Children Seeking Refuge: A Review of the Escalating Humanitarian Crisis of Child Sexual Abuse and HIV/AIDS in Latin America

Exploring the long-term sequelae of childhood sexual abuse on risky sexual behavior among Chinese transgender women

Introduction

Childhood sexual abuse (CSA) is a hidden but serious public health issue that can lead to a series of behavioral consequences and health problems in adulthood. It has been well documented that transgender women (TGW) have a high prevalence of CSA victimization. Moreover, risky sexual behaviors are also widespread among TGW; nevertheless, research investigating the associations between CSA victimization and risky sexual behaviors in TGW represents a gap in the literature.

Methods

Our research was carried out mainly in Shenyang of China from November 2018 to January 2019. Sociodemographic characteristics, as well as information on participants' HIV awareness and sexual behaviors, were collected through face-to-face interviews. The impact of CSA was examined through hierarchical logistic regression, adjusted for sociodemographic factors and HIV awareness.

Results

In the sample of 247 adult TGW, 14.2% of them had a CSA history. In the previous 6 months, 30.8% of the participants reported condomless anal intercourse (CAI) and 38.5% of them had multiple sexual partners (MSP). The findings demonstrated that TGW with CSA history were more likely to take part in CAI (p = 0.001, OR = 4.252) or have MSP (p = 0.004, OR = 3.260) in adulthood. Furthermore, HIV knowledge was not a predictor of CAI or MSP, but higher HIV risk perception was associated with a greater probability of CAI.

Conclusion

Transgender women with a history of CSA were more prone to engage in CAI and have MSP in China.

Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project

Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.

Exploring parental understanding of child sexual abuse and prevention as a measure for HIV prevention in Rwampara district

Background

Worldwide, more than 95 million children are sexually abused each year with children in sub-Saharan Africa experiencing sexual assault at higher rates than those in more developed areas. In Uganda, 20% of young people indicated that their sexual debut was non-consensual. The risk for transmission of HIV to children through Child Sexual Abuse is high because of greater mucosal tissue damage and the often repetitive nature of abuse. This contributes significantly to the burden of HIV in Uganda. Despite these risks, studies have shown gaps in active parental involvement in child sexual abuse prevention despite their being the primary protectors of children. Against this background we sought to explore parental understanding of childhood sexual abuse and prevention as a measure for HIV prevention in Rwampara District, South Western Uganda.

Methods

A phenomenological study was carried out in four health centers that serve the communities of Rwampara district. A total of 25 (n = 25) parents or guardians of children aged 9–14 years were purposively selected to participate in the study. The participants were subjected to in-depth semi-structured interviews which were recorded, transcribed, and translated for thematic analysis.

Results

Parents’ understanding of child sexual abuse was limited to penetrative sex between a man and a child. Three of the parents interviewed reported to have had children who had been sexually abused while one of the parents had been abused when she was young. The children reported to have been abused were female and were between 3-14years. We also identified gaps in the sensitization of parents regarding home-based prevention of child sexual abuse and psychological support for the victims of abuse.

Conclusion

Our study shows that child sexual abuse exists in rural western Uganda. There remains a significant gap in the awareness of parents regarding the extent of sexual abuse, signs of sexual abuse, case handling, and psychological support for victims of sexual abuse. This significantly affects the capacity of parents as the primary protectors of children to identify and protect the children against the multiple forms of child sexual abuse.

Sexual Abuse vs. Sexual Freedom? A Legal Approach to the Age of Sexual Consent in Adolescents in Spanish-Speaking Countries

Child and adolescent sexual abuse (CSA) is an international public health problem. Despite the importance of CSA, there is no consensus definition, and the lack of consensus is related to difficulties in conducting prevalence studies as well as research in other areas. To establish a consensual definition, legal aspects such as the age of sexual consent and the difference in age or power between victim and aggressor as well as aspects related to sexual freedom and sexual indemnity must be considered. Therefore, the main goal of this research was to analyze the age of sexual consent in the legal systems of Spanish-speaking countries and to examine whether the Romeo and Juliet clause is established. To achieve the proposed aims, we employed the legal interpretation method, and we analyzed the current Criminal Codes of the 21 Spanish-speaking countries. From the results, it is found that the age of sexual consent varies between countries, establishing valid sexual consent between 13 and 18 years. In addition, only six countries have the Romeo and Juliet clause that protects sexual freedom in adolescents. Finally, we discussed the lack of consensus on the age of sexual consent and the limitations presented by the Romeo and Juliet clause.

Childhood Sexual Trauma and Antiretroviral Therapy Adherence: A Mixed-Methods Systematic Review

Childhood sexual abuse (CSA) has been shown to be more prevalent among populations living with HIV. Antiretroviral therapy (ART) adherence is crucial for populations living with HIV as it significantly increases the likelihood of attaining and maintaining viral suppression. Previous findings on the association between CSA and ART adherence have been mixed. The current mixed-methods systematic review aimed to identify quantitative and qualitative studies from CINAHL, PsycInfo, PubMed, and Web of Science examining the relationship between CSA and ART adherence. Authors were also contacted if relevant data were unpublished. Studies had to be published from January 1, 2000 to April 1, 2019, written in English, and examined CSA as an exposure and ART adherence as an outcome. Four domains were combined: 1) childhood sexual abuse; 2) child; 3) antiretroviral; and 4) adherence. Eight quantitative and two qualitative studies were retained. The results showed that four quantitative studies found no association while the other four found factors such as timing of victimization, mental health and gender influenced the association between CSA and ART adherence. Themes emerging from the qualitative studies included use of ART evoking memories of CSA; CSA impacting mental health; and mental health treatment improving ART adherence. Mixed insights included the intricate links between CSA and ART adherence and the role of external factors on the relationship. ART adherence intervention programs may be needed for people who have experienced CSA. However, future studies are needed that will examine the association between CSA and ART adherence and include subgroup analyses.

Sexual and Reproductive Health Outcomes of Violence Against Women and Girls in Lower-Income Countries: A Review of Reviews

Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.

Male-On-Male Child and Adolescent Sexual Abuse in the Caribbean Region of Colombia: A Secondary Analysis of Medico-Legal Reports

Child and adolescent sexual abuse (CSA) is an important global health problem, especially in non-Western low- and middle-income countries. A number of studies have indicated that, in Latin American countries, male CSA is phenomenon of great concern. However, research on this topic is seriously lacking, and more specifically, on male-on-male CSA. We carried out a qualitative and quantitative secondary analysis of 680 cases of alleged male-on-male CSA that occurred between the years 2017 and 2018 in the Caribbean Region of Colombia. We analyzed the contents of forensic interviews with the alleged victims, conducted by professionals working at the Colombian Institute of Legal Medicine and Forensic Sciences. Our findings indicated a high prevalence of cases of alleged male-on-male CSA among young minors. Most of these cases were allegedly perpetrated by offenders known to the victim and involved high levels of violence. Evidence-based and culturally grounded preventative actions, such as training-based programs for teachers and parents among other public health initiatives are needed to address this type of CSA. Further research is also required to gain a more fine-grained understanding of the cultural and social context of CSA in the Caribbean Latin American countries.

Childhood Sexual Abuse, Sexual Behavior, and Revictimization in Adolescence and Youth: A Mini Review

Childhood sexual abuse (CSA) is considered as an activity aimed at providing sexual pleasure, stimulation, or sexual gratification to an adult who uses a minor for this purpose, taking advantage of the situation of superiority. CSA can have devastating consequences for the child. Previous studies have concluded that those who suffer an episode of CSA perform more risky sexual behaviors and are more likely to experience further episodes of sexual victimization during adolescence and early youth. There are two theoretical contributions that, although they offer partial views, can help to understand the association between CSA, sexual behavior, and revictimization in adulthood: the traumagenic dynamics model and the information-motivation-behavioral skills model. This short review provides an overview of the problems and theoretical explanations that have been presented up to the present, underlining the importance of prevention and sex education as of childhood, as well as the need to continue investigating in order to develop specific theoretical models that help to understand and prevent CSA and its consequences.

Child neglect and abuse: a global glimpse within the framework of evidence perspective

AIM

This systematic review was conducted in order to integrate evidence-based knowledge and experience related to child neglect and abuse into the nursing literature.

BACKGROUND

The negative and intense effects of neglect and abuse on an individual can last into adulthood. Nurses who are in close contact with such cases have an important role to play in detecting child neglect and abuse and supporting the families involved. When nurses fulfil this role, it is important that evidence-based information and interventions are known to ensure that the process is a healthy one.

DATA SOURCES

Medline/Pubmed and Cochrane Library databases, from 2012 to 2016.

REVIEW METHODS

The PRISMA guide, a basic search algorithm, was used as a basis for the review.

RESULTS

This systematic research involved 32 articles that met the criteria. When the characteristics of the studies were examined, it was found that one study dealt with physical abuse, seven studies dealt with sexual abuse, 21 studies with neglect and abuse and three studies with all abuse types. It was also found that 16% addressed intervention, 22% addressed the relationship between abuse and other factors, 31% addressed prevention and 31% addressed the defining dimension.

CONCLUSIONS

It has been found that, in general, all types of negligence and abuse are studied together and that nurses lack the knowledge and skills needed to assess childhood neglect and abuse.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Nurses have a critical role to play in identifying the dark spots and associated factors in the story of individuals because they are health professionals who are in close contact with patients. It is recommended that guidelines be developed and used in the diagnosis and treatment of abuse and neglect. Thus, in these cases, the standardization of care will be achieved.

School violence, perceptions of safety and school attendance: results from a cross-sectional study in Rwanda and Uganda

Background

Adolescents displaced by conflict face a number of risks, and access to education has potential to have multiple protective aspects in humanitarian settings. Yet, the impact of violence experienced at school by adolescents in humanitarian contexts is poorly understood, especially in terms of impacts on educational outcomes.

Methods

A household survey of adolescents in a refugee camp in Rwanda (n=274) and in two refugee settlements in Uganda (n=763) was conducted. Multiple logistic regression models were used to assess the influence of violence experienced at school on school attendance, feelings of fear and feelings of safety at school.

Results

In multiple logistic regression models, adjusting for socio-demographic variables, exposure to school violence was significantly associated with feelings of safety at school (adjusted odds ratio (AOR)=2.29, 95% confidence interval (CI)=1.20-4.38) and days of school missed (AOR=3.28, 95% CI=1.54-7.01) in Rwanda. In Uganda, exposure to violence was significantly associated with all outcomes: school fear (AOR=2.26, 95% CI=1.48-3.44), school safety (AOR=1.90, 95% CI=1.23-2.92) and school attendance (AOR=2.39, 95% CI=1.52-3.74). Gender-stratified analyses indicated that in both contexts exposure to school violence is significantly associated with school attendance, school fear, and school safety for girls, but the association is weaker amongst boys (with experience of violence significantly associated with school attendance for boys in Uganda, but not for other outcomes and not in Rwanda).

Conclusions

This study presents some initial and novel findings on the relationships between violence experienced at school and educational outcomes amongst adolescents displaced by conflict.