Estimating the burden of disease attributable to interpersonal violence in South Africa in 2000.

To the Editor: Violence, previously considered a social issue, is now an acknowledged public health problem. It is defined as the intentional use of physical force or power, threatened or actual, against another person, against oneself, or against a group or community, that results in injury, death or deprivation. 1 In this study we focus on exposure to the interpersonal type of violence, which includes acts of family violence and community violence. Family violence is further categorised by victim: child, intimate partner, or elder. Community violence occurs among unrelated individuals and includes sexual assault and rape by strangers as well as youth violence. In South Africa (SA) violence has become the normative and accepted strategy for resolving conflict. This is the result of many decades of social injustice and political violence including state-sponsored violence. The political transition has seen a decrease in political conflict but exceedingly high levels of interpersonal violence remain, fuelled by rapid urbanisation and ongoing economic disparities. Injuries directly related to interpersonal violence caused an estimated 27 563 deaths in South Africa in 2000. The age-standardised homicide rate (65 per 100 000) was more than seven times the global average, placing South Africa among the most violent countries in the world. 2 Homicide was the leading cause of fatal injury in males and rates peaked in the 15-29-year age group at 184 per 100 000, ninefold higher than the global rate. 2 High levels of gender-based violence are also evident with excessive rates of female homicides. A recent study has shown that 1 in every 2 women killed by a known perpetrator in South Africa is killed by an intimate partner, leading to the highest reported intimate femicide rate in the world: 9 per 100 000 women. 3 In addition to deaths resulting from interpersonal violence, the years of life lost (YLLs) due to premature mortality, years of life lived with disability (YLDs) resulting from non-fatal injuries and disability-adjusted life years (DALYs) were also estimated. 2,4 However, there is strong evidence to indicate that exposure to non-fatal violence has serious and long-lasting health consequences. Child abuse, intimate partner violence (IPV), sexual assault and rape result in increased incidence of depression, anxiety disorders, eating disorders, post-traumatic stress disorder and substance abuse as well as reproductive health problems and sexually transmitted infections, including HIV infection. 5-15 Acknowledging that the mental health, behavioural and reproductive health consequences of interpersonal violence …