"Women enjoy punishment": attitudes and experiences of gender-based violence among PHC nurses in rural South Africa.

Violence against women is pervasive in South Africa where, as in many other countries, cultural values and norms serve to condone and reinforce abusive practices against women. Primary health care nurses, who are widely distributed throughout the rural areas, may appear to be an ideal network for addressing this issue in resource-poor settings. However, based on a qualitative and quantitative study of a class of 38 PHC nurses, this paper emphasises that the nurses are women and men first--and as such, experience the same cultural values, and indeed, similar or higher levels of violence, as the clients they are expected to counsel and treat. Current models for encouraging nurses and other health care workers to detect and address gender-based violence have evolved largely in the context of developed countries, and have focused primarily on acquiring the knowledge, skills and attitudes necessary to engage this issue in the health care setting. Yet, as this paper suggests, there is an urgent need to understand and address the lived experiences of the nurses, and the duality of their roles as professionals and as community members, before promoting the training of nurses as an effective strategy for dealing with gender-based violence. One such training model was piloted and assessed in this study. The intervention used partnership with a domestic violence NGO to initially focus on dealing with the attitudes and experiences of the nurses as individuals, and to begin a process of self-awareness and sensitisation. Only then did the intervention turn to their roles as professional nurses. Clearly, there is a need for further research to explore these issues in more depth and to inform the development of appropriate training strategies for health care workers, particularly in developing countries. Moreover, such research may well have implications for the design and implementation of training interventions aimed at raising awareness and capacity within other sectors such as the welfare, police and judicial systems.