"I later went to a spiritual father who prayed for me after which those things (bad dreams and psychological disturbances) later stopped"
The main reason why survivors of rape did not report the incident or seek help was the shame associated with the incident and the fear of disclosure of their secret to others, although they may also have informed peers who did not have appropriate solutions to their problems. One of the survivors said she could not tell her father but only asked him some 'indirect questions'; she said: "I only told my friend all that happened but I later went to my father to asked some questions indirectly" Among those who experienced attempted rape, three of the seven survivors did not seek help nor report the incident to anybody. One of them said in her narrative; "I did not seek any help; I can tell you that this is the first time I am narrating this story"

Suggested methods of prevention of further experience of NCS by the survivors
Survivors of rape and attempted rape were asked how they could possibly prevent such occurrences in the near future. One of the two male rape survivors said he did not think he could prevent it while the second person made mention that he would leave the scene as soon as he noticed that such a thing may happen to him. Among the five female rape survivors, two of them made mention of being careful with men. One of them said: "One should stop seeing guys or boyfriend in secret or hidden places" However, two of them said they did not know and the last person reported arming herself against possible rape in the future. "I always carry a small knife inside my pocket that anytime he tries such with me, I will stab him. That is the best prevention I know for now" Among the male attempted rape survivors, the method reported to prevent further occurrence of the incident was limitation of relationship with ladies. Among the females, two of them could not give any preventive method while the other three made mention of being careful with males. One of them said: "I need not to trust anybody and should not follow guys to any secret or hidden place" Another person said: "I need to be very careful of whom I associate myself with and before going to visit a guy, I must be very sure the type of person he is"

DISCUSSION
Contrary to the general belief that only females could experience NCS, this study has established the fact that both males and female do experience NCS. This is consistent with similar studies. 6,10 Findings from this research showed that gender differences occur in the context in which rape and attempted rape occur. It also showed gender disparities in the situations surrounding the occurrence of non-consensual sexual experiences with the females likely to report the more violent aspects while males reported verbal threats, nudity, unsolicited hugging or kissing and undressing from their female perpetrator. Gender differences also occurred in the types of perpetrators reported.
The leading perpetrator among females were male friends while among males, perpetrators were predominantly their female friends. This is consistent with a Kenyan study by Erulkar 13 in which most of the perpetrators were intimate partners including boyfriends, girlfriends and husbands. The current study reflects the findings from a study conducted among adolescents in urban India in which the most commonly reported perpetrators of NCS were females for friends for boys, however most female did not know their perpetrators unlike the current study in which perpetrators of the females were well known to their survivors. 9 Findings from this study also corroborate some previous studies which showed that authority figures were involved in the perpetration of NCS. 8,10,14 For example, a qualitative study conducted in Nigeria by Ajuwon 10 showed that one of the eight rape survivors interviewed reported being raped by her instructor in Koran school. In addition, gender difference was also evident on the reported method used by perpetrators. Although several factors such as alcohol consumption and cigarette smoking have been shown to contribute to the experience of NCS 7,12 , the current study suggests that individual who had been sexually abused in childhood may subsequently participate in non-consensual sexual or risky sexual activities. One of the interviewee said that he later gave in to the threat from his perpetrator (a female) because sexual intercourse was not new to him. He reported his first sexual experience was a rape perpetrated by a lady in a party.
Rape has been linked to a host of health-related consequences which are profound with short and long term consequences. These include unwanted pregnancy and the potential complications such as sexually transmitted infections including HIV/AIDS, chronic pain, post-traumatic stress, suicidal thoughts and depression. In women, rape can cause trauma to the vaginal wall that allows easier access to HIV and other diseases. The risk of transmission is likely to be higher in girls and young women, because girls' vaginal tracts are immature and tear easily during sexual intercourse. Other health consequences include depression and abuse of alcohol and other drugs. 10,14,15,16 Consequences of rape and attempted rape uncovered in the current study include psychological and physical consequences such as virginity loss, vaginal bleed, nightmares, sadness, bruises and unwanted pregnancy and consequently unwanted childbirth.
Help seeking was a rare practice among the five females rape survivors interviewed, only one sought help. This is consistent with findings of a study conducted among adolescents in Ibadan, Nigeria which show that only one out eight rape survivors reported the incident. 7 Rape survivors, especially females likely not seek help or redress so as to prevent stigmatization and shame. 7 Threat of social stigma prevents young people from speaking out about rape and abuse. Related to this are fear of reprisal and deep-rooted unequal gender norms. 17 Hence, survivors of NCS would rather suffer in silence instead of seeking appropriate help by reporting to the appropriate authorities such as school authorities on campus, police station and health care centre.
The fact that many of the survivors could not give appropriate methods to avoid further non-consensual sexual experience suggests a gap in knowledge on NCS preventive measures among these students. Many said they did not know how they could prevent it. Although a few (females) made mention of being careful with males, however one of them reported that she was carrying a knife around the campus in case her perpetrator (Lecturer)makes any attempt to repeat the rape in future. These findings serve as evidence for urgent interventions among the target population.

Programme implications
Findings from this study serve as evidence for development of sexual violence prevention programmes among the target population and students of all tertiary institutions targeting both sexes. Doing this will also empower potential perpetrators to desist from such acts. Proposed programmes for interventions include public enlightenment on the prevalence and consequences of the experiences of NCS. Students need to be well aware about the potential situations that may lead to rape. Such signs included nudity and unsolicited intimate gestures especially by female perpetrators including hugging and kissing.
Also, students are to be well informed on how and where to report when they experience or see any sign of impending rape occurrence or the actual experience especially when it comes to the issue of lecturers being the perpetrator, thus preventing survivors from suffering in silence. The school authorities in partnership with governmental and non-governmental agencies need to develop health promotion and education promotion programmes to tackle this problem among students of higher learning. This programme should be very comprehensive so as to address factors at all the levels that influence nonconsensual sexual experience -individual, relationship, community, and society. This will surely reduce the incidents of such experiences.

CONCLUSION
Both males and females experienced rape and attempted rape, although with some forms of gender disparity in the context of the experience and means of escape by attempted rape survivors. Survivors either did not help or appropriate help and most did not know how to prevent future related experience. As such, this underscores the need to develop gender sensitive sexual violence prevention programmes to address this phenomenon among the target population.