"On the website for No Means No Worldwide, a rape-prevention nonprofit agency started by a San Francisco couple in Kenya, is a page of testimonial videos from girls who have experienced a verbal or physical attack. Rachael - like all of the others, a teenage girl who lives near Nairobi - described the time a man tried to lure her into his home. She yelled "No!" in front of a crowd of people, and he left her alone. Caroline used a self-defense skill called the "groin grab" to fend off a boy from her school who assaulted her. "I grabbed his groins and yelled, 'No!' " Caroline said. "I took my sweater, opened the door and ran out of the house, leaving him in pain." And there's Valentine, who recalled a time when she was 12 or 13 and a neighbor asked if she'd ever been told she was beautiful, then grabbed her breasts. She yelled at him too, told him to leave her alone, and the man walked away. Now, Valentine said into the camera, chin up and a small smile on her face, "he sees me on one side of the street, he crosses to the other side." The girls and hundreds of others like them have participated in a rape-prevention workshop created by Jake Sinclair and Lee Paiva, a San Francisco doctor and his artist wife who have been working in Kenya for 14 years. Their program is working, and that's not just according to the dozen or so testimonials online, the couple said. Two studies out of Stanford - one published in April this year, one the year before - have found that girls who have gone through the couples' classes experience fewer sexual assaults after the workshops. More telling, perhaps: More than half of the girls report using some tool they learned from the classes to protect themselves, from kicking a man in the groin to yelling at someone to stop. "It's great to see the girls just find their voice, to find the power to say 'no,' " Sinclair said. "It's so enlightening. You can see it in their eyes, that something's changed."" - Anne Bouey

"Rape is an international epidemic, with global rates ranging widely, depending on the source, from 10 to 50 percent of women who are victims. In recent years, the problem has attracted extensive attention - from international outcry against high-profile rapes in India to increasing criticism of how college campus sexual assaults are handled in the United States. Rape puts women, and men, at risk of contracting sexually transmitted diseases, including HIV, plus developing mental health problems like depression and anxiety. Sexual assault can isolate victims from their families and friends and have lasting effects that prevent them from going to school or getting jobs. As such, rape is a global public health concern, but discussions about how to stop it are muddled at best, and no one approach is universally embraced. Sinclair and Paiva don't expect their workshops to be the one answer. But at a time when there seems to be a lot of outrage about rape but little on-the-ground action to stop it, they hope their small efforts will find a wider audience - throughout Africa and other parts of the developing world, and even in the United States, Paiva said. The couple first went to Africa in 2000 to help children who had been orphaned and left homeless due to the AIDS epidemic. Sinclair, a pediatrician with clinics around the Bay Area, had started a program to help homeless kids in the United States and wanted to do the same in Africa. But he and his wife quickly realized that their U.S.-based tactics wouldn't work overseas, beginning a long lesson in working within local frameworks. Eventually, instead of providing aid directly to the orphans, they created a microloan program to help grandparents and other extended relatives who were taking them in." - Anne Bouey

"As they built their loan program they developed relationships with families and aid workers in Nairobi, where they were basing their work. One day in 2006, Paiva was walking through a slum neighborhood with a grandmother when the conversation became alarming. "She just kept pointing out places or people who had been sexually assaulted," Paiva said. "She was telling me, 'That's a rape baby, that girl was raped by so and so, this was the place where a grandmother's body was found murdered and raped.' It was just unbelievable." Paiva, who had experienced sexual violence herself, resolved to get involved. She'd taken a women's self-defense and empowerment class in the Bay Area in the 1990s, and decided to use that as her foundation. Over the next few years, and using their own money, she and her husband designed a program to teach girls verbal and physical self-defense techniques along with lessons in topics like consent and body autonomy. The program is now part of No Means No Worldwide. The workshops are now in dozens of schools and Sinclair and Paiva have developed classes for both genders, ages 12 to 20. Classes are taught entirely by local instructors who have undergone extensive training. The program costs about $450,000 a year, and is still covered by Sinclair and Paiva, although they're seeking outside funding. The couple spends several months at a time in Kenya overseeing the work there, returning to San Francisco to make money and develop strategies for expanding their nonprofit. The classes are held over six weeks, in two-hour sessions once a week. The girls and young women begin with lessons that define sexual assault and self-defense, then they learn techniques for using verbal and physical defenses to fend off an attack. The boys and young men learn to recognize an assault and how they can intervene to help. "For the girls, we teach assertiveness, setting up boundaries, awareness and intuition," Paiva said. "There's a lot of feminism in there. It's almost like we are countering the intense socialization of girls. And we are doing the same things now with young men." - Anne Bouey

"The Stanford study that was published this year looked at the program in four Nairobi slum neighborhoods. It compared 1,978 girls in 31 schools who participated in the workshop to 428 girls in a control group who did not take the classes. Before the classes began, about 18 percent of girls in both groups said they had been sexually assaulted in the previous year. For the study, sexual assault was defined as penetration of the vagina, mouth or anus with a penis or other object. The study found that in the 10 months after the workshops ended, girls in the control group reported the same number of sexual assaults as in the previous 10 months. But among the girls who had taken the classes, the rate of sexual assaults fell by about a third. The study also found that 52 percent of girls who took the workshops used something they'd learned in the class to protect themselves from an assault. And 65 percent said they'd used those skills to stop someone harassing them. "At this point, we've collected some good data that show this intervention is working," said Clea Sarnquist, lead author of the study and a senior research scholar in pediatrics at Stanford. "A lot of these girls are using voice and verbal skills first," Sarnquist said. "That's one of the key things, is teaching the girls that they have the right to protect themselves - that they have domain over their own bodies, and they have the right to speak up for their own self interest." The program isn't without some potential for controversy. One concern is that it may put too much emphasis on the girls to stop rape, instead of tackling the source of the problem - the boys and men who are responsible for sexual assaults. There is also the issue of victim-blaming - that by instructing girls to defend themselves, the trainers are implying that those who don't fight, physically or verbally, have done something wrong. Paiva said that's not the message they're giving their students. And, she said, sexual assault is so endemic, so deeply embedded in so many cultures worldwide, that it's going to take efforts by both men and women - boys and girls - to stop it. "I'm not holding my breath for a men's-led movement to even begin to make a dent in the global rape epidemic," Paiva said. "It needs to be a men's issue, it really does. But I'm really adamant, don't leave girls and women out." - Anne Bouey