Sexual violence is a pertinent health challenge, which has increased the risk of various sexual and reproductive health problems and also has an impact on physical and mental health (1). According to our literature review, all studies conducted on SV prevalence rates are mainly descriptive or cross-sectional in sub-population and changes in the prevalence of SV over time are not well documented. Hence, the present study assessed the trends of SV prevalence rates in world countries in a period of 25 years from 1993 to the 2017 to make comparisons across populations.
As the results of this study show, compared to men, the prevalence rate of SV against women are at least twice as many, across all continents. SV against women, influenced by cultural factors and values, is often a result of unequal power equations between men and women (12). By contrast, SV against men is less understood or acknowledged, but it is. Although in general it seems that because men are stronger sex, they have a lower rate of SV than women, based on gender norms combined with cultural and religious taboos and scarce services, it may be very difficult for males to disclose that they are survivors of SV. In addition, the service providers may not recognize the male experience of SV. Therefore, in such societies with gender norms combined with cultural and religious taboos, the prevalence rate of SV in men may be underestimated (3).
The results of the present study also manifested that the decremental trend of prevalence of SV in Europe and the United States is outstanding than in others. This is particularly prominent in the Americas, where there has been a decline in the prevalence of SV in both sexes, with the largest decrease in the prevalence of SV against women. In Asia, as well as in Australia, this declining trend has occurred, albeit to a lesser extent, compared to the aforementioned continents. It is vital to point that in African countries, although the prevalence rate of SV against African women has decreased to some extent, it has increased against men. Of course, it should be kept in mind that the rate of low SV against women in some societies might be related to victimized women being unlikely to report an attack due to fear of discrimination, feeling shame, and not being able to identify (13).
Further, the results of this study showed that the prevalence rate of SV in countries with high HDI, in recent years, has been declining, with a higher rate in men than women. It should be pointed that in countries with a high HDI, there are effective programs in this field, including the ‘Universities Supporting Victims of Sexual Violence: Training for Sustainable Student Services’, where the project, running across seven European countries, aimed to develop, pilot and evaluate cases to help university staff respond more effectively to disclosures of SV (14). Moreover, countries with a high HDI are usually high income, and the studies show that estimates over SV from high-income countries seem to be lower than those from low and middle-income countries (13). In countries with low to moderate human development, the prevalence rate of SV has been declining against men and increasing against women. Again, it is important to note that in societies where shame is the more prevalent emotion, victims of SV may not open a case about the event and therefore may not be reported. In addition, most countries with a moderate to low HDI are culturally communities where human relationships are at the core and individual identity is subsumed in the family or kinship, causing gender bias and blaming of the victim. This societies, compared with societies where the individual is the main focus and individual independence is more important, such cases are often not reported (15). Hence, the lack of reporting of these cases in such societies may have caused the rate of prevalence of SV in countries with high and low HDI to be reported as close.
The paper went on to examine which countries in the world have experienced similar trend of SV prevalence rate in recent decades. The results manifested that the highest decline in the prevalence of SV against men occurred in Bermuda. Among the countries of the world, SV against women in some African countries, as well as in some American countries, has been declining, such as Bermuda, Guyana, Mexico, Nigeria and Saint Lucia. The Democratic Republic of Congo, and Equatorial Guinea have been ranked next. Civilians in Africa’s conflict zones, both for women and men are often vulnerable to SV and most of the SV in these areas is due to this fact (16). Programs aimed at reducing SV among such communities may have been effective in reducing the rate of SV. Based on available studies, it appears that the greatest activity is in African countries (17).
In addition, the highest increase in prevalence rates of SV against men were in Luxembourg and Equatorial Guinea, and as for women, it was reported in China, North Korea and Taiwan. The high prevalence of SV against women in china has been estimated in resent studies which is in line with the present study’s result and the recent announcement of the Domestic Violence Law represents a first step to raise awareness and prevention of violence against women (18, 19). No study with a direct look at North Korean women was found, but several studies have examined SV between undocumented refugees without basic legal protection, and so they become exposed to human trafficking and a sex trade is built upon their exploitation (20).
It seems that the rate of SV prevalence is highly heterogeneous among world countries; this may be due to the definitions used, tools used, and more importantly, the culture and norms. Therefore, some of the differences between countries may be due to these reasons. In addition, lack of accurate and reliable data for SV prevalence rate in some countries may be considered as a limitation which causes GBD to report the estimated prevalence rate.
Overall, given the high economic and social burden that SV has on victims and society, the rate of SV in most countries does not seem to have dropped remarkably and requires special attention from relevant policy makers. It is emphasized that programs on sexual and gender-based violence, including men as well as women, to provide guidance on how to access survivors, facilitate reporting, provide protection and deliver essential medical, legal and social services. According to the present study findings, there are gaps in understanding who is the victim of SV in different cultural contexts and societies where the notion of dominance of men over women prevails; hence, implementation of national population prevalence surveys is necessary in all countries for establishing SV as a serious social issue globally.