As sexual violence affects all parts of society, the responses that arise to combat it are comprehensive, taking place on the individual, administrative, legal, and social levels.
Individual approaches
Programmes for perpetrators There are few programmes outside of the criminal justice system which are targeting perpetrators of sexual violence, generally aimed at men convicted of male-on-female sexual assault, who form a significant portion of criminal cases of sexual violence. A common response of men who commit sexual violence is to deny both that they are responsible and that what they are doing is violent. These programs, found mainly in Industrialized nations, work with male perpetrators to make them admit responsibility and be publicly seen as responsible for their actions. One way of achieving this is for programmes that target male perpetrators of sexual violence to collaborate with support services for victims, which would potentially be a revictimization of rape victims and be a poor choice of action unless the rape perpetrator is highly contrite and apologetic, as well as with campaigns against sexual violence.
Life-skills and other educational programmes In recent years, several programmes for sexual and reproductive health promotion, particularly those promoting HIV prevention, have begun to introduce gender issues and to address the problem of sexual and physical violence. Two notable examples developed for Africa but used in many parts of the developing world include "Stepping Stones" and "Men As Partners". These programmes have been designed for use in peer groups of men and women and are delivered over several workshop sessions using participatory learning approaches. Their comprehensive approach helps men, who might otherwise be reluctant to attend programmes solely concerned with violence against women, participate and discuss a range of issues concerning violence. Furthermore, even if men are sometimes the perpetrators of sexual violence, the programmes are careful to avoid labelling them as such. A review of the effect of the Stepping Stones programme in Africa and Asia found that the workshops helped the men participating take greater responsibility for their actions, relate better to others, have greater respect for women and communicate more effectively. As a result of the programme, reductions in violence against women have been reported in communities in Cambodia, the Gambia, South Africa, Uganda, Fiji, the United Republic of Tanzania and elsewhere. The evaluations to date, though, have generally used qualitative methods and further research is needed to adequately test the effectiveness of this programme.
Developmental approaches Research has stressed the importance of encouraging nurturing, with better and more gender balanced parenting, to prevent sexual violence. At the same time, Schwartz has developed a prevention model that adopts a developmental approach, with interventions before birth, during childhood and in adolescence and young adulthood. In this model, the prenatal element would include discussions of parenting skills, the stereotyping of gender roles, stress, conflict and violence. In the early years of childhood, health providers would pursue these issues and introduce child sexual abuse and exposure to violence in the media to the list of discussion topics, as well as promoting the use of non-sexist educational materials. In later childhood, health promotion would include modelling behaviours and attitudes that avoid stereotyping, encouraging children to distinguish between good and bad touching, and enhancing their ability and confidence to take control over their own bodies. This intervention would allow room for talking about sexual aggression. During adolescence and young adulthood, discussions would cover myths about rape, how to set boundaries for sexual activity, and breaking the links between sex, violence and coercion. While Schwartz's model was designed for use in industrialized countries, some of the principles involved could be applicable to developing countries.
Health care responses
Medico-legal services In many countries, when sexual violence is reported, the health sector has the duty to collect medical and legal evidence to corroborate the accounts of the victims or to help in identifying the perpetrator. Research in Canada suggests that medico-legal documentation can increase the chance of a perpetrator being arrested, charged, or convicted. For instance, one study found that documented physical injury, particularly of the moderate to severe type, was associated with charges being filed, irrespective of the patient's income level or whether the patient knew the assailant, either as an acquaintance or an intimate partner. However, a study of women attending a hospital in Nairobi, Kenya, following rape, has highlighted the fact that in many countries rape victims are not examined by a gynaecologist or an experienced police examiner and that no standard protocols or guidelines exist on this matter. The use of standard protocols and guidelines can significantly improve the quality of treatment and psychological support of victims, as well as the evidence that is collected. Comprehensive protocols and guidelines for female victims of assault should include:
recording a full description of the incident, listing all the assembled evidence; listing the gynecological and contraceptive history of the victim; documenting in a standard way the results of a full physical examination; assessment of the risk of pregnancy; testing for and treating sexually transmitted diseases, including, where appropriate, testing for HIV; providing emergency contraception and, where legal, counseling on abortion; providing psychological support and referral. In some countries, the protocol forms part of the procedure of a sexual assault evidence kit that includes instructions and containers for collecting evidence, appropriate legal forms and documents for recording histories. Examinations of rape victims are by their nature extremely stressful. The use of a video to explain the procedure before an examination has been shown significantly to reduce the stress involved.
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