Prevalence and patterns of child sexual abuse and victim-perpetrator relationship among secondary school students in the northern province (South Africa)

The lifetime prevalence of child sexual abuse assessed in young adults in Lithuania

OBJECTIVE

We examined the prevalence of different types of childhood sexual abuse (CSA) in Lithuania focusing on how these experiences were related to victim's age and relationship to the perpetrator.

METHODS

The participants came from a representative household survey of youth aged 18-29 and the sample consisted of 2000 participants (47.7 % women) with a mean age of 23.9 years (SD = 3.6). The ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R, Dunne et al., 2009) for young adults was used to investigate childhood exposure to CSA. Both current sociodemographic information and information on circumstances during childhood (e.g., number of siblings, family members with whom the participant lived between 7 and 12 year of age) were collected.

RESULTS

The prevalence of any CSA experience before the age of 18 was 15.9 %, with higher rates for women (13.5 % and 18.5 % for men and women, respectively). Being spoken to in a sexual way or sexual things being written about the person was the most prevalent form of CSA. In contrast, number of victims that reported sexual intercourse was much lower. The most common type of perpetrator was another young person. Intrafamilial CSA was rare with higher risk in step-relationships.

CONCLUSIONS

Our study provides representative prevalence estimates of the CSA in a region for which such estimates were not previously available. These Lithuanian estimates correspond well with previous literature. Importantly, the findings point to peers being an important perpetrator group in CSA cases. This and other findings can inform the planning of relevant policy measures and actions to both prevent CSA and investigate cases effectively.

Which groups are most affected by sexual violence? A disaggregated analysis by sex, age, and HIV-status of adolescents living in South Africa

BACKGROUND

Estimates on sexual violence (SV) among adolescents are rarely disaggregated by key indicators.

OBJECTIVE

We examine the independent effects of sex, age, HIV status and mode of HIV acquisition on the exposure to SV using generalised estimating equations models and proportional hazard model.

PARTICIPANT AND SETTING

Data from a 4-year prospective cohort study of 1447 adolescents (ages 10-19, 57% girls, 76% living with HIV) in South Africa.

METHODS

We describe the lifetime prevalence of three forms of SV: non-contact (unwanted showing of private parts), contact (coerced sexual debut, attempted and completed forced penetrative or oral sex,) and exploitative (sex in exchange for goods/money).

RESULTS

Overall, 23.9% (95%CI = 21.7%-26.1%) reported exposure to SV at some point in their lives: non-contact = 5.7%, contact = 9.0% and exploitative = 15.8%. While girls reported higher rates of exploitative (18.4% vs 12.3%; p < 0.001) and contact SV (12.3% vs 4.6%; p < 0.001), there were no differences in levels of non-contact SV by sex (6.5% vs 4.6%; p = 0.086). Exposure to any SV doubled in late adolescence (10-14 years = 7.0% vs ≥15 years = 31.7%; aIRR = 2.07; 95%CI = 1.82-2.37). Though level of SV were comparable between those living with HIV and those HIV-uninfected (22.9% vs 26.2%; p = 0.182), adolescents who recently acquired HIV were twice as likely to experience SV compared to adolescents who perinatally acquired HIV (42.3% vs 15.7%; aIRR = 2.03; 95%CI = 1.73-2.39). This association persisted when analysis was restricted to incidence SV during follow-up (aIRR = 1.53; 95%CI = 1.23-2.10).

CONCLUSION

Exposure to SV was high for both sexes, increased with age and more prevalent among adolescents who recently acquired HIV. SV prevention and response services must also be offered to boys and strengthened in HIV care services.

Child Sexual Abuse and Problems Reported by Survivors of CSA: A Meta-Review

A systematic meta-review of reviews and meta-analyses on problems reported by survivors of Child Sexual Abuse (CSA) was conducted. The aim was to comprise a comprehensive overview of 1) problems reported by survivors of CSA, and 2) variables moderating these relations. Two raters independently conducted a search through PubMed, PsychINFO, Campbell Library, Cochrane Library and Web of Science. Twenty-five reviews and meta-analyses reporting on 53 problems related to CSA were analyzed. All fell into five domains: medical, psychological, sexual, repeated (self-)harm, and a final category of other problems. Thirty-six of all problems (68%) were consistently and significantly more commonly reported by CSA survivors as compared to individuals without a history of CSA. Most moderator analyses did not significantly influence these relationships. In conclusion, CSA is associated with various problems across different domains and overall, these problems are prevalent independent of specific characteristics of and circumstances surrounding the abuse.

Experience-Based Perception of Vulnerability Factors to Child Sexual Abuse by Health Care Professionals in Nigeria: A Qualitative Approach

Child sexual abuse (CSA) remains a major public health concern worldwide. In Africa, particularly, Nigeria, CSA is a silent, but lethal public health menace with prevalence reaching as high as 56% for different child sexual violence. Understanding the vulnerability factors of CSA promotes the creation of strategies toward prevention of CSA. Due to social stigmatization of victims and their families in Nigeria, it is difficult for researchers and policymakers to have access to firsthand information about predisposing factors to CSA, which negatively impacts efforts toward prevention of CSA. Health care professionals are sources of experience-based, anonymous information about various public health issues. This study aims to understand qualitatively health care professionals' perception of vulnerability factors of CSA. The study presents a thematic content analysis of a semi-structured interview of 14 health care professionals working with sexually abused children in Nigeria, on their perception of vulnerability factors of CSA, while aligning the factors with known models of violence. Participants in the study reported several interrelated vulnerability factors involving the individual, sexual abuse perpetrator, family, environment, socioeconomic situations, and the lack or nonimplementation of policies against CSA. The study concludes that identifying these factors can assist health care professionals, parents, and family to better respond to child sexual violence cases and policymakers to create new strategies of preventing CSA, thereby improving the health and safety of children in Nigeria.

Descriptive Analysis of the Characteristics of Proven Cases of Sexual Abuse in Victims With Intellectual Disabilities and Children With Typical Development in Spain

Children and people with intellectual disability (ID) are considered to be highly vulnerable and in need of special protection against sexual abuse (SA). The objective of this work was to analyze the characteristics of cases of SA in children with typical development and in people with ID in Spain. To do so, 25 cases of each type that had been investigated by specialized groups of the Judicial Police of the Spanish Civil Guard and that had been classified as proven and confirmed by police and forensic-medical evidence were analyzed. The results allowed the establishment of the typical minor victim profile as Spanish female (76%), with an average age of 8.64 years. Typical victim with ID was characterized as being of Spanish, aged 20.28 years on average, without prior sexual experience, and similar percentages of males (40%) and females (60%). In both cases, the aggressor usually acted alone, was known to the victim, had an average age of 42 years, and without a history of sexual offenses. The most common child sexual crime was SA with penetration, practiced repeatedly, using strategies such as the use of force, authority, rewards, or secrecy. Victims with ID suffered sexual abuse with penetration, using force, authority, threats or blackmail. Finally, 36% of minors not disclose the events by only 8% of victims with ID. Spontaneity was found in the 40% first disclosure in both victims, with greater police evidence and greater recognition of guilt on behalf of the aggressors against victims without disabilities. Minors took an average of 26.26 days to report the facts, and victims with ID of 64.94. It is necessary to know more about these types of offenses to design appropriate prevention and detection programs.

Sexual and Physical Violence in Childhood Is Associated With Adult Intimate Partner Violence and Nonpartner Sexual Violence in a Representative Sample of Rural South African Men and Women

Intimate partner violence, nonpartner sexual violence, and physical and sexual violence against children are significant public health issues in South Africa. Theory suggests that experiencing violence in childhood plays a role in propensity to perpetrate violence or vulnerability to violence in adulthood. Most research to date on this topic has been conducted in high-resource countries or within urban or high-risk populations. We explore the relationship between violence in childhood and violence in adulthood in a community-based sample of 18- to 49-year-old adults in rural South Africa using data from a population-based survey (N = 1,044) in North West province in 2014. We measured childhood violence before age 15 years, experience of nonpartner sexual violence in adulthood, and IPV victimization and perpetration in the last 12 months. We conducted multivariate logistic regression; gender was tested as an effect modifier. All estimates are weighted to the subdistrict population. More women (2.7%) than men (0.8%) reported childhood forced sex, whereas fewer women (2.0%) than men (7.9%) reported childhood physical violence. Women and men reported similar rates of IPV victimization (6.8% vs. 5.4%), IPV perpetration (3.3% vs. 4.8%), and forced sex by a nonpartner (1.6% vs. 1.2%). We found that men and women who experienced childhood violence (combined physical and/or sexual) were significantly more likely to experience forced sex by a nonpartner (men: adjusted odds ratio [aOR] = 5.53, 95% confidence interval [CI] = [1.27, 24.0], p < .05; women: aOR = 51.1, 95% CI = [10.58, 246.3], p < .01) compared with those who did not experience childhood violence. They were also 2.5 times as likely to perpetrate recent IPV (aOR = 2.5, 95% CI = [0.97, 6.7], p = .06) or experience recent IPV (aOR = 2.5, 95% CI = [0.9, 6.9], p = .07), although this finding was marginally significant. These results align with the literature from other settings and population groups.

Boys Are Victims, Too: The Influence of Perpetrators' Age and Gender in Sexual Coercion Against Boys

Sexual coercion among adolescent boys in South Africa is an underresearched topic despite the frequency of such events. Although quantitative research has illuminated the prevalence of sexual coercion toward boys, it has provided little understanding of the context of sexual coercion for adolescent boys. Given the often severe consequences of sexual coercion, it is important to further understand these experiences to inform prevention efforts. The current study aims to provide a more nuanced understanding of the context of sexual coercion. Data come from the baseline assessment for a translational research evaluation of a school-based intervention. The current study focuses on a subset of early and middle adolescent boys who reported experiencing sexual coercion (n = 223). Analyses examine boys' reports of their perpetrators' characteristics and details about the sexual coercion encounter. Logistic regression is used to examine how coercion tactics used by the perpetrator differs depending on the perpetrator's age and gender. Eighth-grade boys were most likely to report that their perpetrator was a similar-aged female and that perpetrator's age played a particularly important role in what tactics were used. Adult perpetrators were more likely to use physical force, threaten them, harass them electronically, and drink or use drugs at the time. Results provide important insight into boys' experiences of sexual coercion that have implications for both future research and intervention efforts. Although much research is needed on the topic, intervention programs should recognize that both male and female adolescents can be victim and perpetrator.

Thirty years of the convention on the rights of the child: Developments in child sexual abuse and exploitation

Since its adoption by the United Nations in November 1989, the Convention on the Rights of the Child (CRC) has become the most universally ratified human rights treaty in history; presently only the United States has not ratified it. The CRC articulates children's human rights and notably includes freedom from sexual abuse and exploitation. Yet thirty years after the Convention was adopted, child sexual abuse and exploitation (CSA/E) remain serious, persistent, and evolving global issues. This overview both describes the current state of research on child sexual abuse and exploitation and evaluates the CRC's legacy in terms of State-level responses to CSA/E. Points of agreement and disagreement over what constitutes CSA/E and how widespread it is are explored. Also presented are the contexts in which CSA/E takes place, and factors associated with children's risk of being sexually abused or exploited. Emerging issues in these areas are the internet and children's use of it, as children may now become subject to abuse or exploitation even when physically alone. The second part of the paper addresses the CRC's influence on States' domestic legislation and States' responses to CSA/E more broadly. Gaps in efforts to monitor and report on the CRC's implementation with respect to its impact on CSA/E are described. The discussion offers guidance for future efforts to research and respond to child sexual abuse and exploitation, and in particular the ongoing need for support to survivors beyond the legal response paradigm.

Anal/anogenital lesion revealing child sexual abuse: A case series of an unusual situation in a black African setting

INTRODUCTION

Child sexual abuse (CSA) remains a big taboo in black Africa with an underestimated prevalence. In our context, the majority of cases are known by revelations of the child at least one year after the facts.

PRESENTATION OF CASES

We report three cases of CSA revealed by an anal/anogenital lesion requiring surgery. All of these patients were female with ages ranging from 20 months to 8 years. The lesions encountered were: an anal abscess, a fissure-in-ano with permanent anal mucosal eversion and a complex perineal tear including partial anal sphincter rupture with partial section of the rectovaginal septum. The outcome was favorable in all cases after surgery. The abuser was subsequently able to be identified after the statements of two of these three children.

DISCUSSION

Detection of anogenital lesions during a pediatric consultation should make practitioners aware of the possibility of sexual abuse. Surgical repair of these lesions can be simple or complex, requiring major reconstructions. In such cases, it's important to listening to the child's voice.

CONCLUSION

Anogenital lesions discovered during pediatric consultation must evoke sexual abuse. The silence and the taboo surrounding these abuses in Africa must be break down.

Differences in Abuse, Neglect, and Exposure to Community Violence in Adolescents With and Without PTSD and Depression

South African adolescents are exposed to high levels of violence and trauma, including community violence, abuse, and neglect. Violence and trauma are associated with negative mental health outcomes, including posttraumatic stress disorder (PTSD) and depression. Demographic characteristics, additional exposure to trauma, community violence, and types of childhood abuse and neglect may place adolescents at greater risk of developing PTSD. This study aimed to first assess the weighted contribution of demographic factors, trauma load, community violence, and types of abuse and neglect in predicting PTSD symptom severity. Second, we aimed to determine group differences in demographic factors, trauma load, community violence, and types of abuse and neglect among participants with no disorder, PTSD only, PTSD and depression, and depression only. Participants were 215 adolescents identified with emotional and/or behavioral problems and referred to an adolescent trauma clinic from schools in the Western Cape region of South Africa. Clinical assessments were undertaken to assess community violence exposure; physical, sexual, and emotional abuse; physical and emotional neglect; and a clinical diagnosis of PTSD and comorbidity. Trauma-exposed adolescents with PTSD and depression reported significantly higher levels of emotional abuse and community violence exposure in comparison with trauma-exposed adolescents without a disorder. Emotional abuse, community violence exposure, and female gender were significant predictors of PTSD in regression analysis. These findings underscore the contribution of different types of trauma in the development of PTSD. Interventions focused on preventing trauma, PTSD, and depression should be multifaceted and be targeted at various levels, for example, individual/interpersonal level (reduce abuse in the household and immediate environment) and community/societal level (reduce crime rates in communities and strengthen conviction policies). Traumatized youth should routinely be screened for a history of abuse and particularly exposure to community violence, given their strong association with PTSD.

The Prevalence of Sexual Abuse in Adolescence in Suriname

Studies conducted to ascertain the prevalence of child sexual abuse (CSA) in the Caribbean are poorly synthesized. Present study reports on the lifetime and year prevalence of unwanted sexual experiences, the risk of CSA at different ages within adolescence, and differences between the three largest ethnic groups in Suriname. One thousand one hundred and twenty (1,120) adolescents completed a questionnaire on child maltreatment, including CSA. The study's stratified sample consisted of students (ages 12 to 17) from five districts in Suriname. More than 16% of all boys and 15% of all girls indicated that they had been exposed to some form of CSA in the past 12 months. Girls reported significantly more intrafamilial CSA by a minor than boys. Boys reported significantly more experiences of being touched or forced by a minor outside the family to look at/touch the abuser's private parts than girls. Besides, 16 and 17-year olds were the most vulnerable. An increased risk of CSA (year prevalence) was found as adolescence progresses. A significant portion of CSA constituted peer-to-peer sexual victimization. Afro Surinamese adolescents were found to report the highest rates of CSA. Appropriate legislation, policies, and services for prevention and recovery are needed in Suriname.

Creative arts in psychotherapy for traumatized children in South Africa: An evaluation study

Aim

To evaluate the feasibility and effect of a 10-session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event.

Design

A multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites).

Methods

125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping.

Results

Results showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth.

Conclusion

In spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context.

Bullying victimization and child sexual abuse among left-behind and non-left-behind children in China

Background

Bullying is one of the most important factors associated with child abuse. However, robust tests supporting the assumption that being bullied can contribute to child sexual abuse (CSA) among left-behind children (LBC) remain sparse. This study aims to investigate the association of bullying victimization with CSA among LBC in China.

Methods

A cross-sectional study was conducted in six middle schools of Sichuan and Anhui province in 2015. The bullying victimization was assessed by seven items from the Revised Olweus Bully/Victim Questionnaire. The experience of CSA was measured by ten items CSA scale with good consistency.

Results

A total of 1,030 children met the sampling criteria, including 284 LBC and 746 non-LBC. The prevalence of CSA was 22.89% in LBC and 20.19% in non-LBC (p > 0.05). Bullying victimization was related to CSA among both LBC (adjusted Odds Ratio [aOR] = 2.52, 95% CI [1.34–4.73]) and non-LBC (aOR = 2.35, 95% CI [1.58–3.53]). The association between bullying victimization and CSA was much higher among left-behind girls (left-behind girls: aOR = 7.36, 95% CI [2.16–24.99]; non-left-behind girls: aOR = 2.38, 95% CI [1.08–5.27]). Also, LBC of a young age (11–15), children with siblings, living in rural areas and non-traditional family structure who were bullied were more likely to suffer CSA than their non-LBC peers.

Conclusions

Bullying victimization is associated with a significant increase in CSA among both LBC and non-LBC. Anti-bullying programs should target vulnerable populations including female LBC and LBC with siblings to reduce the risk of CSA.

Prevalence of child abuse in school environment in Kerala, India: An ICAST-CI based survey

Very few studies focus on childhood abuse in developing countries and only a small fraction of such studies explicitly deal with abuse in a school environment. The purpose of this study was to estimate the prevalence of sexual, physical, and emotional abuse in a school environment in a developing country. Abuse history was collected using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool - Children's Institutional Version (ICAST-CI). Demographic variables were also collected. Student supportive measures were provided both during and after the survey. 6682 school attending adolescents in Thrissur, Kerala participated in this cross sectional self report study. One year and lifetime prevalence of physical (75.5%, 78.5%), emotional (84.5%, 85.7%) and sexual (21.0%, 23.8%) abuse was high. Abuse was considered to be present even if an individual item from these three categories was reported. Most abuse was reported as occurring 'sometimes' rather than 'many times'. More males than females reported being victims of abuse; figures for one-year prevalence were: physical abuse (83.4% vs. 61.7%), emotional abuse (89.5% vs. 75.7%), and sexual abuse (29.5% vs. 6.2%). Various factors significantly increase the likelihood of abuse-male gender, low socioeconomic status, regular use of alcohol and drugs by family member at home, and having other difficulties at school. Children tended to report abuse less frequently if they liked attending school and if they always felt safe at school. The results highlight the urgent need to address the issue of abuse in the school environment and minimize its impact.

Childhood Maltreatment and Perception of Child Maltreatment among Respondents in Nigeria

This study examined childhood maltreatment and perception of maltreatment among respondents in Nigeria. A sample of 304 respondents completed online questionnaire on childhood experience and perception of abusive behaviours. Descriptive analysis was used to examine the responses. Of the 71 abusive behaviours examined, a high level of consensus (95–100 per cent agreement) was reached on five sexually abusive behaviours: having sexual intercourse with a child, asking a child to perform oral sex on adults, having sex in the presence of a child, fondling the breasts of a child for sexual pleasure and forcing a child to masturbate adults or other children. Abusive behaviour least perceived as abusive was experienced by most respondents during childhood: using corporal punishment as the only form of discipline. Finally, those who experienced the following abusive behaviours during childhood were significantly less likely to perceive of them as abusive: witnessing a parent/guardian being drunk all the time and forcing a child younger than 11 years old to take care of parents/guardians or siblings almost daily. Findings highlight the potential risks of childhood experience of abusive behaviours on perception of abusive behaviours and indicate the relevance of abusive behaviours to child protection policy and practice in the region.

The relationship between parental presence and child sexual violence: Evidence from thirteen countries in sub-Saharan Africa

There are compelling reasons to believe that orphans - many millions due to the AIDS epidemic - are more likely to be sexually victimized during childhood. Few studies have empirically investigated sexual violence disparities, and those that do suffer from methodological limitations and limited geographic scope. We used nationally representative data on female adolescents (15-17 years) from 13 countries in sub-Saharan Africa. We built multilevel logistic models to test for an association between the dependent variables (orphanhood and parental absence) and sexual violence, both within countries and pooled across all countries. Approximately 10% of adolescent girls reported past experiences of sexual violence; a third of those victimized were 14 years or younger at the time of their first forced encounter. Paternal orphaning (OR 1.36, p≤0.01), double orphaning (OR 1.47, p≤0.05), and paternal absence (OR 1.28; p≤0.05) were significantly associated with experiencing sexual violence in pooled analyses. Fewer findings reached significance within individual countries. Our findings suggest that the lack of a father in the home (due to death or absence) places girls at heightened risk for childhood sexual abuse; further research identifying pathways of vulnerability and resilience specific to this population is needed. Our findings also indicate that abuse often starts at an early age; thus promising programs should be adapted for younger age groups and rigorously tested.

Examining gender based violence and abuse among Liberian school students in four counties: An exploratory study

The purpose of this article is to uncover the extent of sexual gender based violence (GBV) experienced by a convenience sample of students from select counties in Liberia and to understand the disclosure experiences of those victims willing to come forward. Girls (n=758) and boys (n=1,100) were asked about their sexual GBV experiences including their disclosure experiences, if applicable. Results indicated that sexual violation (i.e., peeping or inappropriate touching) was found among both girls and boys. Sexual coercion (i.e., forced sex) was more prevalent than transactional sex (i.e., trading sex for grades or money). Both sexual coercion and transactional sex were reported by more girls than boys, yet the rates for the most severe form of sexual violence (i.e., sexual coercion) were high for both girls (30%) and boys (22%). When students were asked if they told anyone, 38% reported that they did disclose their experiences. This study contributes to a small but growing body of research to document the prevalence and types of sexual violence against children in Liberia. Consistent with other studies, the evidence shows that sexual violence against boys and girls is occurring at alarming rates.

Adolescent perspectives on social support received in the aftermath of sexual abuse: a qualitative study

The extent and quality of social support provided to young survivors of sexual abuse (SA) have only rarely been examined. This qualitative study aimed to investigate adolescent perspectives on social support received in the aftermath of SA. A total of 26 sexually victimized adolescents (15-18 years old) participated in a qualitative face-to-face, in-depth interview that focused on perceived social support. Qualitative content analysis was conducted as per Mayring (2008) using the qualitative data analysis program ATLAS.ti. In addition, quantitative correlational analyses were conducted to identify characteristics of SA and their associations with perceived social support. Although participants perceived parental support as the most necessary type of support, they were much more satisfied with support from peers. In particular, adolescents stated that they wished they had received more emotional support from their parents in order to better cope with the abuse. About half of participants reported having received counseling, and counseling was seen as very helpful in dealing with the consequences of SA. Only a few adolescents mentioned their school as a source of support. Intra-familial abuse, younger victim age at the time of abuse, an adult perpetrator, and severe abuse were all negatively associated with satisfaction with perceived support. Our results suggest that support for young survivors of SA needs to be improved. Prevention of SA needs particular focus on improving parental reactions to SA, facilitating access to professional support, and raising teacher awareness of the importance of their role in the provision of support for sexually victimized children.

Childhood sexual abuse and HIV sexual-risk behaviour among men who have sex with men in South Africa

Previous research has indicated an association between childhood sexual abuse and an increased risk of engaging in unsafe behaviours during adulthood, including risky sexual practices. This study examines the relationship between self-reported childhood sexual abuse and adult HIV sexual-risk behaviour in a sample of South African men who have sex with men. Potential long-term childhood sexual abuse–related outcomes, including dissociation, recreational and sex-related drug use, depression, impaired interpersonal communication, and adult re-victimisation were treated as variables mediating the relationship between childhood sexual abuse and sexual-risk behaviour. Men using a gay Internet dating site were randomly selected to complete the anonymous electronic survey. Results indicate that one-fourth of participants reported a history of childhood sexual abuse. Men with a history of unwanted sexual activity during childhood were more likely to report recreational and sex-related drug use, and adult re-victimisation experiences. Furthermore, mediation analyses revealed that men who have sex with men who are survivors of childhood sexual abuse are more likely to report drug use and sex-related drug use, and these outcomes in turn are associated with increased HIV risk as measured by number of male sexual partners. These results highlight the importance of mental health services and new approaches in HIV prevention for men who have sex with men who have been sexually abused as children.

Changes in the prevalence of child sexual abuse, its risk factors, and their associations as a function of age cohort in a Finnish population sample

OBJECTIVE

We examined (1) the prevalence of childhood sexual abuse (CSA) experiences as a function of cohort and gender, (2) the prevalence of factors associated with CSA as a function of cohort and whether the association of these factors with CSA remained the same irrespective of cohort, and (3) whether any cohort differences could be explainable by cohort differences in reporting bias.

METHOD

We used the responses of 4,561 men (M=29, SD=7 years) and 8,361 female (M=29, SD=7 years) Finnish participants who responded to the Childhood Trauma Questionnaire-Short Form as well as questions regarding family structure.

RESULTS

The prevalence of CSA experiences varied between 0.7-4.6% for men and 1.8-7.5% for women depending on the item. Younger cohorts reported less CSA as well as less of the risk factors (physical neglect and abuse, emotional neglect and abuse, parental substances abuse, not growing up with both biological parents) that were positively associated with the likelihood of CSA. The effects of these risk factors did not vary as a function of the cohort. Also, the declining trend was not explainable by social desirability being higher in the younger cohorts.

CONCLUSIONS

The results suggest that there is a real decline in the prevalence of CSA and it is associated with a simultaneous decline in factors associated with CSA.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Interpersonal violence: an important risk factor for disease and injury in South Africa

BACKGROUND

Burden of disease estimates for South Africa have highlighted the particularly high rates of injuries related to interpersonal violence compared with other regions of the world, but these figures tell only part of the story. In addition to direct physical injury, violence survivors are at an increased risk of a wide range of psychological and behavioral problems. This study aimed to comprehensively quantify the excess disease burden attributable to exposure to interpersonal violence as a risk factor for disease and injury in South Africa.

METHODS

The World Health Organization framework of interpersonal violence was adapted. Physical injury mortality and disability were categorically attributed to interpersonal violence. In addition, exposure to child sexual abuse and intimate partner violence, subcategories of interpersonal violence, were treated as risk factors for disease and injury using counterfactual estimation and comparative risk assessment methods. Adjustments were made to account for the combined exposure state of having experienced both child sexual abuse and intimate partner violence.

RESULTS

Of the 17 risk factors included in the South African Comparative Risk Assessment study, interpersonal violence was the second leading cause of healthy years of life lost, after unsafe sex, accounting for 1.7 million disability-adjusted life years (DALYs) or 10.5% of all DALYs (95% uncertainty interval: 8.5%-12.5%) in 2000. In women, intimate partner violence accounted for 50% and child sexual abuse for 32% of the total attributable DALYs.

CONCLUSIONS

The implications of our findings are that estimates that include only the direct injury burden seriously underrepresent the full health impact of interpersonal violence. Violence is an important direct and indirect cause of health loss and should be recognized as a priority health problem as well as a human rights and social issue. This study highlights the difficulties in measuring the disease burden from interpersonal violence as a risk factor and the need to improve the epidemiological data on the prevalence and risks for the different forms of interpersonal violence to complete the picture. Given the extent of the burden, it is essential that innovative research be supported to identify social policy and other interventions that address both the individual and societal aspects of violence.

Perceptions of child sexual abuse-a qualitative interview study with representatives of the socio-legal system in urban Tanzania

Through in-depth interviews, this study explored perceptions and experiences of key players handling child sexual offense cases in Dar es Salaam, Tanzania. The informants included public police investigators, magistrates, legal workers, and social workers working with nongovernmental organizations. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis. Five themes emerged summarizing factors associated with sexual offenses, including community passivity, legal system weaknesses, legal framework inadequacy, and key players' vulnerabilities. Addressing the identified weaknesses may promote justice, while changes in attitudes and norms are needed for the prevention of sexual offenses to children.

Group Art Therapy with Sexually Abused Girls

The psychological impact of child sexual abuse has been widely researched. The purpose of this study was to evaluate a group art therapy intervention designed by the authors aimed at reducing depression, anxiety, sexual trauma and low self-esteem among 25 sexually abused girls aged 8–11 years. The programme was based on existential-humanistic, Gestalt, client-centred and abuse-focused principles. The Solomon four-group design was used to investigate the efficacy of the intervention, and the Trauma Symptom Checklist for Children and Human Figure Drawing were used as measures for assessing symptom change. The results indicated that the experimental groups improved significantly compared to the control groups with regard to anxiety and depression. The study adds to the literature on therapeutic approaches that can be applied to sexually abused children and on the use of group art therapy as an intervention technique.

ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries

OBJECTIVES

To gain consensus among an ethnically and linguistically diverse group of international child protection experts on the structure and content of a new survey tool for retrospective measurement of child abuse, and to determine the performance of the instrument through an international field trial with young adults.

METHODS

The questionnaire was developed through focus group discussions with international experts, and then subjected to a Delphi study in two waves to determine the perceived importance and translatability of items. The resultant questionnaire was translated into six languages and field tested in seven countries with convenient samples of young adults aged 18-26 years (N=842).

RESULTS

Child maltreatment experts from 28 countries provided input to questionnaire development. Satisfactory agreement on draft item inclusion and exclusion and the translatability of items was gained. The tool includes 15 primary questions about potentially abusive physical, sexual and emotional events, with follow-up questions about perpetrator characteristics, frequency of acts and periods in childhood when the recalled abuse occurred. The field test revealed lifetime prevalence per item usually exceeded 10% (11/15 items; range 2.1-49.5%). Internal consistency (Cronbach's alpha) was moderate to high for each of three item sub-sets (between .61 and .82) and the rates of missing data were low (less than 1.5% for 14 of 15 items). The great majority of respondents nominated either peer and/or adult perpetrators (between 82.3% and 98.2% depending upon the item), and among these, child/adolescent peers and non-family adults (including teachers for emotional and physical acts) were nominated often.

CONCLUSIONS

The ICAST-R is based on consensus from international experts, translates clearly and has satisfactory properties for adoption as a survey tool to estimate prevalence and describe perpetrators and other contextual aspects of child abuse.

PRACTICE IMPLICATIONS

This tool can be utilized in a broad range of cultures and languages and may contribute to improved research practice. Although the core items are limited to just 15 acts of maltreatment, if these behaviorally specific questions are adopted as key indicators and incorporated into comprehensive local, national or regional surveys, eventually there should be greater comparability in survey estimates.

The international epidemiology of child sexual abuse: a continuation of Finkelhor (1994)

OBJECTIVE

The purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse.

METHODS

Relevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse.

RESULTS

Thirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men.

CONCLUSIONS

Comparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women.

PRACTICE IMPLICATIONS

Twelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining to North America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood.

The prevalence of child sexual abuse in community and student samples: a meta-analysis

BACKGROUND

Studies conducted internationally confirm that child sexual abuse is a much more widespread problem than previously thought, with even the lowest prevalence rates including a large number of victims that need to be taken into account.

OBJECTIVE

To carry out a meta-analysis of the prevalence of child sexual abuse in order to establish an overall international figure.

METHODS

Studies were retrieved from various electronic databases. The measure of interest was the prevalence of abuse reported in each article, these values being combined via a random effects model. A detailed analysis was conducted of the effects of various moderator variables.

RESULTS

Sixty-five articles covering 22 countries were included. The analysis showed that 7.9% of men (7.4% without outliers) and 19.7% of women (19.2% without outliers) had suffered some form of sexual abuse prior to the age of eighteen.

CONCLUSIONS

The results of the present meta-analysis indicate that child sexual abuse is a serious problem in the countries analysed.

Incidence of HIV infection at the time of incident reporting, in victims of sexual assault, between 2000 and 2004, in Transkei, Eastern Cape, South Africa

BACKGROUND

HIV/AIDS epidemic and sexual assault have emerged as the most serious public health problems in South Africa. The country has about 5-million HIV infected individuals. About a million women are raped every year.

OBJECTIVES

To study the incidence of HIV infection in victims of sexual assaults.

DESIGN

This is a retrospective descriptive study. There were 831 victims of sexual assault, who attended the Sinawe Centre during the 5-year (2000-2004) study period. Sinawe Centre is the only unit in this area which deals with cases of sexual assaults. Data were analyzed using PRISM R computer program.

METHODS

This is a retrospective descriptive study. There were 831 victims of sexual assault, who attended the Sinawe Centre during the 5-year (2000-2004) study period. Sinawe Centre is the only unit in this area which deals with cases of sexual assaults. Data were analyzed using PRISM R computer program.

RESULTS

Eight hundred and thirty one cases of sexual assaults (rape) were reported in last 5-years (2000-2004). Increase in sexual assaults by three-times, and one-and-half-fold increase in HIV seropositivity has recorded over the period of 5 years. In 2000, 76 (9.7%) sexual assault cases were registered, and in 2004, 237 (28.5%) cases. Of them, 443 (53.3%) were children under 15-years of age. A total of 114 (13.7%) tested positive for HIV, and 23 (2.7%) were children less than 15 years. In 2000, only 8 (10.5%) tested positive for HIV, and this had climbed to 39 (16.5%) in 2004. There is significant difference in HIV seropositivity among children compared to adults, p<0.05, and Paired t=3.45 with 3df.

CONCLUSION

There is an increasing incidence of HIV infection among victims of sexual assaults in this study.

Young males' gendered sexuality in the era of HIV and AIDS in Limpopo Province, South Africa

This article is focused on young males' sexual identity and behaviors in rural South Africa. The study comprised 19 focus group discussions with adolescents aged 12 to 14 years. The informants depict male sexuality as biologically predetermined, where physical needs and practices such as circumcision legitimize early sexual debut. Furthermore, the construction of male sexual identity and power imbalances in relationships are already evident at an early age, and age and economics are pertinent factors affecting social relations. Violent behavior and sexual abuse are supported by constructed gender inequalities forming an often negative and nonsupportive environment for young people. We stress the importance of planned HIV and sexuality education for young adolescents with support structures that can help endorse individual actions and informed choices. This is especially important in resource-poor settings where young people are likely to be less empowered than is the case in more affluent settings.

Assessing unwanted early sexual experiences in a South-African sample

This study assessed the prevalence of unwanted early sexual experiences of 1434 first-year university students, of whom 409 (28.5%) reported exposure to early unwanted sexual experiences. Most respondents reported knowing the perpetrator (80.2%) and being exposed to the unwanted behavior once (175; 45.7%). The most common coercive practice was "talk" (109; 38%) followed by being scared because they were bigger and stronger (61; 21.3%).

Prevention of child sexual abuse in China: knowledge, attitudes, and communication practices of parents of elementary school children

OBJECTIVE

Active involvement by parents may contribute substantially to the success of school-based programs to prevent child sexual abuse (CSA). In China, little is known about parental understanding of CSA. This study investigated Chinese parents' knowledge, attitudes, and communication practices with their children about CSA.

METHOD

Six hundred and fifty-two parents of Grade 3 pupils of seven elementary schools in Jingzhou city, Hubei province (central China), completed an anonymous questionnaire (response rate=81%).

RESULTS

More than 95% of respondents agreed that elementary schools should provide programs to prevent CSA and were willing to have their children participate in such programs. Although nearly all parents talked with their children about stranger danger, they were much less likely to talk specifically about sexual abuse. Many parents personally lacked basic knowledge about characteristics of perpetrators, the sexual abuse of boys, and nonphysical consequences of CSA. About half (46.8%) expressed some concern that CSA preventive education could cause their children to know "too much about sex." Contrary to expectations from research in western nations, parents who talked with their children about CSA did not have better knowledge or more supportive attitudes to CSA prevention than did parents who said they never discussed CSA with their children.

CONCLUSION

This study confirms and extends two recent surveys indicating strong support for the concept of school-based CSA prevention in China. However, given the apparently low levels of knowledge about CSA, even among those who talk about this problem with their children, future prevention programs should include community-wide efforts to educate adults to ensure that parental advice is accurate and hopefully, effective.

Child abuse and AIDS-related knowledge, attitudes and behavior among adolescents in Zambia

OBJECTIVE

To research the correlation between physical and sexual abuse by family members and AIDS-related knowledge, attitudes, self-efficacy and behavior among urban and rural adolescents in Zambia.

SAMPLE

The sample comprises 3,360 adolescents, aged 10-19, from urban and rural Zambia; 2,160 of them attended school, while 1,200 of them did not.

MEASURES

Standardized scales were utilized to assess AIDS-related knowledge, attitudes, and self-efficacy. In addition, the adolescents reported the extent of their engagement in various high-risk behaviors and their lifetime experience of being sexually or physically abused.

RESULTS

As the level of abuse experienced by the adolescents increased, their level of knowledge about HIV/AIDS, tendency to hold positive attitudes toward prevention, and level of self-efficacy regarding HIV/AIDS prevention decreased. Most importantly, when controlling for socio-demographic variables, findings indicate that past abuse was a key factor predicting participation in high-risk behaviors associated with HIV infection.

CONCLUSION

Physical and sexual abuse of adolescents in Zambia is significantly related to HIV risk behaviors. Future studies should investigate which factors mediate between the experience of abuse and the tendency to engage in risky behaviors.

THE NEWS ABOUT CHILD SEXUAL ABUSE: A SYSTEMATIC ANALYSIS OF REPORTS IN THE SOUTH AFRICAN ENGLISH-LANGUAGE PRESS

The extent and representativeness of child sexual abuse reporting in the South African English-language press were examined. Baseline data for the study comprised a complete record of all cases of child sexual abuse reported to the police in the North Durban Policing area (KwaZulu-Natal, South Africa) from January 2001 to December 2004, with newspaper reports of child sexual abuse being obtained from the 2004 online archives of a South African English-language newspaper. Study findings indicate that press coverage of child sexual abuse is negligible (i.e., an index of crime-news coverage of less than 1%), with the nature of cases covered by the press being largely representative of the types of cases reported to the police.

Childhood sexual abuse among university students in Tanzania

OBJECTIVES

There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated.

METHOD

Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences.

RESULTS

The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. There was a considerable amount of force or persuasion involved in the abusive behavior: betrayal of trust, bribes and physical force were cited frequently. Poverty and superstition were the primary explanations given for child sexual abuse.

CONCLUSION

The study provides evidence for the existence of child sexual abuse in Tanzania. Poverty feeds the "sugar daddy/mammy" phenomenon and combined with various forms of superstition is an important factor in child sexual abuse in Tanzania.

HIV-seroconversion following sexual abuse

Transkei is a poverty stricken former black homeland, now a part of the Eastern Cape Province. Unemployment and the incidental violence are very high. Women are mainly responsible for bringing up their children. Single parenting is also common in this community. Sexual abuse of children is selected to be under-reported. This reports the case of a 13-year-old girl who was raped twice within three months and brought to the Sinawe Centre of the Nelson Mandela Academic Hospital. Failure to adhere to post exposure prophylaxis (PEP) has undermined the implementation of antiretroviral roll out programme by the government. The history, physical examination and laboratory investigations of this case are given. Preventive steps are suggested.

Differences in childhood sexual abuse experience between adult Hispanic and Anglo women in a primary care setting

The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.

Substance abuse and behavioral correlates of sexual assault among South African adolescents

OBJECTIVE

The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality.

METHOD

Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence.

RESULTS

The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00-3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34-5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10-3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12-1.86), suicidal dialogue (OR = 2.48, CI = 1.19-5.19), and suicidal attempts (OR = 3.2, CI = 1.65-6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant.

CONCLUSION

This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem.

Child sexual abuse in sub-Saharan Africa: a literature review

OBJECTIVE

This article reviews the English-language literature on child sexual abuse in sub-Saharan Africa (SSA). The focus is on the sexual abuse of children in the home/community, as opposed to the commercial sexual exploitation of children.

METHODS

English language, peer-reviewed papers cited in the Social Sciences Citation Index (SSCI) are examined. Reports from international and local NGOs and UN agencies are also examined.

RESULTS

Few published studies on the sexual abuse of children have been conducted in the region, with the exception of South Africa. Samples are predominantly clinical or University based. A number of studies report that approximately 5% of the sample reported penetrative sexual abuse during their childhood. No national survey of the general population has been conducted. The most frequent explanations for the sexual abuse of children in SSA include rapid social change, AIDS/HIV avoidance strategies and the patriarchal nature of society. Child sexual abuse is most frequently perpetrated by family members, relatives, neighbors or others known to the child.

CONCLUSIONS

There is nothing to support the widely held view that child sexual abuse is very rare in SSA-prevalence levels are comparable with studies reported from other regions. The high prevalence levels of AIDS/HIV in the region expose sexually abused children to high risks of infection. It is estimated that, approximately.6-1.8% of all children in high HIV-incidence countries in Southern Africa will experience penetrative sexual abuse by an AIDS/HIV infected perpetrator before 18 years of age.

Measuring child sexual abuse in children and youth

Asking children and adolescents directly about their experience of sexual victimization overcomes some of the methodological weaknesses inherent in other approaches. Yet complex legal, ethical, and methodological issues remain. This paper reviews the psychometric properties of those questions or instruments that have measured exposure to child sexual abuse directly. A search of four electronic databases using descriptors "child sexual abuse" and "measurement" or "instrumentation" yielded four telephone administered tools, 13 face-to-face interviews, and 32 self-administered questionnaires. Few instruments had been subjected to rigorous evaluation. Establishing the validity and reliability of instruments measuring child sexual abuse and other forms of victimization are critical for the growth and expansion of the field.