Abstract
This qualitative study explores alcohol-serving venues as sites of risk or protection from violence against women (VAW) in one South African community. In 2010, we conducted in-depth interviews with 31 female patrons, 13 male patrons and 11 venue staff, and conducted structured observations in six alcohol venues. VAW was a common experience and venues contributed to risk through aggression, negative attitudes towards women, risks leaving the venues, and owners tolerating VAW. Concurrently, venues offered potential to avoid VAW through perceived safety and owner protection. Results highlight the influence of the venue environment and importance of addressing the setting of alcohol consumption.
Keywords: South Africa, Qualitative, Violence against women, Gender-based violence, Alcohol, Venues, Gender
INTRODUCTION
South Africa has high rates of heavy and problem drinking (South African Department of Health, Medical Research Council, & Macro, 2007), and at the same time has among the highest rates of violence against women (VAW) worldwide (Seedat, Van Niekerk, Jewkes, Suffla, & Ratele, 2009). Studies in multiple settings, including South Africa, have documented the association between alcohol use and VAW (Foran & O’Leary, 2008), but no studies in South Africa have examined alcohol-serving venues as sites that might contribute to VAW. This study attempts to fill this gap in the literature by qualitatively exploring how the social environment of alcohol-serving venues in one South African township contributed to the culture and practice of VAW.
Epidemiological research suggests that half of South African women will experience physical or sexual assault from a male partner in their lifetimes (Dunkle et al., 2004; Jewkes, Levin, & Penn-Kekana, 2002). The high rates of violence against women must be understood in the historical and cultural context of South Africa. The country’s history of political violence and gross social inequalities during the apartheid produced a society in which violence is commonplace (Kaminer, Grimsrud, Myer, Stein, & Williams, 2008; Williams et al., 2007). Violence is fueled by high rates of poverty and unemployment, childhood exposure to violence, and weak structures to prevent violence and prosecute perpetrators (Seedat, et al., 2009). In addition, patriarchal norms condone violence against women, and lead to many women’s acceptance of violence as a normal part of an intimate relationship (Wood, Lambert, & Jewkes, 2007, 2008). Violence against women has significant impacts on public health, carrying high rates of physical and emotional disability, and risk of death (Seedat, et al., 2009). The mortality rate from intimate partner violence in South Africa is 8.8 per 100,000 women, twice that of the United States (Abrahams et al., 2009).
Research has consistently linked alcohol consumption with aggressive and violent behavior (Boles & Miotto, 2003; Bushman & Cooper, 1990), and with violence against women in particular (Foran & O’Leary, 2008; Leonard, 2001). The relationship between alcohol and VAW holds up across international contexts (Graham, Bernards, Wilsnack, & Gmel, 2011). In South Africa, drinking has been associated with greater odds of men perpetrating physical intimate partner violence (Townsend et al., 2010) and sexual assault (Simbayi et al., 2004). The association between alcohol and VAW has both biological and cultural underpinnings. There is biological evidence that alcohol use leads to disinhibition, hinders problem-solving abilities, increases risk taking behaviors, enhances emotional responses, and makes one less cognizant of consequences (Bushman & Cooper, 1990; Leonard, 2001). Additionally, alcohol consumption may give men permission to express culturally-bound social norms that condone male dominance over women (Graham, et al., 2011; Strebel et al., 2006).
In population surveys in South Africa, only 39% of men and 16% of women reported that they drank alcohol (South African Department of Health, et al., 2007). However, those who drank reported alarmingly high rates of alcohol consumption, with particularly heavy drinking during weekends. These drinking patterns were confirmed in our own research with patrons of alcohol-serving venues in Cape Town, where nearly half of patrons said they had five or more drinks on a typical drinking evening. Heavy drinking among both men and women creates particular risks for VAW (O’Leary & Schumacher, 2003). Men who are heavy drinkers are more likely to perpetrate VAW (White & Chen, 2002), and violence inflicted by heavy drinkers is more likely to cause severe harm (Graham, et al., 2011; Kyriacou et al., 1999; Testa, Quigley, & Leonard, 2003). Heavy drinking by women also puts them at risk, making them more vulnerable to partner violence (Jewkes, et al., 2002) and sexual attacks (Kalichman & Simbayi, 2004), and less likely to report these incidences to law authorities (Felson & Pare, 2005).
Examining the environment in which drinking occurs is essential because research has established that one’s level of alcohol consumption varies by drinking location (Demers et al., 2002; Freisthler, 2011; Harford, Seibring, & Wechsler; Van de Goor, Knibbe, & Drop, 1990). In Western settings, bars have consistently been linked to heavier drinking, compared to other sites where alcohol is consumed (e.g., hotels, restaurants or private parties). Several studies have found that the venue in which drinking occurs has a greater influence on the drinking behavior of patrons than socio-demographic factors (such as race, residence, and typical drinking habits), suggesting that venue-level characteristics have an important influence on consumption patterns (Buddie & Parks, 2003; Casswell, Zhang, & Wyllie, 1993; Demers, et al., 2002). Specifically, bars facilitate drinking with friends, drinking in large groups and ordering drinks by round-buying methods, behaviors which have been associated with heavier drinking (Demers, et al., 2002; Freisthler, 2011; Harford, et al.; Van de Goor, et al., 1990).
In addition to being sites of heavy drinking behavior, bars foster an environment that may contribute to other social problems. Research in South African drinking venues has identified problems that are only indirectly related to alcohol use, such as HIV risk and traumatic injury (Morojele et al., 2006; Wojcicki, 2002). Although VAW has not been studied specifically in these settings, there is reason to believe that these sites may facilitate VAW because of the high prevalence of both hazardous drinking patterns and VAW in South Africa, and evidence of the intersection of these social problems. Research in the U.S. suggests that proliferation of alcohol-serving venues in socially disadvantaged settings can increase risks for VAW by forming and reinforcing attitudes, norms and practices related to VAW and facilitating problem alcohol use among at-risk couples (Cunradi, 2010). At the same time, South African drinking venues also serve as social spaces that may create a sense of community cohesion and provide opportunities for recreation and socialization that do not otherwise exist in these impoverished areas. In the context of high rates of VAW, drinking venues may offer a public space that increases accountability and provides women with refuge from violence that happens behind closed doors. In that sense, these venues may have the potential to protect women and mitigate the impact of VAW.
It is essential that research on violence against women and alcohol look beyond alcohol as a “substance” to also examine the risks and potential protection of the environment or setting in which alcohol is consumed (Homel & Tomsen, 1993). The aim of this study was to explore how the social environment of alcohol-serving venues in a single township in Cape Town, South Africa contributed to the culture and practice of VAW, including both areas of risk, as well as opportunities for protection. Results from this study may inform interventions in alcohol-serving venues that can reduce the threat and practice of alcohol-related violence against women.
METHODS
The qualitative data presented in this paper are part of a larger mixed-methods study to examine gender and sexual risk behavior in the context of alcohol-serving venues in one South African township. Between June 2009 and October 2010, we performed observations in six alcohol-serving venues and conducted in-depth interviews with 44 venue patrons and 11 venue staff. The data were analyzed to examine how the social environment of the venues contributed to violence against women.
Setting
This study was conducted in Delft, a township located 15 miles from downtown Cape Town, South Africa. The township was established in 1990 and is currently home to over 13,000 residents, including an even mix of both Black African and Coloured (a South African ethnic group of historic mixed ancestry) ethnicities. The area is growing rapidly in population, which appears to undermine the sense of community stability. Delft has high levels of unemployment, poverty and crime, and there is little commercial infrastructure. According to the 2001 South African census, 43.7% of residents reported being unemployed, and the majority of adults who were employed were unskilled and manual laborers (South Africa Census Bureau, 2003). There is little commercial infrastructure in Delft and few general community resources, including limited opportunities for recreation and job training.
In order to identify the six alcohol-serving venues included in this study, community intercept surveys were conducted with 210 Delft residents. This process identified 88 alcohol-serving venues in the community, of which 24 were eligible for the study. Venues were eligible if they reported over 50 unique patrons per week who drank in the venue, and had at least 10% female patronage. The six venues were purposively selected to provide an equal representation of venues with predominantly Black and Coloured patronage and to include both small venues (50–100 patrons/week) and larger venues (>100 patrons/week).
Observations and In-Depth Interviews
The fieldworkers, South Africans matched by language and ethnicity to the site, conducted one-week observation blocks (approximately 4–6 hours per day) every four months over the course of the year. They used a structured guide to record detailed observations about the physical environment and social interactions in the venue (Mack, Woodsong, MacQueen, Guest, & Namey, 2005b). Following each observation period, the fieldworkers debriefed with the South African PI. These debriefing sessions were audio-recorded and transcribed, and became part of the fieldwork notes. Both the observation notes and the debriefing transcripts informed the analysis of the in-depth interviews and provided valuable insight into the context of the bar. The fieldworkers’ rapport with the patrons and owners, and familiarity with the setting, informed the conduct and interpretation of the in-depth interviews (Patton, 2002).
Following the observation period, the fieldworkers approached venue patrons, owners and staff, and explained the purpose of the in-depth interviews. Patrons were selected because they were regular attendees of the bar, and could knowledgeably discuss the social environment of the venue. All who were approached agreed to participate, and after written consent, interviews were conducted in a private room in the language of the participant’s choice (Afrikaans, Xhosa or English). With the participant’s permission, the interview was audio-recorded. A $15 grocery card was provided as compensation.
Interviewers used a semi-structured guide with open-ended questions and possible probes (Mack, Woodsong, MacQueen, Guest, & Namey, 2005a). The guide addressed topics including the bar environment, alcohol consumption and impact, gendered power dynamics and violence. After preliminary analysis, 22 of the 44 patrons and 6 of the 11 venue owners/staff were approached for a follow-up interview to explore these topics in more depth. All of the women who completed an in-depth interview belonged to a cohort that completed regular quantitative assessments. Demographic information about these women and information about topics of interest (e.g., VAW, attendance at the venue and substance use) were therefore extracted from their cohort data. Demographic information from male patrons was elicited only through the in-depth interview discussions, and therefore is not as comprehensive as the female demographic data.
All study procedures were approved by the ethical review boards of.
Analysis
The interview audio-recordings were simultaneously translated and transcribed in English. The textual data was analyzed using a grounded theory approach (Charmaz, 2006). Two people (MW and FA) read all the transcripts and wrote analytic memos that summarized emerging themes and identified in vivo codes, terms and interpretations in participants’ own words. The memos were entered into Atlas.ti and all text related to violence against women was coded. The coded text was reviewed and discussed by the first two authors and broad categories were identified relating to the topic of interest. Axial coding identified subcategories and highlighted representative text for each. In an iterative process, the observation data were used to confirm the validity of our interpretations, triangulate individual interview data, add context, and examine differences across venues.
RESULTS
Description of the Sample
The sample included 31 female and 13 male patrons, and 11 venue owners or staff (4 women and 7 men). Demographic and behavioral data from the patron participants are shown in Table 1. Patron ages ranged from 18–55 years old, with an average of 34 and no significant difference between men and women. Only four of the women interviewed (13%) were employed, whereas the majority (73%) of male patrons reported a current job. About one third of men and women in the sample were married. Approximately 42% of women reported attending the venues two or more times per week, over 40% drank six or more alcoholic beverages on a typical night, and the majority met criteria for alcohol dependence and hazardous drinking. In the quantitative survey they took as part of the cohort assessment, over half of the women in our sample reported experiencing either forced sex or intimate partner violence (IPV) in the last 4 months, and 75% endorsed ever experiencing forced sex or IPV in their lifetimes. Twenty of the female participants discussed personal experiences of VAW in their in-depth interviews, including accounts of violence from both strangers and intimate partners. Types of violence included punching, hitting with items (bricks, pipes), stabbing (broken bottles, knives, glass), threats of death, rape, emotional abuse and stalking. No men spoke about physical violence they had experienced from women.
TABLE 1.
Women (N=31) | Men (N=13) | |||
---|---|---|---|---|
Mean (range) | Std. Dev. | Mean (range) | Std. Dev. | |
Age | 34.4 (18–55) | 10.6 | 32.6 (23–52) | 10.5 |
N | % | N | % | |
Race | ||||
Black | 17 | 54.8% | 7/13 | 53.8% |
Coloured | 14 | 45.2% | 6/13 | 46.2% |
Relationship Status | ||||
Married | 9 | 29.0% | 4/12 | 33.3% |
Have Children | 22 | 71.0% | 9/10 | 90.0% |
Employed | 4 | 12.9% | 8/11 | 72.7% |
Highest level of education | ||||
< Standard 8 (no high school) | 14 | 45.2% | ||
Standard 8—10 | 16 | 51.6% | ||
> Standard 10 | 1 | 3.2% | ||
Frequency of alcohol use | ||||
Monthly or less | 8 | 25.8% | ||
2–4 times/month | 10 | 32.3% | ||
2–3 times/week | 9 | 29.0% | ||
>4 times/week | 4 | 12.9% | ||
Number of drinks on a typical occasion | ||||
1–2 drinks | 9 | 29.0% | ||
3–4 drinks | 7 | 22.6% | ||
5–6 drinks | 7 | 22.6% | ||
7–9 drinks | 4 | 12.9% | ||
>10 drinks | 4 | 12.9% | ||
How often drink 6+ drinks in a sitting | ||||
Never | 2 | 6.5% | ||
Less than monthly | 9 | 29.0% | ||
Monthly | 7 | 22.6% | ||
Weekly | 13 | 41.9% | ||
Alcohol dependent (CAGE ≥ 2) | 20 | 77.4% | ||
Hazardous drinking (AUDIT >10) | 24 | 64.5% | ||
Reported ever experiencing: | ||||
Forced sex | 10 | 32.3% | ||
Intimate partner violence (IPV) | 17 | 54.8 % | ||
Either forced sex or IPV | 23 | 61.3% | ||
Reported experiencing in the last 4 months: | ||||
Forced sex | 7 | 22.6% | ||
Intimate partner violence (IPV) | 17 | 54.8% | ||
Either forced sex or IPV | 17 | 54.8% |
Alcohol-Serving Venues as Spaces that Contribute to Violence against Women
Analysis revealed four themes regarding how venues as physical and social spaces contributed to violence against women: alcohol contributed to aggressiveness and sexual violence, venues reinforced negative attitudes toward women, women faced the risk of violence when leaving the venue, and venue owners tolerated and perpetrated VAW.
1) Alcohol contributed to aggressiveness and sexual violence
Women pointed to alcohol as an important contributor to physical abuse, often citing how their partners’ behavior changed dramatically when drinking. One woman explained: “When he is drunk on weekends he becomes violent—he starts a fight in our house—but when he is sober he is calm.” Interviews and observations documented how venue patrons became increasingly aggressive as the night progressed, sometimes leading to altercations outside the venue or once the couple was home. Observations revealed that violence was most common in larger venues and on weekends because, as one male patron explained, “that’s when everyone has money and more drinking takes place.”
Alcohol, combined with the venue atmosphere, increased men’s sense of perceived power, which contributed to aggressiveness towards women. A male patron explained that “alcohol gives our men strength; it’s what causes the arguments.” In addition, the fieldworkers noted during observations that the male-dominated environment of the bar seemed to reinforce gendered hierarchies, which likely legitimized dominance over women.
Women also exhibited violent behavior when drinking. Female patrons reported that when drunk they “make a big fuss out of petty things,” “hurl insults,” and “act out of character.” Women’s aggressiveness provoked male violence, contributing to a cycle of alcohol-fueled violence in relationships. There were multiple examples of reciprocal violence in this sample. An owner related how he hit his wife because “she was a drunk and a nuisance,” then “she swore and tried to hit back,” and he “smacked her again and told her to go to sleep because she was drunk.” In some cases, women’s violence was in self defense. A woman described how she protected herself “the same as [men] do, with sharp objects” to fend off advances from “rude” drunk men. While alcohol gave some women a sense of empowerment to respond to violence, alcohol also contributed to normalization and acceptance of violence in their relationships. A patron explained that her husband would abuse her when they were both drunk, but by the next day, she had “already forgotten” and returned to the venue with him that night. This quote suggests that violence that occurs while drinking is quickly forgotten and dismissed, an attitude and practice that further condones violent behavior.
The purchase and consumption of alcohol also caused disputes among couples. Resources were short in this setting, and both men and women complained about their partners’ spending too much money on alcohol. Many women expressed frustration that their partners bought alcohol when they did not have enough food in the household. At the same time, women’s use of alcohol was also a point of conflict in relationships, in part because it defied gender norms. Men frequently expressed that “good” (i.e., respectable) women do not drink in the venues. Women said their partners berated them for spending time at the venue, and observations revealed that men sometimes came to the venues looking for their partners, often resulting in violent exchanges.
2) Venues reinforced negative attitudes towards women
Across the six venues, patrons and owners expressed negative attitudes towards women, although our observational fieldwork revealed that the expressions of these attitudes varied by venue. In two of the smaller venues that were male dominated, women spoke about how they felt sexually objectified by the male patrons. Across all venues, but in particular in the larger venues, the sites had a sexual charge (e.g., observations of flirtation and pick-ups), and served as sites for meeting new partners. As a result, incidences of VAW in the venues were often fueled by jealousies and accusations of infidelity. One female patron reported that her boyfriend became very jealous when she spent time at the bar: “[My boyfriend] comes looking for me [at the bar], then asks why I sit so late. Then he starts hitting me with sticks, with his fists.” At the same time, some female patrons expressed jealousy and competition with other women for the attention of men. A woman described how she would attack both her partner and the woman receiving his attention. “If he touches a girl, or maybe just talks, then my mind starts because I’m drunk. I’ll start with him, and end with her. I like to hit with beer bottles when I’m drunk.”
While both men and women reported perpetrating violence due to jealousy, there was a clear power dynamic that favored men. A man not only became violent because of suspicions of a partner’s infidelity, but he also became violent when a partner questioned his infidelity, representing a gendered double standard. A woman described how a woman had reviewed her husband’s text messages and discovered he was having an affair, and her husband “got upset because she was going through his phone … and beat her up.” A male patron summarized the pervasive understanding that the power rested in the hands of men: “Some [women] would raise their voices to their husbands, but at the end of the day, they still have to deal with the fists.”
3) Women risked sexual violence when leaving the venue
Alcohol played a significant role in the risk of sexual violence and rape when women left the venue. Female patrons often faced a “no win situation:” either they returned home on their own, in which case they risked being attacked on the way, or they risked being assaulted by a man who agreed to accompany them home. One patron described how she would accept a man’s offer to “walk halfway” home, but then he would “take advantage. The next day I realize[d] that the guy actually raped me.” The largest venue in our sample attracted women who came from outside of the immediate vicinity, introducing particular danger when returning home at the end of the night. A female patron explained how public transportation (minibus taxis) was not considered a safe option because often the last woman dropped off was targeted by the driver. “You go in the car, your friends get dropped door to door, and they will drop you off last since they targeted you [to rape].” Moreover, in all of these situations, women’s intoxication upon leaving the bar gave them less control to defend themselves from unwanted male advances.
Both male and female patrons felt that community members would not intervene to help a woman who was raped by a man she met at the venue. There was an expectation that if a woman drank with or accepted a drink from a man, then the woman would go home with him. One woman explained, “Men [at the venue] expect you to sleep with them if they buy you drinks, and they tell you that you will have to go home with them… A man dragged a friend of mine against her will, but nobody ever does anything about it. They just watch.” As a result, female patrons expressed that they felt unable to report such attacks, out of fear that they would be blamed because they had been at the venue and were intoxicated. As one woman said, “No one will believe me because they already decided I’m a whore.”
4) Owners tolerated and perpetrated VAW
Venue owners often contributed to the acceptance and practice of VAW in their bars. In many cases, the owners accepted poor treatment of women in their venues, and some even perpetrated it themselves. In the most extreme scenario, the owner of a smaller venue was observed to regularly beat up his wife on site, berating her for her drinking behavior. The owner of the largest venue was regularly observed quarreling with both male and female patrons, and patrons reported that he sometimes beat them up. In two other venues, fieldworkers observed how the owner regularly harassed and made inappropriate comments to female patrons and tolerated high levels of sexism and chauvinism in the venue. Three of the married owners openly had affairs with other women, including patrons, and one of these owners was observed threatening to hit these women if they spoke of their relationship to his wife.
Alcohol-Serving Venues Have Potential as Sites to Avoid VAW
While the venues clearly created risks for VAW, many of the women interviewed also pointed to the potential for venues to provide protection for women, especially in the context of otherwise unsafe and chaotic environments. Themes emerged around women’s perceptions of safety in the bar and the potential for positive influences of owners, but in the end, the sense of protection did not outweigh the reality of the risk of VAW fostered by the venues.
1) Women felt safe in the venues
Female patrons spoke about how the venues provided a respite from violence on the street or even in the household. One participant said that her male partner is “very well behaved at the bar,” but “the problems start when [they] get home.” When asked why they liked a particular venue, women almost always responded that they perceived the venue as safe and felt a sense of community there. This was particularly the case in the smaller venues, where women knew other patrons, staff and owners. The feelings of safety stemmed in part from the public nature of the venue, which contributed to a degree of social pressure and accountability. As one woman said, “You behave yourself because tomorrow, what are the neighbors going to say about you?” Additionally, many of the female patrons said they went to the bar with other women, which provided them with a strategy to avoid violence. One woman explained, “[men] don’t do anything when you go as a group. They fear that you are many.”
Some women perceived consuming alcohol as a way to counter the abuse in their current relationships. These women alluded to drinking as a way to empower themselves to stand up against abuse and their inferior position in the community. One female patron explained, “If men hit [women], they have a voice to answer back. If you are sober and the guy argues, you must keep quiet to keep the peace.” Although these women spoke about how drinking in the venue gave them a sense of security and empowerment, the same women explained how they were beaten by their partners for both their drinking behavior and their assertiveness. Therefore, in reality, drinking in the venue only promoted a perception of security, rather than truly providing protection.
2) Owners showed potential for positive influence
Several participants attributed their feelings of safety in the bars to the influence of the owners, who enforced a sense of discipline, as described by one woman: “It is safe to sit there. There is no trouble because it’s not allowed.” The venue owners sought to minimize violence by moderating who was allowed in the venue and by dissipating conflicts that arose. Further, some owners saw themselves as responsible for protecting their patrons and prided themselves on being confidants and advocates: “I always tell my customers, if someone bothers you … just come to me, we’ll sort it out.” One owner said that if a female patron told him about an abusive partner, “My duty is to speak to him or else he cannot sit at my venue.” The support of the owners served as an important form of protection from VAW for the women because male patrons would not want to suffer the social consequences of being rejected from the bar community for acting violently against a woman. However, despite the sense of protection provided by some owners, their positive influence was usually overshadowed by passive acceptance of VAW-related norms and incidents of violence as discussed earlier.
DISCUSSION
The World Health Organization has identified alcohol as an important risk factor for violence against women (World Health Organization, 2005). The current study expands our understanding of the link between alcohol and VAW by considering how alcohol-serving venues as locations create risks for VAW in a township in Cape Town, South Africa. Cross-cultural research has identified bars as high risk drinking locations because they encourage and facilitate high rates of alcohol consumption among patrons, which in turn may lead to greater violence against women (Demers, et al., 2002; Freisthler, 2011; Graham, Osgood, Wells, & Stockwell, 2006; Harford, et al., 2002; Van de Goor, et al., 1990). This study is the first to explore this phenomenon in a South African setting. Our data points to both social and structural factors in and around the venue that put women at heightened risk for physical and sexual violence from intimate partners and strangers, and highlights the need to identify and implement venue-level interventions to protect women from violent episodes.
The social factors that facilitated VAW in the venue setting centered on a sexually charged environment that led to jealousy and accusations, and the pervasive male view of female patrons as sexually available. Alcohol-serving venues in South Africa are primarily attended by men, and our data suggests that these settings reinforce community norms of male dominance (Cunradi, 2010). Economic disparities between men and women (73% of men were employed, versus just 13% of women) likely also reinforced male dominance. The structural factors that facilitated VAW included a lack of regulation of and protection against VAW for women within the venues, and heightened risk of sexual assault when leaving venues at night. Although common themes emerged across all venues, there were variations by the size of venue and familiarity among venue clientele. In general, smaller venues offered female patrons a greater sense of community, which women perceived as a sense of protection from VAW. These venues were generally unlicensed, and faced uncertainties under South Africa’s new alcohol legislation, which begs questions regarding whether the legislation will have unintended consequences by forcing female patrons into the riskier environments of larger, unfamiliar venues.
While our data illustrate many venue-related risks for VAW, there were also indications of the potential for protection against VAW in the same venues. In particular, female patrons discussed feelings of safety and community in the venues, and some highlighted examples of venue owners who provided specific protection against VAW. These findings highlight how risks and potential protection may co-occur in a single venue and how each woman’s experience within and relationship to a venue may influence her perception of risk and protection.
Experience of VAW was a very common occurrence among women in this sample, and indeed is high in South Africa as a whole (Dunkle, et al., 2004; Jewkes, et al., 2002). The heavy alcohol consumption in our study venues likely contributed to increased aggression and acts of violence among the couples in our sample. The contribution of alcohol to VAW has also been noted in other parts of South Africa (Butchart, Kruger, & Lekoba, 2000). Violence in this setting was bi-directional, with both men and women reporting that they became more aggressive towards their partners when intoxicated. Reciprocal violence has received scant attention in the literature, but there are indications in South Africa that women also perpetrate violence against their partners (Wong, Huang, DiGangi, Thompson, & Smith, 2008), and that this behavior is more common among women who drink alcohol (Gass, Stein, Williams, & Seedat, 2010). Although violence was bi-directional, it was clear from our data that the power dynamic favored men and that women were at greater risk for alcohol-related assault and injury. Women reported an increase in their partners’ violent behavior when that partner was drinking, and also described becoming increasingly vulnerable to VAW due to their own intoxication. Women described being beaten due to their drinking behavior, their attendance at the venue, or their drinking with other men. In addition, women were often targeted for sexual assault when they were drunk, perhaps because they were seen as “asking for it” (Jewkes & Abrahams, 2002; Testa & Livingston, 2009), turning the fault of a resulting rape to the woman (Kalichman et al., 2005). Being intoxicated or at a venue during an assault also made women less likely to report the incident to law authorities, representing not only women’s perceptions that they were somehow responsible for the violence but also their lack of confidence in the community and legal response in that context, which has also been observed elsewhere (Brecklin & Ullman, 2002).
The study highlights interesting contradictions regarding women’s perceived risk and safety around the venues. Acts of violence against women were frequently reported and observed in and around the study venues, but female participants consistently reported attending the venues because they were “safe.” This contradiction must be understood within the context of impoverished South African townships, where violence and crime are seen as a daily risk (Hamber, 1999), and where there are few outlets for recreation and socialization. Of the women interviewed for the study, two-thirds reported experiencing VAW, most commonly from a husband or boyfriend, and it is possible that the venue may have offered a respite from such violence in the home. The degree of protection a woman felt in the venue was greater for women who attended more regularly, pointing to a sense of accountability fostered within the venue community.
The role of the venue owners in the context of VAW also presented contradictions. On the one hand, owners reinforced negative attitudes toward women through their own behavior and their acceptance of sexist patron behavior. At the same time, owners offered potential protection and advocacy for female patrons. The primary motivation for this intervention appeared to be economic, with an emphasis on creating happy customers. Owners also talked about how they perceived themselves as community leaders, an attitude that could be used to engage owners in a campaign against VAW.
The qualitative approach of our study has limitations for its application to other settings. Violence against women was one topic among many in the qualitative interviews. VAW was therefore not covered with consistent attention across participants, making it inappropriate to quantify number of individuals who endorsed the varying themes presented. In addition, subjects were purposively selected because they were regular patrons of the venues and thus were likely to be heavier drinkers than other venue patrons. As a result, the experiences of the women in our sample may be different from women who attended the venues on a more occasional basis.
Despite its limitations, this study adds to our understanding of the link between alcohol and violence against women, and clearly illustrates the need for multi-level interventions. Women pointed to the venue as a source of community and camaraderie, which highlights the potential of this setting for group empowerment interventions to address gendered power dynamics, including norms that justify and legitimize violence against women (Wood, et al., 2008). At the level of individuals and couples, our findings support the call for VAW to be addressed within the context of alcohol treatment (Klostermann & Fals-Stewart, 2006), particularly given evidence that treatment of alcohol dependence can result in reductions of VAW (Stuart et al., 2003). In addition, institutional-level interventions are needed to work with bar owners and staff members to be advocates for VAW prevention, building on their self-described identity as community leaders and promoting protection of female patrons as economically beneficial. Community policing is needed in and around alcohol-serving venues to reduce incidents of sexual assault. Finally, at a structural level, it is important to provide other outlets for entertainment and socialization (e.g., cultural venues and sports facilities), including spaces that secure women’s safety and provide opportunities to re-evaluate gender norms. Future studies should include observations to examine whether the presence of alcohol-serving venues contributes to VAW at the broader community level (Cunradi, 2010), and the development and testing of multi-level interventions to reduce alcohol-fueled VAW.
Acknowledgments
This project was supported by a grant (R01 AA018074) from the National Institute of Alcohol Abuse and Alcoholism (NIAAA). We are grateful to all the men and women who participated in this study. We would like to acknowledge the South African research team that collected the data, specifically Simphiwe Dekeda, Albert Africa, Judia Adams, Bulelwa Nyamza and Jabulile Mantantana. We appreciate the support of Annemie Stewart in management of the data. We also thank Madeline McCrary for her contributions analyzing the observation data (supported by the Duke Center for AIDS Research, NIAID grant P30-AI064518).
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