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TRAUMA, VIOLENCE, & ABUSE

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The Scale of Sexual Aggression in Southeast ª The Author(s) 2017
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Asia: A Review DOI: 10.1177/1524838017725312
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Lylla Winzer1, Barbara Krahé2, and Philip Guest1

Abstract
Southeast Asia is one of the most dynamic regions in the world. It is experiencing rapid socioeconomic change that may influence
the level of sexual aggression, but data on the scale of sexual aggression in the region remain sparse. The aim of the present article
was to systematically review the findings of studies available in English on the prevalence of self-reported sexual aggression and
victimization among women and men above the age of 12 years in the 11 countries of Southeast Asia (Brunei, Cambodia, East
Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam). Based on four scientific databases,
the search engine Google, Opengrey database, and reference checking, 49 studies were found on sexual victimization. Of those,
32 included only women. Self-reported perpetration was assessed by only three studies and included all-male samples. Prevalence
rates varied widely across studies but showed that sexual victimization was widespread among different social groups, irrespective
of sex and sexual orientation. Methodological heterogeneity, lack of representativeness of samples, imbalance of information
available by country, missing information within studies, and cultural differences hampered the comparability between and within
countries. There is a need for operationalizations that specifically address sexual aggression occurring after the age of consent,
based on detailed behavioral descriptions of unwanted sexual experiences and allied to a qualitative approach with cultural
sensitivity. Data on sexual aggression in conflict settings and in human trafficking are also limited. Recommendations for future
research are presented in the discussion.

Keywords
rape, sexual victimization, sexual aggression, sexual violence, Southeast Asia

The Scale of Sexual Aggression in Southeast
Asia
Despite the increasing number of publications on sexual
aggression, information on the frequency of the problem is
sparse in Southeast Asia. This culturally, politically, and eco-
nomically diverse region comprises 11 countries, namely,
Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia,
Myanmar, the Philippines, Singapore, Thailand, and Vietnam.
Although some countries are still recovering from political
conflicts (e.g., Cambodia, East Timor, Indonesia, and
Myanmar), most are experiencing deep socioeconomic trans-
formation (Dayley & Neher, 2013) and facing problems such as
undocumented migration, human trafficking, and sex tourism
that have been indirectly linked to the prevalence of sexual
aggression in the region (Darwin, Wattie, & Yuarsi, 2003).
Relatively high rates of teenage pregnancy (Manopaiboon
et al., 2003; Saim, Dufaker, & Ghazinour, 2014; Tan et al.,
2012), illegal abortion (Nguyen et al., 2012), and the wide-
spread prevalence of HIV (van Griensven et al., 2013) and
other sexually transmitted diseases (Morineau et al., 2011)
have also been related to this issue.
For the purpose of the present study, sexual aggression
refers to a continuum of nonconsented sexual behaviors from
sexual touch to any form of penetration that can be perpetrated
through a wide range of coercive strategies (e.g., verbal pres-
sure, threat, and physical force). Rape constitutes the most
severe form of sexual aggression and includes completed
vagina, oral, or anal penetration through exploitation of vic-
tim’s intoxicated state, threat, or use of physical force (Koss
et al., 2007). This article presents a comprehensive review of
studies that assessed the frequency of sexual aggression perpe-
tration and victimization in adolescent and adult samples from
the 11 countries of Southeast Asia.
Background Information on Sexual Aggression
and Victimization in Southeast Asia
Evidence shows that rape and other forms of sexual aggression
have been used in Southeast Asia as a form of political weapon
during conflicts (e.g., Karen Women’s Organization, 2004; The
1
Institute for Population and Social Research, Mahidol University, Nakhon
Pathom, Thailand
2
Department of Psychology, University of Potsdam, Potsdam, Germany
Corresponding Author:
Barbara Krahé, Department of Psychology, University of Potsdam, Karl-
Liebknecht-Str. 24-25, D-14476 Potsdam, Germany.
Email: krahe@uni-potsdam.de
2 TRAUMA, VIOLENCE, & ABUSE XX(X)
Asia Foundation, 2016). Sexual aggression continues to be a
daily threat even for those who manage to escape conflict set-
tings and live in border camps (Frelick & Saltsman, 2012).
Coercive sex is also used as a form of exploitation in the sex
industry, in the context of illegal migration and human traffick-
ing (Darwin et al., 2003).
In the general population, despite the decline of age of sex-
ual debut and the increasing number of women reporting pre-
marital sexual experiences, conservative gender roles still
persist in the region, indirectly endorsing sexual aggression
against women. Within an intimate relationship, women are
still expected to assume a more passive position (Tangmun-
kongvorakul & Bhuttarowas, 2005). The belief that “making
love” with their husbands is a duty rather than a personal need
is described to be generally accepted (Thaweesit, 2005). This
belief is also reflected in the law. Marital rape is not always
explicitly mentioned in the law, and procedures for divorce
can be stigmatizing (Bourke-Martignoni, 2001; Cambodian
Committee of Women [CCW], 2007; Kisekka, 2007) or even
illegal (e.g., in the case of the Philippines; Sano, Sedziafa, &
Tenkorang, 2016).
Indeed, the region still faces many challenges concerning
the legislation that addresses rape. The legal definition of rape
and the level of law enforcement vary widely across the 11
countries. According to a United Nations (UN) report (Kisekka,
2007), rape and the age of consent are not always clearly
defined, and law enforcement is largely subject to the judge’s
interpretation rather than the law in the statute book. Some
penal codes focus more on the physical harm associated with
the act than on the absence of consent, criminalizing the perpe-
trator’s behavior only if there are severe physical injuries
involved. Laws in accordance with Islamic criminal law (i.e.,
Malaysia and Indonesia) may also indirectly endorse sexual
aggression by blaming victims if they do not comply with an
expected dress code. Although there has been some progress in
the drafting of new legislations concerning rape in this region,
the process has been slow, inhibited by conservative values,
lack of resources, and a history of political repression, prevent-
ing people from speaking out and advocating for better laws.
Impunity for those who engage in sexually coercive beha-
vior is also a concern in the region (Jewkes, Fulu, Roselli, &
Garcia-Moreno, 2013). Perpetrators can go unpunished by
exploiting the status of their victims (e.g., sex workers and
victims of trafficking), by benefiting from laws that protect
them (e.g., the military), or by taking advantage of the ineffi-
cient judicial responses that favor those with more social influ-
ence and financial resources. Law enforcement can be
arbitrary. Victims may be encouraged to marry their perpetra-
tors in order to save their honor, or sexual aggression can be
treated as a minor offense, especially in border camps, and be
informally “penalized” through compensation payments or a
signed agreement in which the aggressor promises not to re-
offend (CCW, 2007; Frelick & Saltsman, 2012; Karen
Women’s Organization, 2013; Kisekka, 2007).
The medical response capacity for victims of sexual aggres-
sion is also a major issue in the region. Although most countries
are actively trying to improve their health sector, the quantity,
quality, and level of integration of health services vary widely
(UN Population Fund [UNFPA], 2010). Laos still does not have
an established national health system. Cambodia and Myanmar
have a small-scale response, such as capacity building. Viet-
nam has recently started pilot projects, and East Timor has
established hospital-based approaches responding to sexual
aggression cases. Even in countries considered to have a mod-
erate response level (e.g., Indonesia and Thailand), the provi-
sions to support victims of sexual aggression are limited.
All these aspects emphasize the need to investigate how per-
vasive the problem is in the region, so that legal and medical
responses can be adjusted accordingly. Since most international
reports focus on female victimization, there is also a need for
more information on male victimization. To our knowledge, there
are only a handful of literature reviews on sexual aggression that
include Southeast Asian studies in their analysis. Previous
reviews focused more on the global scale of the problem
(Abrahams et al., 2014; Dartnall & Jewkes, 2013), on young ages
(UNFPA, UN Educational, Scientific and Cultural Organization,
& World Health Organization [WHO], 2015), and on samples
recruited in emergency settings (Stark & Ager, 2011; Vu et al.,
2014). Because they include only a few studies from this region,
they fail to describe the scope of the problem for the 11 countries.
In order to fill this gap, the aim of the present article is to
systematically search and summarize the findings of studies
available in English that address the frequency of self-
reported sexual aggression perpetration and victimization in
Southeast Asia in individuals older than the age of 12, which
is the lowest age of consent in this region. We are interested in
the prevalence and incidence rates for sexual aggression for
each of the 11 countries, how sexual aggression and victimiza-
tion were assessed, what the target populations were, the rela-
tionship status between victims and perpetrator, and the
methodological limitations of these studies.
Method
Selection of Studies
Four databases were consulted: MEDLINE via PubMed, Sco-
pus, PsycINFO, and Web of Science. In order to identify non-
indexed publications (e.g., National Surveys, reports by
nongovernment organizations [NGOs]), reference checking,
Opengrey database, and the search engine Google were also
used. The following key words were employed: sexual aggres-
sion OR sexual violence OR sexual coercion OR sexual assault
OR rape OR intimate partner violence AND Southeast Asia OR
country by name (i.e., Brunei, Cambodia, East Timor, Indone-
sia, Laos, Malaysia, Myanmar, the Philippines, Singapore,
Thailand, and Vietnam). The inclusion criteria were that stud-
ies needed to present prevalence information about any form of
sexual aggression and/or victimization among women and men
older than the age of 12, which is the lowest age of consent in
the region. Studies were excluded if the frequency of sexual
aggression or victimization was presented in a single figure
Winzer et al. 3

Records identified through Medline Additional records identified through

via Pubmed, Scopus, Web of Science Google search engine, Opengray

Identification
and PsychInfo searching database and reference checking
(N = 1,594) (N = 6)

Records excluded: titles

Non-duplicate citations screened and abstracts did not
meet the inclusion
Screening

(N = 959)
criteria
(N = 874)

Full-text articles excluded, with

reasons
(N = 33):
- n = 13 studies provided sexual
aggression or victimization
Full-text articles assessed rates combined with other
Eligibility

for eligibility forms of aggression

(N = 85) - n = 12 studies addressed other
forms of aggression rather than
sexual aggression
- n = 5 studies were based on
the same database, providing
overlapping findings
- n = 2 studies had an updated
version of their findings
- n = 1 study provided rape
rates for both respondents and
Included

family members in a single

Studies included in the figure during the conflict in
final analysis (N = 52) Myanmar

Figure 1. Selection flow diagram.

combined with other forms of aggression (e.g., emotional or
physical).
In the four databases, an initial pool of 1,594 studies was
identified. Six further studies were found through other
sources. After eliminating duplicates, 959 studies remained in
the sample. Of these, 874 were excluded because the titles and
abstracts did not meet the inclusion criteria. This left a sample
of 85 full-text articles that were assessed for eligibility. Of
these, 33 failed to comply with the inclusion criteria on closer
inspection and were eliminated. The final sample consisted of
52 articles eligible for inclusion in the review: 49 on victimiza-
tion and 3 on the perpetration of sexual aggression. The stages
of the selection process are detailed in Figure 1.
Results
Definition of Sexual Aggression and Victimization
The way the research question was framed and the inclusiveness
of the operationalization of sexual aggression and victimization
varied widely across the studies (see Table 1). Most studies
applied between one and three questions in order to assess sexual
victimization (some exceptions are Bouhours, Chan, Bong, &
Anderson, 2013; Falb, McCormick, Hemenway, Anfinson, &
Silverman, 2013; Hynes, Robertson, Ward, & Crouse, 2004).
Most studies also included broad terms (e.g., “sexual acts,”
“sexual activities,” “something sexual,” “sexually degrading
acts,” “physical intimate act,” “sexual experiences,” “sexual
intercourse,” and “forced sexual contact”), without specifying
exactly what sexual behaviors were assessed. In nine studies, it
was not specified how the authors defined the problem. Eight
studies applied the WHO Women’s Health and Life Experiences
Questionnaire or variations of this instrument (Astbury & Walji,
2014; Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006;
Hayati, Hogberg, Hakimi, Ellsberg, & Emmelin, 2011; Kiss et al.,
2015; Nguyen et al., 2012; Shuib et al., 2013; Tran et al., 2013;
Vung, Ostergren, & Krantz, 2008). Only three studies discrimi-
nated rates of severe from less severe forms of sexual victimiza-
tion (Choo, Dunne, Marret, Fleming, & Wong, 2011; Falb et al.,
2013; Ruangkanchanasetr, Plitponkarnpim, Hetrakul, & Kongsa-
kon, 2005). In addition, one study used an open question (Rush-
ing, Watts, & Rushing, 2005), and another study combined a
4 TRAUMA, VIOLENCE, & ABUSE XX(X)

Table 1. Operational Definition of Sexual Aggression and Victimization.

Country/Author(s) Operationalization of Sexual Victimization

Cambodia
Astbury and Walji (2014) WHO Women’s Health and Life Experiences Questionnairea
McCauley, Decker, and Silverman (2010) Forced to perform sex acts against her will
Moret et al. (2016) “Have you been physically forced to have sex or had sex when you did not
want to?”
East Timor
Hynes, Robertson, Ward, and Crouse (2004) By nonfamily members: included “unwanted kissing,” “touched on sexual
parts of body,” and “forced give/receive oral/vaginal/anal sex”; by
partner: included “threats of physical harm or force to obtain sex”
Indonesia
Hayati, Hogberg, Hakimi, Ellsberg, and Emmelin (2011) WHO Women’s Health and Life Experiences Questionnairea
Morineau et al. (2011) Ever forced into sex
Sheridan, Scott, and Roberts (2016) Forced sexual contact
Malaysia
Choo, Dunne, Marret, Fleming, and Wong (2011) “Touched or fondled your private parts or forced you to touch or fondle
their private parts”; “forced you to have sexual intercourse”
Marret and Choo (2016) “Forced me to have sexual intercourse”
Saim, Dufaker, and Ghazinour (2014) Not specified
Shuib et al. (2013) WHO Women’s Health and Life Experiences Questionnairea
Tan et al. (2012) Not specified
Wickersham et al. (2016) Ever had any unwanted sexual experience since the age of 18
Philippines
Ansara and Hindin (2009) Ever had sex with the husband when she did not want to because she was
afraid of what he might do
Antai and Anthony (2014) Forced sexual intercourse; other sexual acts when undesired
Kuning, McNeil, and Chongsuvivatwong (2003) “Have you ever been physically forced to have sex with someone?”
Lucea, Hindin, Kub, and Campbell (2012) “First sexual experience was unwanted or pressured,” “ever had sex
against your will,” and “ever had sex out of fear of what your partner
would do”
Sano, Sedziafa, and Tenkorang (2016) The first time you had sexual intercourse, would you say you had it because
you wanted or because you were forced to have it against your will?
Serquina-Ramiro (2005) To be physically, psychologically, and verbally forced to engage in a physical
intimate act against his or her will
Tsai, Cappa, and Petrowski (2016) Physically forcing a woman to engage in sexual intercourse or other sexual
acts she did not want to; forcing with threats or in any other way to
engage in sexual intercourse or other sexual acts she did not want to;
and trying or attempting to force, persuade, or threaten a woman to
engage in sexual intercourse or other sexual acts against her will
Urada et al. (2016) Not specified
Urada et al. (2014) “Have you ever experienced the following violence or abuse against you?”
Yes or no response choices included “sexual abuse”
Singapore
Bouhours, Chan, Bong, and Anderson (2013) Forced into sexual intercourse, attempted to force into sexual intercourse;
touched sexually; forced or attempted to force into sexual activity with
someone else; any other sexual violence
Thailand
Allen et al. (2003) Having sexual contact or intercourse against her will
Chaveepojnkamjorn and Pichainarong (2011) Ever forced to have sexual intercourse
Chemnasiri et al. (2010) Not specified
Decker et al. (2011) Forced initiation into sex work: “first sexual initiation was both
nonconsensual and with a paying costumer”
Farley et al. (2003) “Have you been raped?,” “Who raped you?,” and “How many times have
you been raped since you were in prostitution?”
Garcia-Moreno, Jansen, Ellsberg, Heise, and Watts (2006) WHO Women’s Health and Life Experiences Questionnairea
Guadamuz et al. (2011) Being forced to have sexual intercourse against one’s will
Manopaiboon et al. (2003) Being physically or mentally forced to have sexual contact or sexual
intercourse against one’s will
Ruangkanchanasetr, Plitponkarnpim, Hetrakul, and Kongsakon Not specified
(2005)
(continued)
Winzer et al. 5

Table 1. (continued)

Country/Author(s) Operationalization of Sexual Victimization

Saito et al. (2012) For example, being physically forced to have sex, partner demanded sex,
partner often made me have sexual intercourse against my will
Saito et al. (2013) “My husband physically forced me to have sex”; “my husband demanded
sex whether I wanted to or not”
Tangmunkongvorakul, Carmichael, Banwell, Utomo, and Sleigh Ever been forced, physically or psychologically, to have intercourse against
(2011) their will
Thananowan and Vongsirimas (2016) “Within the last year, has anyone forced you to have sexual activities?”
Van Griensven et al. (2004) Being mentally or physically forced to have sexual contact or sexual
intercourse against your will
Van Griensven et al. (2013) Not specified
Thai-Cambodia border
Mollica et al. (1993) Not specified
Thai-Myanmar border
Cardozo, Talley, Burton, and Crawford (2004) Not specified
Falb, McCormick, Hemenway, Anfinson, and Silverman (2013) Forced to remove or stripped her clothing, subjected to unwanted kissing
or touching on sexual parts of her body and forced or threatened with
harm to make her give or receive oral sex or to have vaginal or anal
intercourse
Petersen, Worm, Olsen, Ussing, and Hartling (2000) Not specified
Vietnam
Le, Holton, Huong Thanh, Wolfe, and Fisher (2015) “At any time in your life, did anyone try to force you to have sex, that is,
sexual intercourse of any kind, even if it didn’t happen?”
Le et al. (2014) His or her partner has ever forced them to have sex
Nguyen et al. (2012) Variation of WHO Women’s Health and Life Experiences Questionnaire
Rushing, Watts, and Rushing (2005) “What can you tell us about your first sex with a client?”
Tran et al. (2013) WHO Women’s Health and Life Experiences Questionnairea
Vung, Ostergren, and Krantz (2008) Variation of WHO Women’s Health and Life Experiences Questionnaire
Cambodia, Thailand, and Vietnam
Kiss et al. (2015) WHO Women’s Health and Life Experiences Questionnairea

Operationalization of Perpetration of Sexual Aggression

Cambodia and Indonesia

Fulu, Jewkes, Roselli, and Garcia-Moreno (2013) “Forced partner to have sexual intercourse with you when she did not
want to” and “had sexual intercourse with partner when you knew she
didn’t want to but you believed she should agree because she was your
wife/partner”
Jewkes, Fulu, Roselli, and Garcia-Moreno (2013) “Forced a woman who was not your wife or girlfriend at the time to have
sex” or “had sex with a woman who was too drunk or drugged to
indicate whether she wanted it”
Vietnam
Yount et al. (2016) Physically forcing his wife to have sexual intercourse

Note. WHO ¼ World Health Organization.

a
This instrument includes three questions: being physically forced to have sexual intercourse when she or he did not want to; had sexual intercourse when she or
he did not want to because she or he was afraid of what the partner might do; being forced to do something sexual that she or he found degrading or humiliating.

quantitative and a qualitative approach, offering respondents the
opportunity to define sexual victimization in their own words
(Tangmunkongvorakul, Carmichael, Banwell, Utomo, & Sleigh,
2011). In this study, young people reported they also perceived
behaviors such as being forced to watch pornography and a part-
ner’s refusal to use a condom as sexual coercion.
Sexual Victimization in Women and Men
The 49 studies on self-reported sexual victimization are listed
in Table 2, ordered by country.
Country. Most studies were conducted in Thailand (15 studies),
Philippines (9 studies), Malaysia (6 studies), and Vietnam
(6 studies). Three studies were conducted in Cambodia and
three in Indonesia. East Timor and Singapore each contributed
one study. Four additional studies were conducted in border camps
(i.e., on the Thai-Myanmar and the Thai-Cambodia border). A
further study provided information from Cambodia, Thailand, and
Vietnam together. No studies were found for Brunei and Laos.
Sample sizes varied from 17 to 8,481 participants. Except
for four studies, all studies included samples with more than
100 participants. Twenty studies included samples with more
than 1,000 individuals; however, only nine were based on data
 Table 2. Studies of Self-Reported Sexual Victimization.

6
Sexual Victimization
Age in Years
Country/Author(s) Sample (N) (M) Time Limit/Window % Women % Men Perpetrator

Cambodia
Astbury and Walji (2014) 177 Disabled and 177 18–45 Lifetime Total: 4.2; disabled: 6.8; — Household member
nondisabled women nondisabled; 1.7 (not partners)
McCauley et al. (2010) 136 Trafficked women Not specified Not specified 33.1 — Not specified
Moret et al. (2016) 220 FSW 15–29 In the previous year 27 — Any
East-Timor
Hynes et al. (2004) 288 Women 18–49 A year before the crisis 16.4 — Intimate partner
During the crisis 22.7 Nonfamily member
Postcrisis 9.7 Nonfamily member
In the previous year 15.7 Intimate partner
Indonesia
Hayati et al. (2011) 765 Women 15–49 Lifetime 22 — Intimate partner
Morineau et al. (2011) 1,450 MSM 15 In the previous year — 10.1 Not specified
Sheridan et al. (2016) 102 Female students (20.3) Not specified 17 — Any
Malaysia
Choo et al. (2011) 769 Male and 1,101 female 15–17 (16) Lifetime 13.8 (touch); 3.1 14.8 (touch); Any
students (intercourse) 3 (intercourse)
Marret and Choo (2016) 3,349 Students 12–18 During face-to-face 1.1 2.5 Online
meetings with online acquaintance
acquaintance
Saim et al. (2014) 17 Unmarried teenage 12–18 Reason for pregnancy 76 — Any
mothers
Shuib et al. (2013) 2,640 Ever-partnered 18 Lifetime 1.7 — Intimate Partner
women
Tan et al. (2012) 26 Pregnant teenagers 12–18 Reason for pregnancy 18.5 — Boyfriend
3.8 A stranger
Wickersham et al. (2016) 103 Female drug users 19–60 Since the age of 18 23.8 — Not specified
Philippines
Ansara and Hindin (2009) 1,861 Partnered women Mid-40s In the relationship 22 — Husband
Antai and Anthony (2014) 8,478 Women 15–49 Lifetime 5 — Intimate partner
Kuning et al. (2003) 8,481 Women who had at 15–49 Not specified 5.2–10.3a — Not specified
least one pregnancy
Lucea et al. (2012) 474 Women 15–31 Lifetime 63 — Intimate partner
Sano et al. (2016) 7,293 Sexually 15–49 At sexual debut 4.6 — Any
experienced women
Serquina-Ramiro (2005) 298 Male and 302 female 15–19 Lifetime 64.6 42.3 Intimate partner
unmarried adolescents
Tsai et al. (2016) 1,566 Partnered young 15–24 In the previous year 4.8 — Intimate partner
women
Urada et al. (2016) 166 FSW 18–37 Lifetime Total: 34.9; trafficked: — Not specified
42.1; nontrafficked: 34
Urada et al. (2014) 482 Female bar/spa 18–60 Lifetime Total: 20; sex worker: — Not specified
workers 35; nonsex worker: 12
(continued)
 Table 2. (continued)

Sexual Victimization
Age in Years
Country/Author(s) Sample (N) (M) Time Limit/Window % Women % Men Perpetrator

Singapore
Bouhours et al. (2013) 2,006 Women 18–69 Lifetime 4.2 — Any
In the previous year 0.5
Thailand
Allen et al. (2003) 359 Female students 15–21 Lifetime 21 — Any
Chaveepojnkamjorn and 5,184 Male high school (n ¼ 2,419) <15 Not specified — Total: 5.9; nondrinkers: 4.9; Not specified
Pichainarong (2011) students (n ¼ 2,765) 15 drinkers: 9.6
Chemnasiri et al. (2010) 274 MSM, 312 MSW, and 15–24 Lifetime — Total: 21.6; MSM: 24.5; Any
241 TG MSW: 13.5;
TG: 29
Decker et al. (2011) 815 FSW 14 At initiation to sex work Total: 4.4; trafficked: — Any
11.8; nontrafficked: 3.6
Farley et al. (2003) 110 FSW, including 28 TG 14–46 (26) During sex work 38 — Any
Garcia-Moreno et al. (2006) 1,049 Ever-partnered 15–49 Lifetime 29.9 (city) — Intimate partner
women (city) 28.9 (province)
1,024 Ever-partnered In the previous year 17.1 (city)
women (province) 15.6 (province)
Lifetime 14 (city) Nonpartner
18 (province)
After the age of 15 6 (city)
3 (province)
Guadamuz et al. (2011) 821 MSM, 754 MSW and 15 (24.8) Lifetime — Total: 18.4; MSM: 19.4; Any
474 TG MSW: 12.2; TG: 26.4
Manopaiboon et al. (2003) 893 Male and 832 female 15–21 Lifetime 21 6.5 Any
young people
Ruangkanchanasetr et al. 2,311 Male and female (15.5) In the previous year Total: 17.1 (sexual assault); 2.4 (rape) [students: 1.4; Not specified
(2005) adolescents (in and out- community: 3.1; juvenile home institutions: 24.5]
of-school adolescents)
Saito et al. (2012) 274 Postpartum women 18–45 (25.9) During the 6 weeks 11.3 — Intimate partner
postpartum
Saito et al. (2013) 421 Pregnant women 18–40 (25.9) During the pregnancy 19.2 — Intimate partner
Tangmunkongvorakul et al. 561 Male and 289 female 17–20 Lifetime Total: 26.4; general school Total: 8.8; general school Not specified
(2011) adolescents or university: 25; or university: 3.2;
vocational school: vocational school: 9.1;
22; out-of-school: 33.7 out-of-school: 10.9
Thananowan and 532 Women with 15–65 In the previous year 11.5 — Intimate partner
Vongsirimas (2016) gynecological problems
Van Griensven et al. (2004) 893 Male and 832 female 15–21 (18.4) Lifetime Hetero: 19.6; GLB: 32.2 Hetero: 4.6; GLB: 25.9 Any
students
Van Griensven et al. (2013) 1,744 Homosexually 18 Lifetime — Total: 17.3; HIVþ: 29.6; Not specified
active men HIV: 19.6
(continued)

7
8
Table 2. (continued)

Sexual Victimization
Age in Years
Country/Author(s) Sample (N) (M) Time Limit/Window % Women % Men Perpetrator

Thai-Cambodia border
Mollica et al. (1993) 388 Male and 605 female 18 During the conflict 17 Not specified
displaced persons Displacement period 5
Thai-Myanmar border
Cardozo et al. (2004) 206 Men and 284 women 15 In the past 10 years 3 3 Not specified
Falb et al. (2013) 861 Displaced partnered 15–49 During the conflict 0.6 (kiss or touch) — Nonpartner
women 0.3 (intercourse)
Petersen et al. (2000) 48 Displaced women 12 Not specified 6.3 — Not specified
Vietnam
Le et al. (2015) 1,535 High school >15 Lifetime 3.5 Any
students
Le et al. (2014) 1,701 Ever-married young 14–25 Lifetime 3.2 1 Intimate partner
people
Nguyen et al. (2012) 1,281 Partnered women 18–49 Lifetime 10.4 — Intimate partner
Rushing et al. (2005) 20 FSW 16–27 At initiation to sex work 80 — Client
Tran et al. (2013) 497 Pregnant women (26) Lifetime 3.6 — Intimate partner
Vung et al. (2008) 883 Partnered women 17–60 Lifetime 6.6 — Intimate partner
In the previous year 2.2
Cambodia, Thailand, and Vietnam
Kiss et al. (2015) 383 Men and 288 women >18 Not specified 43.9 1.3 Not specified
in posttrafficking
services
Note. MSM ¼ to men who have sex with other men; MSW ¼ male sex workers; FSW ¼ female sex workers; TG ¼ male-to-female transgenders; Hetero ¼ heterosexuals; GLB ¼ gays, lesbians, and bisexuals.
a
Depending on the number of pregnancies.
Winzer et al.
from representative samples (Antai & Anthony, 2014; Bou-
hours et al., 2013; Choo et al., 2011; Garcia-Moreno et al.,
2006; Le, Tran, Nguyen, & Fisher, 2014; Nguyen et al.,
2012; Sano et al., 2016; Shuib et al., 2013; Tsai, Cappa, &
Petrowski, 2016). In terms of gender composition, 32 studies
included women only, 5 studies addressed men only (4 included
only men who have sex with other men), and 12 studies
included both women and men.
Among women, the lifetime prevalence of sexual victimiza-
tion was 4.2% in Cambodia (Astbury & Walji, 2014), 22% in
Indonesia (Hayati et al., 2011), 4.2% in Singapore (Bouhours
et al., 2013), and ranged from 14% to 33.7% in Thailand (Allen
et al., 2003; Garcia-Moreno et al., 2006; Manopaiboon et al.,
2003; Tangmunkongvorakul et al., 2011; van Griensven et al.,
2004; van Griensven et al., 2013), from 5% to 64.6% in the
Philippines (Antai & Anthony, 2014; Lucea, Hindin, Kub, &
Campbell, 2012; Serquina-Ramiro, 2005; Urada et al., 2016;
Urada et al., 2014), from 3.2% to 10.4% in Vietnam (Le et al.,
2014; Nguyen et al., 2012; Tran et al., 2013; Vung et al., 2008),
and from 1.7% to 13.8% in Malaysia (Choo et al., 2011; Shuib
et al., 2013). Among men, figures ranged from 3% to 14.8% in
Malaysia (Choo et al., 2011) and from 3.2% to 29.6% in Thailand
(Chemnasiri et al., 2010; Guadamuz et al., 2011; Manopaiboon
et al., 2003; Tangmunkongvorakul et al., 2011; van Griensven
et al., 2004; van Griensven et al., 2013); 42.3% of men in
the Philippines (Serquina-Ramiro, 2005) and 1% in Vietnam
(Le et al., 2014) reported some form of sexual victimization
in their lifetime. However, due to methodological differ-
ences, a direct comparison between countries is impossible.
Time frames. The prevalence data generated by the studies
included in this review either assessed the percentage of parti-
cipants who reported at least one instance of sexual violence
victimization (lifetime prevalence) or the percentage of people
who experienced at least one instance of sexual victimization in
the 12 months preceding the survey (last-year incidence).
Lifetime prevalence rates. Twenty-three studies addressed the
lifetime prevalence of sexual victimization. Lifetime preva-
lence varied from 1.7% to 64.6% among women and from 1%
to 42.3% among men. Studies that used the WHO’s question-
naire showed that, among women, the lifetime prevalence rate
of victimization by intimate partner was 1.7% in Malaysia
(Shuib et al., 2013), 22% in Indonesia (Hayati et al., 2011),
and ranged from 3.6% to 10.4% in Vietnam (Nguyen et al.,
2012; Tran et al., 2013; Vung et al., 2008) and from 28.9%
(province) to 29.9% (Bangkok) in Thailand (Garcia-Moreno
et al., 2006). Three of these studies were based on represen-
tative samples (Garcia-Moreno et al., 2006; Nguyen et al.,
2012; Shuib et al., 2013). Further two studies also based on
representative samples showed lifetime prevalence rates of
4.2% in Singapore (Bouhours et al., 2013) and 5% in the
Philippines (Antai & Anthony, 2014).
Last-year incidence rates. Nine studies addressed the fre-
quency of sexual victimization in the previous year. Last-
year incidence of female victimization ranged from 0.5% to
9
27%. Studies that used the WHO definition of sexual aggres-
sion found that the past-year incidence rate of female victimi-
zation by an intimate partner was 2.2% in Vietnam (Vung et al.,
2008), 4.8% in the Philippines (Tsai et al., 2016), and ranged
from 15.6% (in a selected province) to 17.1% (Bangkok) in
Thailand (Garcia-Moreno et al., 2006). Only one study
addressed last-year victimization rates among men and found
that 10.1% of an Indonesian sample of men who have sex with
other men reported that they had been forced to engage in sex
in the previous year (Morineau et al., 2011). In another study,
the percentage of participants who were coerced in the previous
year was not reported separately for each sex. The authors
found that 17.1% of respondents of both sexes reported that
they had been a victim of sexual assault, and 2.4% of them
reported having been a victim of rape in the previous year
(Ruangkanchanasetr et al., 2005).
Sexual debut. Four studies addressed sexual victimization at
sexual debut. Sano, Sedziafa, and Tenkorang (2016) found that
4.6% of a large representative sample of females in the Philip-
pines reported that their sexual debut was forced. In this study,
single women were more likely to report forced sexual debut
than married women. Another study from Thailand found that
in 71% of the cases of sexual coercion, coercion happened at
the first sexual intercourse (Tangmunkongvorakul et al., 2011).
Lucea, Hindin, Kub, and Campbell (2012) also included forced
sexual debut in their definition of sexual victimization, but the
authors did not provide rates separately for this item. Decker,
McCauley, Phuengsamran, Janyam, and Silverman (2011)
addressed the combination of sexual debut and initiation to sex
work in Thailand. They found that 4.4% of the sample
described their first sexual intercourse as both nonconsensual
and with a paying client.
During and postpolitical crisis. Two studies compared rates of
sexual victimization during and after a period of political con-
flict. Mollica and colleagues (1993) found that sexual victimi-
zation was almost 3 times higher in Cambodia during than after
the conflict (17% vs. 5%). Hynes, Robertson, Ward, and
Crouse (2004) also found a lower rate of victimization in the
postcrisis period (9.7%) compared to that during the conflict
period (22.7%) in East Timor.
Participant characteristics. A wide variation was observed
between studies regarding the characteristics of the included
samples. Some studies included primarily younger participants,
sexual minorities, or pregnant women or focused specifically
on sex workers, victims of trafficking, and displaced persons.
Young samples. Thirteen studies focused on victimization in
persons aged between 12 and 21 years. Lifetime prevalence of
sexual victimization varied from 3.1% to 64.6% for females
and from 3% to 42.3% for males. In samples composed exclu-
sively of high school and college students, lifetime prevalence
rates ranged from 3.1% to 32.2% among females and from 3%
to 25.9% among males. By addressing the influence of the
Internet on sexual behavior in Malaysia, Marret and Choo
10
(2016) found that 1.1% of female and 2.5% of male students
were sexually victimized in face-to-face meetings with
acquaintances they had met online. Chaveepojnkamjorn and
Pichainarong (2011) found that male students who had used
alcohol in the previous 30 days were more likely to report
sexual victimization than nondrinkers, but the difference was
not significant. Other studies also found that youths who had
dropped out of school were significantly more likely to report
some form of sexual victimization compared to in-school
youths (Ruangkanchanasetr et al., 2005; Tangmunkongvorakul
et al., 2011).
Homosexuals and bisexuals. Lifetime prevalence rates among
homosexual or bisexual males ranged from 17.3% to 25.9%
(Chemnasiri et al., 2010; Guadamuz et al., 2011; van Griensven
et al., 2004; van Griensven et al., 2013). Last-year incidence
was found to be 10.1% among men who have sex with other
men in a study conducted in Indonesia (Morineau et al., 2011).
Homosexual and bisexual females were included in only one
study where they were found to have a lifetime prevalence rates
of sexual victimization of 32.2% (van Griensven et al., 2004).
The same study also found that lifetime prevalence rates among
female and male homosexuals and bisexuals were significantly
higher than those among heterosexuals. Male-to-female trans-
genders were included in both male (Chemnasiri et al., 2010;
Guadamuz et al., 2011) and female samples (Farley et al.,
2003); however, only studies with male samples provided sep-
arate information for this group. With rates ranging from 26.4%
to 29%, male-to-female transgenders were significantly more
likely to report lifetime sexual victimization than men who
have sex with other men in the general population and male
sex workers (Chemnasiri et al., 2010; Guadamuz et al., 2011).
A further study found that HIV-positive gay men were more
likely to report sexual victimization compared to HIV-negative
gay men (van Griensven et al., 2013).
Sex workers. Eight studies included samples with male
(Chemnasiri et al., 2010; Guadamuz et al., 2011) and female
sex workers (Decker, McCauley, Phuengsamran, Janyam, &
Silverman, 2011; Farley et al., 2003; Moret et al., 2016; Rush-
ing et al., 2005; Urada et al., 2016; Urada et al., 2014). Among
men, lifetime prevalence rates of sexual victimization ranged
from 12.2% to 13.5% (Chemnasiri et al., 2010; Guadamuz
et al., 2011). In women, victimization rates among sex workers
ranged from 4.4% to 80% (Decker et al., 2011; Farley et al.,
2003; Moret et al., 2016; Rushing et al., 2005; Urada et al.,
2016; Urada et al., 2014), with time windows varying between
studies. In Thailand, 4.4% of female sex workers reported that
their first ever sexual intercourse was with a paying client and
the experience was nonconsensual (Decker et al., 2011).
Another study found that 38% of Thai female sex workers,
including male-to-female transgenders, reported having been
raped in sex work and more than a half of these victims
reported that they had been raped more than 5 times (Farley
et al., 2003). In Cambodia, 27% of female sex workers reported
being subjected to forced sexual intercourse in the previous
year. The same study also found that sexual aggression was
TRAUMA, VIOLENCE, & ABUSE XX(X)
more likely to be perpetrated by nonregular (18%) than by
regular (4%) clients (Moret et al., 2016). In the Philippines,
lifetime sexual victimization among female sex workers was
around 35% (Urada et al., 2016; Urada et al., 2014). Philippine
bar workers with a recent history of selling sex were signifi-
cantly more likely to report lifetime sexual victimization than
bar workers without a history of selling sex (Urada et al., 2014).
Finally, in Vietnam, 80% of sex workers reported that their
initiation to sex work had involved coercion. However, due
to the very small size of the sample (N ¼ 20), this rate should
be interpreted with caution (Rushing et al., 2005).
Victims of trafficking. Four studies addressed sexual victimi-
zation among victims of trafficking. Three focused on sex traf-
ficking, although the time frame of coercion was unclear in two
of these three studies. Trafficking into sex work can be consid-
ered coercive by definition; however, the studies reviewed rely
on the perception of coercion of the women trafficked. In Cam-
bodia, 33.1% of female victims of trafficking for sex work
reported they had been forced to perform sex against their will
(McCauley, Decker, & Silverman, 2010). The time window is,
however, unclear for this study. Decker and colleagues (2011)
found that trafficked female sex workers (11.8%) were signif-
icantly more likely than nontrafficked sex workers (3.6%) to
report that their first ever sexual experience had involved force
by a paying partner, implying they had their virginity sold in
the trafficking trade. Urada and colleagues (2016) also found
that trafficked sex workers (42.1%) reported higher lifetime
prevalence of sexual victimization compared to their nontraf-
ficked counterparts (34%), suggesting that the first group was
at higher risk for sexual victimization even before the experi-
ence of being trafficked. The difference, however, did not reach
statistical significance. Only one study addressed human traf-
ficking for different sectors (e.g., fishing, factory, construction,
agriculture, domestic work, and sex work). In a sample drawn
from those who were in posttrafficking services in Thailand,
Vietnam, and Cambodia, Kiss and colleagues (2015) showed
that 1.3% of male and 44% of female victims of trafficking
reported some form of sexual victimization. Nevertheless,
because the time window is not specified in this study, it is
unclear if the victimization had occurred before, during, or
after the trafficking period.
Displaced persons. Falb, McCormick, Hemenway, Anfinson,
and Silverman (2013) found that 0.3% of displaced women
reported experiences of forced sex during the conflict in Myan-
mar. Petersen, Worm, Olsen, Ussing, and Hartling (2000)
found that 6.3% of a small female sample (N ¼ 48) in the
Thai-Myanmar border region reported they had been raped, but
the time window considered is unclear. Cardozo, Talley, Bur-
ton, and Crawford (2004) found that 3% of men and 3% of
women reported having been raped in the previous 10 years of
conflict in Myanmar. On the Thai-Cambodian border, Mollica
and colleagues (1993) found that the sexual victimization rates
for the period of displacement (5%) were considerably lower
than during the conflict (17%) for both sexes. In East Timor,
Hynes and colleagues (2004) found that women who had been
Winzer et al. 11

Table 3. Studies of Self-Reported Sexual Aggression Perpetration.

Perpetration of Sexual
Aggression

Country/Author(s) Sample (N) Age in Years (M) Time Window %Women %Men Victim

Cambodia
Fulu et al. (2013) 1,390 Men 18–49 Lifetime — 21.0 Intimate partner
Jewkes et al. (2013) 1,776 Men 18–49 Lifetime — 8.3 Nonpartner
20.8 Partner and nonpartner
Indonesia
Fulu et al. (2013) 785 Men (urban site) 18–49 Lifetime — 24.2 Intimate partner
746 Men (rural site) 18.0
840 Men (Jayapura) 43.7
Jewkes et al. (2013) 854 Men (Jakarta) 18–49 Lifetime — 8.5 Nonpartner
799 Men (rural Java) 5.8
879 Men (Jayapura) 23.4
12.8 (total)
31.9 (total) Partner and nonpartner
Vietnam
Yount et al. (2016) 522 Married men 18–50 Lifetime — 0.2 Current wife

displaced to a camp during the political crisis were almost 3
times more likely to be sexually victimized (21.5%) than those
who had not been displaced.
Pregnant women, women in the postnatal period, and women
who had at least one pregnancy. In Thailand, it was found that
19.2% of pregnant women reported they had been coerced to
have sex during pregnancy (Saito, Creedy, Cooke, & Cha-
boyer, 2013) and 11.3% in the 6-week postpartum period
(Saito, Creedy, Cooke, & Chaboyer, 2012). In Vietnam, 3.6%
of pregnant women reported some form of victimization by
their intimate partner (Tran et al., 2013). However, as the study
focused on lifetime prevalence, it was not able to identify vic-
timization that had occurred specifically during pregnancy. In
the Philippines, one study investigated the frequency of forced
sex among women who had at least one pregnancy and found
rates that ranged from 5.2% to 10.3%, according to the number
of pregnancies (Kuning, McNeil, & Chongsuvivatwong, 2003).
Nevertheless, because the time window was not specified, the
link between pregnancy and sexual victimization is unclear.
Two further studies found that forced sexual intercourse was
a common cause of teenage pregnancy (Saim et al., 2014; Tan
et al., 2012).
Other groups. Astbury and Walji (2014) found that disabled
women (6.8%) were significantly more likely to report lifetime
sexual victimization committed by household members than
nondisabled women (1.7%) in Cambodia. However, the com-
parison must be taken with caution due to the small number of
victims in the sample. Wickersham and colleagues (Wicker-
sham et al., 2016) found that 23.8% of female drug users in
Malaysia reported some form of unwanted sexual experience
since the age of 18 years. Those who reported having injected
drugs in the last 30 days (40.9%) were significantly more likely
to be victimized than those with no drug injection (19%) in the
same period.
Relationship with the perpetrator. Fourteen studies included vic-
timization by any type of perpetrator, 14 studies solely
addressed victimization by an intimate partner, and 3 studies
addressed victimization by both partners and nonpartners. Fur-
ther studies addressed sexual victimization perpetrated by
household members other than intimate partners (Astbury &
Walji, 2014), nonpartners during the conflict in Myanmar (Falb
et al., 2013), clients (in the case of sex workers; Rushing et al.,
2005), and acquaintances met online (Marret & Choo, 2016).
Lifetime prevalence rates of sexual victimization by any per-
petrator ranged from 3.1% to 32.2% among women and from
3% to 29% among men. Lifetime prevalence of sexual victi-
mization by intimate partners ranged from 1.7% to 64.6%
among women and from 1% to 42.3% among men. Last-year
incidence rates of sexual victimization by intimate partners
varied from 2.2% to 17.1% among women. Only one study
directly compared rates of sexual victimization by partners
with rates of victimization by nonpartners (Garcia-Moreno
et al., 2006). This study found that the lifetime prevalence of
sexual victimization by intimate partners in Thailand (29.9% in
Bangkok and 28.9% in a selected province) was considerably
higher than those by nonpartners (14% and 18%, respectively).
Perpetration of Sexual Aggression
Only three studies addressed self-reported perpetration of sex-
ual aggression in Southeast Asia (Fulu, Jewkes, Roselli, &
Garcia-Moreno, 2013; Jewkes et al., 2013; Yount et al.,
2016). They were conducted in Cambodia, Indonesia, and
Vietnam and included only aggression committed by men (see
Table 3). Lifetime rates of male sexual aggression perpetration
varied from 0.2% to 43.7% against intimate partners and from
5.8% to 23.4% against nonpartners. Lifetime prevalence of
raping another man was 3.3% in Cambodia and between
1.5% and 1.8% in different sites of Indonesia (Jewkes et al.,
12
2013). Because two of these publications referred to different
aspects of the same sample, it is possible to directly compare
their results. Rape perpetrated against intimate partners in
Cambodia (21%) and Indonesia (from 18% to 43.7%; Fulu
et al., 2013) occurred substantially more frequently than rape
against nonpartners in both countries (8.3% in Cambodia; from
5.8% to 23.4% in Indonesia; Jewkes et al., 2013). Jewkes, Fulu,
Roselli, and Garcia-Moreno (2013) found that multiple perpe-
trator rape in Cambodia (5.2%) and Jayapura in Indonesia
(6.8%) was considerably more frequent than in all other sites
addressed in the study (between 1% and 2%), except for Papua
New Guinea. In Cambodia, the prevalence of multiple perpe-
trator rape (5.2%) was even higher than the prevalence of single
perpetrator rape (3.1%). The same study also showed that more
than half of the perpetrators committed the first rape before the
age of 19 years.
Discussion
The present article summarized data available in English on the
frequency of self-reported sexual aggression perpetration and
victimization among individuals older than the age of 12 years
in 11 countries from Southeast Asia. Because of major meth-
odological heterogeneity among studies, direct comparisons
between and even within countries should be made with cau-
tion in order to avoid misleading conclusions. The fact that
most studies were conducted in Thailand and the Philippines
does not imply that sexual victimization is more prevalent in
these two countries. Similarly, the lack of indexed publications
in both Laos and Brunei does not suggest the absence of the
problem there. Laos has been called the “forgotten country” of
Southeast Asia. In the case of Brunei, despite its high Gross
National Income per capita, the level of sex work and human
trafficking (Dayley & Neher, 2013) suggests that sexual
aggression should be a concern in the country.
Conclusions About the Scale of Sexual Aggression in
Southeast Asia
The present review has provided a number of conclusions about
the problem of sexual aggression in Southeast Asia. First, the
number of published quantitative studies on sexual victimiza-
tion has more than doubled in the last decades: from 1 in the
1990s to 15 in the decade from 2000 to 33 studies since 2010.
Of the three recent studies on perpetration, two provided
insightful and detailed description on this issue in Cambodia
and Indonesia (Fulu et al., 2013; Jewkes et al., 2013) and may
serve as models to inspire and guide future research on self-
reported perpetration in the whole region.
Second, the findings illustrate how widespread sexual victi-
mization is, that it can happen already at a young age and to
both sexes, regardless of sexual orientation, and is perpetrated
by both nonpartners and partners. Most studies focused on
female victimization, but an increasing number of studies have
included both women and men in their analyses. Sexual orien-
tation was addressed mainly among male samples (except for
TRAUMA, VIOLENCE, & ABUSE XX(X)
van Griensven et al., 2004), despite evidence from the region
that lesbian women may suffer “corrective rape,” which is a
form of rape perpetrated by a man against a lesbian woman in
order to “correct” her lesbianism (Dalisay, Quizon, & Land-
icho, 2014).
Third, sexual victimization at sexual debut should also be a
concern, since a considerable number of young people reported
that their first sexual intercourse involved coercion. Forced
sexual debut was also reported by female sex workers (Decker
et al., 2011). Qualitative studies on human trafficking for sex-
ual purposes confirm that many girls have their virginity sold at
initiation to sex work (Darwin et al., 2003). According to these
studies, virginity is a valuable commodity in the sex industry of
Southeast Asia, not only because this is a way to make clients
feel that they are protected against contracting HIV, but also
because there is a widespread belief that having sex with a
virgin prolongs one’s life and brings prosperity to the business
and family. Studying victimization at first sexual intercourse
offers some advantages, because it focuses on one act and
facilitates comparisons among studies (Guest, 2005). One dis-
advantage is that aggression that happened in other contexts is
not considered, underestimating the real scope of the problem
in that population.
Fourth, a relevant attribute of studies conducted in Southeast
Asia is the inclusion of a heterogeneous range of participants.
This can be explained by the historical background in which
these studies were conducted. A turning point in research on
sexuality in Southeast Asia was the threat of AIDS in the late
1980s. Evidence from Thailand shows that before this period,
studies focused more on attitudes toward dating and marriage,
in particular among well-educated and middle-class groups
(Ojanen, 2014). With the arrival of the AIDS epidemic, it
became clear that prevention of HIV/AIDS would necessarily
involve direct assessment of sexual behavior, including history
of sexual victimization, especially in those groups described as
more vulnerable by the WHO (2012), such as homosexuals,
transgenders, sex workers, and young people. In addition, the
engagement of the UN, NGOs, the women’s movement, aca-
demia, civil society, and in some cases, governments, in pro-
moting gender equality has strongly influenced research in the
region (Kisekka, 2007; UNFPA, 2010). Many studies have
started to address sexual victimization in women of the general
population, revealing that sexual aggression commonly hap-
pens within intimate relationships and challenging the common
stereotype that “real rape” is only perpetrated by strangers.
Despite the inclusion of a wide variety of social groups, it is
not possible to determine whether any of them are at greater
risk of being victimized, since no study directly compared the
frequency of sexual victimization among specific groups with
those derived from representative samples of the general pop-
ulation. Many studies at least tried to include characteristics
assumed to be related to differences in victimization in their
samples. For example, young people who dropped out of
school (compared to students), trafficked sex workers (com-
pared to nontrafficked sex workers), male-to-female transgen-
ders (compared to male sex workers and men who have sex
Winzer et al.
with other men in the general population), homosexuals, and
bisexuals (compared to heterosexuals) were more likely to
report sexual victimization. Yet, because most studies included
convenience samples, the generalizability of their findings
is limited.
Fifth, victimization by intimate partners was common in the
database. Many instances of victimization occurred in the con-
text of marriage, which is socially supported by attitudes
toward aggression within marriage, such as “a good wife obeys
her husband” and “a man should show who the boss is” (Hayati
et al., 2011). Vung, Ostergren, and Krantz (2008) attributed the
relatively low rates of sexual aggression by an intimate partner
in Vietnam to the fact that many women perceive forced sexual
intercourse as normal in the context of marriage, not being able
to recognize the concept of marital rape. Sano and colleagues
(2016) also described that married women are less likely to
report coercion in the context of marriage because this might
imply marital dysfunction, which is considered highly deviant
according to the Catholic and collectivist values in the Philip-
pines. This again underlines the need to consider the specific
context of cultural norms and beliefs to interpret responses to
prevalence surveys. It also shows the need to use instruments
with behaviorally specific descriptions of unwanted sexual
acts, so that unacknowledged victims of sexual victimization
will be represented in the statistics.
Sixth, there is still very limited information available on
how human trafficking might be linked to an increased risk for
sexual victimization, since only four studies empirically
addressed the problem. Despite evidence that a considerable
number of victims of trafficking reported sexual victimization,
it is still not clear when and how the aggression took place.
From the four studies available, two did not specify the time
frame considered and one focused on any episode of victimiza-
tion in the lifetime (therefore not clearly identifying the asso-
ciation between the victimization and the experience of being
trafficked). Human trafficking is a very complex phenomenon,
is differently defined across studies, includes different degrees
of coercive strategies (from deception to physical force), and
aims at different economic sectors. This illustrates that the link
between human trafficking and sexual aggression is multifa-
ceted. Considering the high prevalence of human trafficking in
Southeast Asia, there is a need for more studies that explore
(qualitatively and quantitatively) how sexual victimization
might be linked to the context of trafficking.
Finally, the review has revealed that information available
on sexual aggression perpetration and victimization in conflict
settings is still limited. Our findings indicate that political con-
flicts exacerbated the levels of sexual aggression in Cambodia
and East Timor. From the recent conflict in Myanmar, evidence
is based only on people who managed to escape the country and
live in camps on the Thai-Myanmar border (Cardozo, Talley,
Burton, & Crawford, 2004; Falb et al., 2013; Petersen, Worm,
Olsen, Ussing, & Hartling, 2000), neglecting the most severely
injured victims or those who died. This might explain the low
rates found by Falb and colleagues (2013). Mass rape during
conflicts also seems to increase tolerance for sexual aggression
13
in the postconflict period. High rates of sexual aggression
found in Jayapura and Cambodia have been attributed to the
postconflict status of both places (Fulu et al., 2013; Jewkes
et al., 2013). The urgency of addressing sexual aggression in
conflict zones has to do with the crucial need to provide at least
a minimum level of medical and legal support for victims,
despite political instability. How to approach victims in con-
flict regions without neglecting the safety of researchers and
respondents represents a challenge that future studies need to
overcome in order to create reliable evidence on sexual aggres-
sion during political turmoil.
Methodological Limitations
A substantial methodological diversity was found across stud-
ies, hampering comparisons between studies and the emer-
gence of a coherent knowledge base. This problem is not
specific to the region considered here but is characteristic of
the field of sexual aggression research in general, as typically
described by literature reviews from both developed and devel-
oping countries (Dartnall & Jewkes, 2013; Jejeebhoy & Bott,
2005; Krahé, Bieneck, & Möller, 2005; Krahé, Tomaszewska,
Kuyper, & Vanwesenbeeck, 2014; Kruttschnitt, Kalsbeek, &
House, 2014; Schuster & Krahé, in press-a; Schuster & Krahé,
in press-b; Winzer, 2016). Diversity included (1) variability in
how sexual aggression and victimization were defined,
reflected also in the type and number of questions presented;
(2) variability in the sample composition in terms of sex, age,
sexual orientation, and occupation; (3) variability in the time
frame for which frequency reports of sexual aggression and
victimization were elicited; and (4) variability in terms of the
relationship between victims and perpetrator considered in the
survey.
Most studies conducted in Southeast Asia presented only a
few questions and used broad terms when operationalizing
sexual victimization, which may have led to inaccurate estima-
tions (Cook, Gidycz, Koss, & Murphy, 2011) and neglected
cultural aspects of the problem. Linked to that, around 17%
of all studies did not even provide a definition of sexual aggres-
sion, pointing to the need of greater attention to quality in the
process of reviewing such research reports for publication. Pre-
senting a clear definition to survey respondents is critical, given
that perceptions of what is considered sexual aggression may
vary greatly across countries, depending on religion, legal
rights of women, attitudes toward sex, and cultural factors
which could all influence final frequency rates. Comparisons
among countries should always be made with caution, because
absolute numbers, even when obtained from similar instru-
ments (e.g., WHO Women’s Health and Life Experiences
Questionnaire), do not always reflect what a culture perceives
as violent. Instruments based on detailed behaviorally specific
descriptions of sexual aggression (Koss et al., 2007) rather than
on broad terms, combined with a qualitative approach (Guest,
2005) might diminish cultural gaps in future research. In other
words, an etic approach, in which an instrument is carefully
translated and adapted to another language, should be ideally
14
combined with an emic approach, in which the concept of sex-
ual aggression is qualitatively investigated within a culture
(Berry, Poortinga, Segall, & Dasen, 2011). An equivalent
methodological approach and a common understanding of sex-
ual aggression would allow comparisons between countries in a
way that differences in the frequency rates could be attributed
neither to methodological nor to cultural differences, but to true
variations of the problem (Krahé et al., 2014).
Because only few studies addressed last-year incidence
rates, there is still little information on the recency of the prob-
lem and increases or decreases over time. This information is of
particular interest for policy makers, because it estimates the
number of new cases of sexual aggression in a year. In fact, a
great part of the evidence on sexual victimization in the region
is based on lifetime prevalence rates. These studies provide
valuable information because they include a large variety of
social groups. However, many studies do not draw a clear line
between sexual victimization before and after the age of con-
sent, thereby conflating childhood sexual abuse and noncon-
sensual sexual experiences. Some exceptions are studies that
address lifetime prevalence of sexual victimization perpetrated
by an intimate partner, for which it can be assumed that respon-
dents had already reached the age of consent. Future research
should address this limitation by clearly defining sexual victi-
mization in terms of nonconsensual sexual experiences accord-
ing to the age of consent in the respective country.
Conclusions and Recommendations for Future Research
Evidence on sexual aggression and victimization in Southeast
Asia, despite being fragmented, illustrates how widespread the
problem is, irrespective of sex and sexual orientation. Hetero-
geneity in the measures, lack of representativeness of samples,
imbalance of data available by country, missing information
(e.g., about the conceptual definition of sexual aggression), and
cultural differences make it difficult to compare data between
and within countries. There is a need for better operationaliza-
tions of sexual aggression and victimization based on detailed
descriptions of behaviors involved in the experience of coer-
cion. There is also a shortage of data that identify new cases in
a year or clearly distinguish incidents of childhood sexual
abuse from sexual coercion that happened after the age of
consent. Data on sexual aggression experienced in human traf-
ficking and conflict settings are also limited.
Future research should increase the quantity and quality of
data, in particular in those countries where little or no infor-
mation is available. In practical terms, studies should assess
the experience of sexual aggression and victimization in rep-
resentative samples of both females and males, taking into
account sexual orientation and combining quantitative and
qualitative approaches, following best practice recommenda-
tions (e.g., Krahé & Vanwesenbeeck, 2016). Studies should
apply instruments with multiple questions, clearly defining
the age of consent and the behaviors being assessed. Respon-
dents should also be given the chance to define sexual aggres-
sion in their own words. Moreover, it is important to
TRAUMA, VIOLENCE, & ABUSE XX(X)
investigate whether and why specific social groups are at
higher risk of being victimized compared to the general pop-
ulation. Ideally, studies should apply a longitudinal design, so
that both victimization and perpetration can be regarded from
a developmental perspective, identifying protective and risk
factors and short- and long-term consequences of the
experience.
As a limitation, manuscripts written in national languages
were not included in this review. Furthermore, the age of
12 years as a minimum age did not consider the variations
of the age of consent across the 11 countries. Despite these
limitations, the present review provides a relevant contribu-
tion to the international literature, which is largely based on
North American and European studies, by summarizing data-
based evidence on self-reported sexual aggression and victi-
mization in Southeast Asia. This is the first literature review
that has systematically searched for studies published in Eng-
lish on this issue. Despite the enormous burden sexual aggres-
sion represents in the region, medical and legal sectors in most
countries have not responded according to the size of the
problem. Having a good-quality database represents the first
step toward advocating for changes in both health and justice
systems to ensure that victims will not be left behind, perpe-
trators will not stay unpunished, and societies will eventually
acknowledge sexual aggression a serious human rights
violation.
Critical Findings
 Sexual aggression is widespread in the Southeast Asian
region, irrespective of sex, and sexual orientation.
 Most studies focus on female victimization, the few
studies on perpetration focus on male perpetrators.
 First episodes of sexual aggression and victimization
often occur at a young age, and sexual aggression often
occurs within an intimate relationship.
 Sexual orientation is addressed mainly by studies with
male samples.
 Sexual aggression is mostly operationalized by a small
number of broad questions.
 Findings are based mostly on lifetime prevalence rates
and seldom on last-year incidence rates.
 Data on sexual aggression perpetrated in human traffick-
ing and conflict settings are limited.
 Methodological heterogeneity, lack of representative-
ness of samples, imbalance of data available by country,
and cultural differences hamper the comparability
between and within countries.
Implication for Research
 Assess sexual aggression and victimization in represen-
tative samples of men and women using longitudinal
designs, so that both victimization and perpetration can
be examined from a developmental perspective.
Winzer et al.
 Combine quantitative and qualitative approaches with
cultural sensitivity.
Implications for Practice
 Investigate if and why specific social groups are at
higher risk of victimization compared to the general
population.
Implications for Policy
 Increase the quantity and quality of data available, in
particular in those countries where little information is
available, so that legal and medical responses can be
improved accordingly.
Acknowledgments
The authors gratefully acknowledge the support of Tanya Bovornvat-
tanangkul in the initial phase of this review.
Declaration of Conflicting Interests
The author(s) declared no potential conflict of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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Author Biographies
Lylla Winzer, PhD, holds a bachelor’s degree in psychology and a
master’s degree in medical sciences from the University of Sao Paulo,
Brazil. She obtained her PhD in psychology at the University of Pots-
dam, Germany, and she is currently working as a Foreign Expert in the
Institute of Population and Social Research at Mahidol University in
Thailand. Her research interests include sexual aggression, domestic
violence, and child abuse in low- and middle-income countries, with
focus on prevalence, health-care responses, protective and risk factors,
and mental health consequences.
Barbara Krahé, PhD, is a professor of social psychology at the Uni-
versity of Potsdam, Germany. Her research interests lie in the area of
applied social psychology, in particular aggression research (sexual
aggression, media violence, and aggression) and social cognition
research applied to legal decision making (rape myths and biases in
judgments about sexual assault).
Philip Guest, PhD, is a demographer who research interests include
fertility and migration. He has taught at the Institute for Population
and Social Research of Mahidol University in Bangkok where he
now is an adjunct professor. He previously was the Chief of the
Demographic Analysis Branch in the Population Division of the
United Nations. He also was a senior associate of the Population
Council and country representative of the Council’s Bangkok office
where he coordinated a range of program activities dealing with
reproductive health, intervention research, expansion of contracep-
tive choice, gender, sexuality, and development research. He holds a
PhD from Brown University.