Post-traumatic Stress Disorder After Sexual Abuse in Adolescent Girls

Post-exposure prophylaxis for HIV infection in sexual assault victims

OBJECTIVES

Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this.

METHODS

We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion.

RESULTS

The median age of participants was 25 years [interquartile range (IQR) 21-33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6-24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120.

CONCLUSIONS

Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow-up testing and new better tolerated drug regimens must be investigated to address these issues.

Adolescent Girls' Experiences With Sexual Pressure, Coercion, and Victimization: #MeToo

BACKGROUND

The #MeToo social media campaign in the United States has highlighted what is a pervasive problem in many cultures-the sexual intimidation and victimization of women by men, especially those in roles of authority.

METHODS

In a study of 735 girls, ages 15-19 years, enrolled in a sexual risk reduction randomized controlled trial, we captured baseline data using audio-computer assisted self-interviews to increase validity and reliability of responses to questions regarding such behaviors.

RESULTS

Despite their age, one-half of these girls reported being coerced into sex acts (excluding intercourse) with 1 in 5 reporting such victimization by a man who used his position of authority. Alarmingly, 12-28% of girls reported being forced into penetrative sex acts against their will. Far too many girls reported they had had multiple episodes of such violence.

LINKING EVIDENCE TO ACTION

It is clear that this study captures a common, but minimally documented, threat faced by adolescent girls ranging from men pressuring them to engage in sex activities through the use of victimization, intimidation, or provision of substances to underage girls to gain compliance. Using such evidence to enhance and tailor sexual risk reduction, health, safety, and communication interventions for both males and females is essential. Identifying triggers to at-risk situations, providing skill building in communication, negotiation and refusal skills, as well as clearly discussing consent issues among both genders are important components in evidence-based interventions if we are to impact positively the next generation to curtail sexual pressure, coercion, and violence.