Background A 2009 survey of adult men in South Africa found that 27.6% reported ever having perpetrated rape. The majority reported first perpetrating rape before age 20. Intimate-partner violence and rape are associated with HIV. We assessed the prevalence and predictors of reported rape perpetration among in-school, adolescent males at baseline of a cluster-randomised trial.

Methods Grade-nine males at 46 secondary schools in Cape Town and Port Elizabeth townships completed a confidential, self-administered questionnaire on touchscreen mobile phones. The questionnaire assessed structural/demographic, psychosocial, lifestyle, and behavioural/relationship factors, and reported rape perpetration. Multiple logistic regression models were used to identify factors associated with reported rape perpetration, adjusting for school-level clustering and more distal variables in the conceptual framework.

Results A total of 1991 boys were enrolled (median age 16 years, 95.6% Xhosa-speaking). Of these, 342 (17.2%) reported ever having perpetrated rape. Factors associated with reported rape perpetration were older age (AOR = 1.14, 95% CI = 1.01–1.29), having a father with no secondary education (AOR = 1.42, 95% CI = 1.01–1.99), living with one’s father (AOR = 1.37, 95% CI = 1.01–1.86), having been traditionally circumcised (AOR = 2.22, 95% CI = 1.21–4.09), male-dominant gender norms (OR = 1.33, 95% CI = 1.05–1.68), harmful alcohol use (AOR = 2.02, 95% CI = 1.41–2.90), having had sex while drunk in the last year (OR = 1.86, 95% CI = 1.26–2.76), and having ever perpetrated physical violence against a partner (OR = 2.80, 95% CI = 1.93–4.07). Rape perpetration was also associated with low self-efficacy to prevent HIV (OR = 2.52, 95% CI = 1.77–3.57), more stigmatising attitudes towards people living with HIV (AOR = 1.44, 95% CI = 1.17–1.78), having had partner 5+ years younger in the last year (OR = 2.10, 95% CI = 1.24–3.55), self-reporting having been tricked or raped during one’s first sex (AOR = 1.91, 95% CI = 1.10–3.32), and depressive symptoms (OR = 2.91, 95% CI = 2.09–4.05),

Conclusion Rape perpetration is prevalent among school-going adolescent males. Development and evaluation of interventions addressing stereotypical/traditional masculine norms and behaviours and relevant structural/psychosocial factors is paramount in reducing rape perpetration. Further research should investigate the potential association between traditional Xhosa circumcision and rape perpetration.