Introduction

HIV/AIDS has become a full-blown epidemic in South Africa [22]. Within the country, KwaZulu-Natal has the highest prevalence rate (South African Health Study 2007) with women being more affected than men. Statistics on people with disabilities (PWD) are not available, yet local interpretations of disability and traditional gender stereotypes increase the risk of HIV infection for PWD with women facing particular susceptibility to infection. The vulnerability of PWD has been slowly recognized by NGOs, politicians and other stakeholders and some attempts have been made to include PWDs in HIV/AIDS prevention and treatment effort. For example, one innovative approach to HIV prevention includes the development of disability specific HIV Prevention training material [2]. It is expected that such efforts will help reduce the vulnerability of PWD to infection. This article argues that although the access to prevention is considered crucial for reducing the vulnerability of PWD, it might not change the vulnerability of PWD in KwaZulu-Natal (KZN), as the dominant risk factor for PWD is sexual exploitation and abuse [12]. Sexual exploitation and abuse is based on local gender stereotypes, Zulu cosmology of disease and misfortune, as well as the devaluation of disability.

Literature Review

The link between HIV/AIDS and disability was first brought to the attention of the world through the Global survey on HIV/AIDS and disability [11]. Groce and colleagues stressed that although AIDS researchers have studied the disabling effects of HIV/AIDS on previously healthy people, up until 2004 little attention had been given to the risk of HIV/AIDS for individuals who have a physical, sensory, intellectual, or mental health disability before becoming infected. Groce explained further that it is commonly assumed that disabled individuals are not at risk and that they are incorrectly thought to be sexually inactive, unlikely to use drugs, and less at risk when it comes to violence or rape than their non-disabled peers. However, a growing number of reports indicated at that time that PWD are actually at increased risk for every known risk factor for HIV/AIDS [9].

The symposium on HIV/AIDS and disability in Germany 2004 highlighted the urgent need to address the issue of HIV/AIDS and disability especially in developing countries. One of the results of this symposium was that disability organizations and service providers began to take on the task of making HIV/AIDS prevention and treatment accessible to PWD [8]. Since 2004, literature that highlights the vulnerability of PWD [16] and evaluates access to prevention and treatment, has become available. Some NGOs have also created material that is disability specific [2, 3]. A particularly promising development in South Africa is the recently released report on HIV/AIDS and disability by the South African AIDS Council. The report recognizes PWD as vulnerable and gives recommendations with regard to making HIV/AIDS prevention and treatment accessible for PWD [19].

The African Campaign on Disability and HIV/AIDS is another driving force that supports knowledge exchange and capacity building on the continent. All these initiatives, reports and research has largely been focused on improving access to prevention and treatment. Few studies concentrate on how PWD conceptualize their body and sexuality or explore sexual experience of PWD [1, 21]. Very few studies focus on the link between the socio-cultural construction of disability, sexual abuse and the risk of HIV/AIDS [10]. The interweaving aspects of these phenomena are, however, crucial in addressing vulnerability of PWD to HIV.

Despite the scarcity of research in the area of disability and HIV/AIDS, research on disability, sexuality and sexual abuse is available. The bulk of work on these topics is poorly distributed, as most of the research focuses on these issues within industrial countries [4, 5, 14, 18, 23, 24]. The available research does demonstrate that PWD, particularly women living with disabilities, are especially vulnerable to sexual abuse. Brownridge’s survey in Canada shows, for instance, that women with disabilities had a 40% greater chance of being a victim of violence than women without disabilities [5]. Using the Behavioral Risk Factor Surveillance System (BRFSS), an American study [14] found that even though women with disabilities were not significantly more likely to experience physical assault, they had four times the odds of experiencing sexual abuse in comparison to their non disabled peers. Smith presents a similar conclusion and highlights in her analysis of BRFSS data that “gender and disability increase the likelihood of all forms of abuse, especially unwanted sex” [18]. The only available survey in Africa on sexual abuse of PWD has been provided by Handicap International in Ethiopia. The results showed that 46% of the disabled participants had experienced sexual violence (Handicap International 2007).

As survey data of this kind is not available for South Africa, one can only speculate that the situation is similar if not worse. Reports and a few scarce writings on the topic can be drawn to support the hypothesis that PWD, and disabled women in particular, are threatened by sexual abuse [7, 12].

Research conducted in Cape Town by Dickman et al. [7], highlighted the need to assist people with intellectual disabilities (ID) while reporting a crime and during the course of a trial [7]. The process of reporting rape and enduring a trial is very difficult for able bodied people, let alone the hurdle that disability adds. Dickman et al. [7] stress that “the caregiver may not believe the person, there may be an ethos of non-reporting within facilities, or the caregiver may simply believe that the investigation will do more harm than good for the person concerned”. In addition, the recognition of sexual crimes is made more difficult by the myth of rampant sexuality and the misplaced notion of a genetic threat to society or, paradoxically, the view that people with ID are asexual [7]. During the course of a trial, professional assessments regarding the suitability of a victim as a witness need to be provided, but in South Africa these are often not available. As a result, prosecutors often do not know how to use PWD as witnesses and have no ability to adjust their technique of questioning. This also applies to those circumstances when a person with disability is the perpetrator. Consequently, trials often don’t proceed and the case may be dropped. Training of police officers and prosecutors is, in this area, completely underdeveloped and therefore Disability organizations like the Cape Mental Health have taken over this task. They however only reach a small number of cases in Cape Town. [6].

From the reviewed literature and NGO reports, one can hypothesize that sexual abuse is a reality and a contributing risk factor in the spread of HIV amongst PWD. It is also hypothesized that sexual abuse of PWD is caused by the interweaving patterns of stigmatization of disability, gender and HIV/AIDS. In this paper, data collected during a three year study of PWD and their caregivers has been reviewed in relation to sexual abuse and its significance while addressing HIV/AIDS amongst PWD in KwaZulu-Natal.

Methodology

With appropriate permission and agreement, this study was conducted with PWD and their caregivers between 2005 and 2007 in KwaZulu-Natal (KZN), South Africa. The aim of the study was to collect data on the cultural construction of disability and the patterns of stigmatization between HIV/AIDS and disability. Social representations of gender, disease and disability were explored through in depth interviews.

The study focused on a small number of people (25), who were approached through a local disability organization (DPSA, Disabled People South Africa). A pilot study (5 participants) was used to identify culturally relevant themes that could be used in a ranking exercise. In the main study, (20 participants) the sample was primarily drawn from the eThekweni area, however other municipalities were also included in the sample frame (see Fig. 1). The participants were chosen for their ability to reflect on the circumstances of PWD. As very little research was available on disability in KZN, grounded theory had to be applied. Theoretical and snowball sampling was used to identify participants. All participants were either PWD themselves, who also functioned as Community Based Rehabilitation (CBR) facilitators, or they worked with PWDs as caregivers, teachers, therapists or traditional healers.

Fig. 1
figure 1

Map of all research sites in KwaZulu-Natal

In-depth interviews and a ranking exercise were conducted with each participant. Questions and ranking items were ascribed to three major areas of interest:

  • Cultural interpretation of disability

  • Living conditions of PWD and access to services

  • Sexual culture and HIV/AIDS

The first area explored social representations of disability and its relation to stigmatization. The second area explored the social economic situation of people with disability to establish their vulnerability on the grounds of financial gains and dependency. The last area explored sexual culture in KZN in general and how this affects PWD and their sexual life.

The ranking exercise was a tool in which the participants had to rank themes in a particular order. As described, the themes emerged as relevant from the pilot study. For the duration of the research the ranking exercise had a predominately didactic purpose, mainly to focus the participants on relevant issues and to provide a base for discussion. In this way the ranking exercise was used to guide the interview. The interview guide was therefore rather used as an aide mémoire. In some cases it was not necessary to use the guide, as the ranking exercise already gave the stimulus to provide information relevant to the questions.

Systematic content analysis was carried out on the transcribed interviews. This was supported by the computer program MaxQDA. Similar to other qualitative software packages the program facilitates the analysis through electronic coding and organizing the data. A modified grounded theory approach guided the analyses. Based on emerging themes, commonalities and major differences, a preliminary coding system was developed with codes worded directly from the data. These were later summarized and categorised into broader codes that were translatable into scientific language. One focus group was used to reconfirm study findings with 5 key stakeholders. Through re-reading the data, common themes were identified, some of which will be described in the following sections.

Results

While the study’s main purpose was to inquire into Zulu cosmology and its relation to disability and HIV/AIDS it also produced interesting results relating to gender and sexual abuse. In this article an evaluation of the ranking exercise and a review of the study themes in relation to sexual abuse and HIV/AIDS will be presented. Themes will be analyzed in their relation to the stereotyping of gender and disability. It will be shown how these stereotypes may tend to increase the vulnerability to HIV/AIDS.

In the ranking exercise, each participant was shown ten items which had to be ranked in accordance to it being a problem for PWD. Interestingly, women and men ranked this quite differently (see Table. 1). While women on average ranked sexuality and abuse as the main issue, men ranked unemployment as the biggest problem in the life of a disabled person. The combined voices of women and men have shown that negative attitudes of able bodied people are the main issue. While this perception of sexual abuse only represents the view of a small sample, it does highlight the fact that besides attitude and access problems, sexual abuse can be an issue in the lives of PWD in KZN. Women seem to bear the greater burden. This is supported by the themes identified in the data through systematic content analysis.

Table 1 Results of ranking exercise: issues ranked in accordance of being perceived as a problem for PWD

Notions of Disability

Disability is associated with several myths that can exacerbate the vulnerability of PWD towards HIV/AIDS. Many participants (10/25) expressed that PWD are perceived as being sexually abnormal. This abnormality is interpreted as being either ‘not sexually active’ or that they ‘like sex too much’ (CBR worker and women with physical disability). Even though myths contradict each other, both are the result of stereotyping PWD as a homogenous group that behave in a certain way. Furthermore, this interpretation of disability has extensive consequences for sexual education and HIV/AIDS prevention. It may therefore not be surprising that participants reported that PWD would be excluded from sexual education as one does not want to ‘wake sleeping dogs’ (teacher in special school). On the contrary, sexual abuse or exploitation was sometimes interpreted as a blessing such as that the person with disability can ‘count herself lucky’ to have sexual intercourse (CBR worker, men with physical disability). The participants indicated that as a result of these myths PWD are denied access to sexual education, protection and consequently also HIV prevention.

In addition, disability in traditional Zulu cosmology is sometimes regarded as a curse from god, a lack of ancestor protection, or exposure to ritual pollution. In all three cases, disability becomes a personalized shame and either the person with the disability themselves or their parents are blamed for the misfortune. This theme of blame was reflected by all interview participants. Participants reflected that blame feeds the stigmatization of PWD even further and reduces their acceptance in society or as a spouse. This would be especially the case when disability is seen as polluting. In Zulu cosmology people who are regarded as cursed or polluted might find it difficult to gain access to employment or to be successful in business, as people are scared of contagion. As a result PWD might find themselves in a predicament where they have to depend on others, are threatened by poverty and are vulnerable to abuse and HIV.

Contrary to the notion that PWD are cursed or polluted, PWD are seen as pure and chaste if the disability is interpreted as paying for the parent’s sins or as ensures the disabled person’s virginity. Participants stated since virginity is valued highly in KZN, young people with disabilities and women are especially targeted in a sexual way. In this context, perceptions about PWD have synthesized with other myths and values common in KZN. The perception that PWD are free of ‘pollution’ as they do not have sex exposes PWDs to ‘virgin cleansing’ practices (CBR worker), in other words sexual purification rituals. In the local culture, people with severe learning disabilities are seen as ‘the fresh ones’ and believed to be virgins (manager of day care centre and mother of child with ID). As a result of the myth that sex with a virgin can cure HIV/AIDS, people with disabilities have become potential victims of rape. Seven participants reflected this particular belief.

Being on the fringe of society, with less knowledge, protection and power, young people with disabilities, especially those with intellectual disabilities (ID), can become easy victims of sexual exploitation and abuse. Some of the participants reflected that people with (ID) are perceived as being very open about sexuality. Sexual expression gives one the opportunity to draw attention to oneself. As sexual activity is encouraged within the peer culture, people with ID can easily fall within the trap of sexual exploitation and misinterpret sexual interest for honest affection. One case study documented a young girl that slept with several men so as to just be ‘loved’ by someone. It was explained that usually no one would care about her, so she ‘attached love’ to her efforts to feel successful and needed. This was her only chance to attract ‘love’ (CBR worker about girl with ID).

It should be noted that ‘love’ and ‘sex’ are often confused in the local teenage culture. As the term ‘sex’ is rather taboo, the word ‘love’ is chosen instead. “Being in love” or “romance” on the contrary are understood as true affection for each other. This terminology is confusing, particularly for people with ID, who find it difficult to understand complex concepts. As the interviews revealed the lack of sexual education by educators, parents and caregivers compound this confusion. As a result, people with ID are very vulnerable to sexual exploitation, abuse and HIV/AIDS. In addition, the gendering of HIV/AIDS has increased the HIV risk for PWD, especially women.

Gendering HIV/AIDS

All participants volunteered some information about the unequal relationship between women and men. While most women reflected on this critically, most men were unaware of the unequal element in relationships they described. PWD were measured as prospective sexual partners with the same gender stereotypes as able-bodied people. Sexuality is therefore highly determined by gender norms. The male participants reflected that in the local culture a man is expected to be sexually active and many young men aspire to be an “isoka”, the local word for Casanova. Others in contrast explained that a woman should be submissive and not challenge her husband’s authority. In this context two cases showed that deafness is a sought-after trait for some men seeking partners. The inability to communicate through spoken words may be seen as an advantage in a society where gender inequality is high. However, this ‘advantage of deafness’ is exploited by able-bodied men particular if, as in these two cases, the woman is from a low socio-economic background, powerless and dependent on her partner. These women have little ability to negotiate sexual pleasure and safer sexual practice.

In addition, people who cannot speak or make themselves heard are easy targets of rape as they cannot shout for help and have difficulties reporting abuse to the police. An exceptional case illustrates the interweaving patterns of gender and disability.

A CBR worker described the case of a deaf woman who was raped and tried to report the abuse at a police station, using sign language. The police officer, who did not understand her, believed that she was asking for sex and raped her again at the police station. The notion that PWD are sexually over-active, combined with the notion that men are ever-potent beings who have to be sexually active whenever the opportunity arises can contribute to potential situations such as this one.

In the case of physical disability, gender stereotypes result in other disadvantages for PWD. Due to the fact that marriage is often based on financial considerations, people with physical or intellectual disabilities face a triple disadvantage. First, they are believed to be unable to fulfil traditional roles as they are not considered valuable spouses. As the interviewed showed this seems to be more severe for women than for men. Women with spinal injuries, for instance, would not be considered for marriage as they are not believed to be able to look after the family and here especially the husband. The traditional doctrine in KZN requires a wife to be a physically hard-working woman that can bear children, a role that might be difficult to fullfil with a physical disability. This in turn increases the probability that PWD do not engage in relationships at all or get involved in multiple partnerships. Second, the likelihood of finding stable partnerships in which PWD practice safe sex and experience pleasure is greatly diminished under such conditions. Third, the lack of acceptance as a marriage partner also creates opportunities for abuse because the person with disabilities can be seen as less protected by society at large or simply ‘fortunate’ to experience sex. As a result PWD are potentially at higher risk to HIV infection. This can develop in very obtuse ways as the next case study shows.

A CBR worker, who operated in the rural area of the SisonkeFootnote 1 district, described the case of a mother and her daughter with physical disability. The mother saw her daughter as not being sexual active and capable of ‘looking after a man’. She felt devastated by the prospect of not having any grandchildren. As a solution she sent a brotherFootnote 2 to penetrate her daughter. As a result of the abuse, the young girl became pregnant and delivered a baby. The mother of the girl then claimed the baby as her own. As the two women entered into a dispute over the rights to the child, the CBR worker became involved. Although this is an extreme case and rather atypical for a parent, it does illustrate how individuals in a society can interpret disability, measures PWD with gender stereotypes, and at the same time deny PWD to fulfil gender roles like in this case the role of a mother. The dangerous element hidden in this reality is the widespread and invisible sexual abuse of PWD, which in turn exposes them to HIV.

Responding to Vulnerability

Parents, teachers and caretakers have different ways of coping with the threat of sexual abuse and exploitation. While some choose to deny the very existence of PWD having a sexual life or as the victims of sexual abuse, others show little interest in the topic at all (see Table. 2).

Table 2 Ways of responding to vulnerability

Most participants (19/25) reflected that they either had not received sexual education themselves or that parents and teachers would not educate PWD about sexuality. Simply denying the very existence of sexuality when it comes to PWD has emerged as a very common theme. Abstinence was valued highly and viewed as an attractive quality in a potential mate, while condoms and “alluring” was attached with a negative stigma. Interestingly PWD also reflected these attitudes. The denial ideology perceives sexual activity and condom use as something that should be forbidden and is better not spoken about. In this context participants argued that by teaching about condoms, one encourages sexual activity.

Furthermore, PWD and ID are quickly pronounced as being impossible to teach ‘these people anything’ (CBR worker, women with physical disabilities). Education about sexuality is therefore not considered as an option. That especially girls are often victims of abuse or that they are ‘too sexually active’ is known to the communities, as the resulting pregnancy can not be missed (CBR worker). A secret approach to dealing with ‘the problem’ is sterilization (teacher in special school). Even though this is no longer official policy, some institutions and parents still seem to choose sterilization as an easy way out (2/25).

Another case that illustrates denial ideologies is the following of a school for children with learning difficulties. Teachers and caregivers at the school felt helpless towards curbing their pupils’ sexual activities and therefore separated the girls and boys into different classes and assigned different areas of the school for boys and girls e.g. certain staircases. The interactions and curiosity of the boys and girls could not be contained and simply displaced to outside of the school. School authorities then decided to let boys and girls leave the premises at different times. Consequently, their experimentation was therefore moved even further away from the influence of the school. A teenager herself reflected that she did not get any sexual education from the school. For the school, making sexuality invisible at the premises seemed to be easier than dealing with reality.

The failure to educate about sexually appropriate behavior can have serious consequences as the next case demonstrates. The interview partner, a disabled CBR worker herself, explained the situation of a neighbouring girl (P.), who had a severe learning disability. P.’s mother and the school had failed to educate P. about appropriate sexual behaviour. Abstinence was offered as the only solution and the mother denied her grown-up daughter the chance of having a boyfriend, although this was recommended by a friend. Never-the-less P. managed to find her way and was frequently found with men from the local tavern. The men took advantage of the desperate girl and had sexual intercourse with her on different occasions. P.’s experience of being wanted and “loved” for once in her life, while nobody else had bothered, made sexual contact very precious to her. The result was, however, that P. got infected with HIV, and at the stage of the interview, her health was quickly deteriorating. People did not openly talk about it and the fact that she was HIV+ has never been disclosed. However, suppositions were cast as she showed typical signs of AIDSFootnote 3 in the final stage of her suffering. For the outside world, she was a disabled girl that had become very sick. People wondered about her condition but nobody approached the actual problem. She was never sent for counselling. The denial of her positive status also probably resulted in her developing AIDS and prevented her treatment with ARVs.Footnote 4 The girl died in 2006, officially registered as death from another medical condition.

Some participants (4/25) reported however a more progressive approach towards sexuality. The participants, in this case parents and caretakers, had realized that their sons and daughters have a sexual life no matter how desperately they would try to avoid it. The parents and caretakers tried to openly discuss sexuality and sexual practices. One also acknowledged that their offspring’s might need to develop creative ways of having protected sex for instance in the case of missing arms and hands. Faced with the reality of everyday life in KwaZulu-Natal parents however still bring across old stereotypes. Generally, boys get taught how to use condoms and girls get taught how to say no and to speak up about situations or instances when they are ‘not comfortable with a person’ (parent).

Discussion

The review of the data supports the hypothesis that sexual abuse is possibly an underestimated and enormous problem for PWD in KwaZulu-Natal. The particular vulnerability of PWD to HIV/AIDS can be explained with the interweaving patterns of stigmatization between the stereotypes and myths surrounding disability, gender, sexuality and HIV/AIDS (see Fig. 2).

Fig. 2
figure 2

Interweaving patterns of stigmatization between disability, gender and HIV/AIDS

The stigma associated with disability creates vulnerability, as PWD find it difficult to form long, stable partnerships in which they can practice safer sex, experience sexual pleasure and be protected from violence. In addition, gender stereotypes and myths surrounding HIV increase the risk of sexual abuse and HIV infection for women in particular. It is therefore not surprising that women in our study identify sexual abuse as the main problem in their lives. If sexual abuse is such an enormous threat, then surely it is a major obstacle in HIV prevention.

The data therefore supports the hypothesis that even though access to prevention and treatment are not yet guaranteed, sexual abuse is an additional element that needs to be addressed to reduce the vulnerability of PWD to HIV/AIDS. In this context, the reasons and causes of this potential vulnerability need to be revealed. When the data is reviewed with Andrew and Vernon’s work [4], several reasons can be listed:

  • Combined cultural devaluation of women and PWD

  • Increased dependency on others

  • Denial of human rights that results in perceptions of powerlessness

  • Less risk of discovery as perceived by the perpetrator

  • Difficulties to be believed in court

  • Less education about appropriate and inappropriate sexuality but more need for education

  • Social isolation and increased risk of manipulation

  • Physical helplessness and vulnerability in public places

  • Interweaving myths about HIV/AIDS and other STDs

While many of these aspects are also typical for other cultural contexts the interweaving patters of stereotyping disability, gender and HIV have formed a particularly challenging framework in which PWD in KZN have to live. Therefore, it is not only important for PWD to access information and education but also necessary that a wider audience learns more about disability and changes their attitudes towards gender and HIV/AIDS.

In addition, the profile of prospective perpetrators needs to be better understood. Some surveys in the United States have shown that husbands and boyfriends were the most likely abusers of PWD [20, 24]. However, it is most probable that this is different in KZN. Reports from participants suggest that the abuser could be a relative, stranger as well as a boyfriend or husband. This requires clarification in a larger survey. The identification of risk factors also needs much more attention and a stronger emphasis needs to be brought to screening and developing of interventions that address violence against PWD. A great obstacle is the access to screening instruments so that sexual abuse can be detected early. As Smith [18] suggests, screening instruments such as the Abuse Assessment Screen-Disability (AAS-D) could be translated and be used for such purposes.

Sexual abuse and exploitation needs to be dealt with firmly and the sexual abuse of PWD needs to be addressed in a legal framework. South Africa has reviewed its law on sexual abuse [15] and strengthened its position in regard to the abuse of people with ‘mental disabilities’ and children. In reality however, the sexual abuse of PWD is underreported [17] and if brought to trial, it may be very difficult for PWD to take the stand as a witnesses. By law, South Africa protects PWD from sexual abuse. However, the reality might be different and it seems to be necessary to strengthen law reinforcement. Initiatives like the intervention programme of Cape Mental Health in the Western Cape assist complainants with intellectual disabilities in sexual assault cases [7]. This programme could be used as an example of good practice and should be considered for implementation in KZN.

Additionally, sexual education that includes basic anatomy and skills for relationship building, are required. The education or intervention programs have to however include teachers, caregivers and parents. They need to be equipped with the right attitude and skills. Sexual activity needs to be accepted as a fact of life. Parents, caretakers and teachers need to be able to talk about sexuality and they need to have knowledge regarding protection from sexual abuse. They need to know what is sexual abuse or exploitation and what it is not. Furthermore, they need to know where and how to report such a crime and who can be asked for assistance, something that would also be useful for a police officer. Sexual abuse has to be addressed using these important stakeholders, while the right to sexual pleasure and a fulfilled life, including a partner have to be promoted. Once sexuality is freed of taboo, it will be easier to equip PWD with the right skills to negotiate safer sex. Simultaneously, awareness of and protection from sexual abuse, will be brought to the forefront.

On a more national level there are however some promising initiatives. DPSA and the South African AIDS Council have just released a report on disability and HIV/AIDS. In this report sexual education has become an area that is being given more attention. Parents and PWD have come up with creative ideas of how, for instance, condom use can be taught to blind people or how condom use has to be adjusted for people who have no arms [19]. Initiatives in Cape Town have seen to simplifying sexual education for people with ID and the approach is in the process of being brought to KZN [13].

Conclusions

The study highlights the need for addressing sexuality, sexual abuse and the exploitation of PWD in an attempt to reduce the risk of HIV/AIDS within the disabled population in KwaZulu-Natal. The results of the analysis are consistent with the findings that women with disabilities are most likely to experience sexual violence or sexual exploitation. The interweaving patterns of stigmatization between gender, disability, sexuality and HIV/AIDS combined with a lack of sexual education and public protection are responsible for the increased vulnerability of PWD. The development and implementation of specialized interventions that focus on the needs of PWD in KZN is warranted.

Furthermore, future research needs to provide authorities with basic data such as the quantity of sexual abuse, the profile of perpetrators and the process of prosecution. In addition, individual approaches or projects of good practice should be included in future research so as to frame successful interventions. Lessons could be learnt that will be useful in further training and the intervention of staff at police stations, hospitals, schools and in parent child programs. It should also be considered if the disability movement in South Africa could learn from the disability movements in other countries, who have already gone through the process of sexual liberation and whose members claim openly their right to sexual pleasure rather than focusing on sexual harassment only.