"They were the ones that saw me and listened." From child sexual abuse to disclosure: Adults' recalls of the process towards final disclosure

BACKGROUND

When child sexual abuse (CSA) is not disclosed, children run the risk of being subjected to longer or repeated abuse, not receiving necessary treatment, and being re-victimized.

OBJECTIVE

This study examines what adults exposed to child sexual abuse in hindsight evaluate as important for disclosure. The aim was to explore exposed own experiences of steps towards final disclosure.

PARTICIPANTS AND SETTING

Data were obtained from adult users of Norwegian Sexual Abuse Support Centers. Included were users exposed to CSA before the age of 18 (N=23).

METHODS

Data were collected through anonymous questionnaires at each support center. The material was transcribed and analyzed in the tradition of Interpretative Phenomenological Analysis.

RESULTS

The study illustrates a process towards disclosure as a dialogically anchored process evolving over time and along life-course inside encounters with important others towards whom the exposed pays attention, attunement, and adjustment whether to tell, delay, re-try, turn towards others, or actually disclose. Their experiences elucidate processes towards exploring and telling through direct and indirect hints and signs, decisions to tell, re-decisions and delaying, or withholding until adulthood, and the dependency on trusted confidants who ask and listen for final disclosure to occur.

CONCLUSION

Thus, the present study sends an important message to exposed, confidants, and professionals when questions of CSA appear. That is to know of, facilitate, trust, and tolerate the dialogical dependency on being asked and heard by trusted persons and the many steps a process towards disclosure of CSA may entail in order to succeed.

HIV serostatus disclosure: development and validation of indicators considering target and modality. Results from a community-based research in 5 countries

RATIONALE

HIV serostatus disclosure is a complex challenge for persons living with HIV (PLHIV). Despite its beneficial effects, it can also lead to stigmatization and rejection. The current lack of multi-dimensional measurement tools impede an in-depth understanding of the dynamic of disclosure.

OBJECTIVE

To develop and validate complex measures of serostatus disclosure.

METHODS

This international community based research study was performed by joint research teams (researchers/community based organizations (CBO)) in five countries (Democratic Republic of the Congo, Ecuador, Mali, Morocco and Romania). A convenience sample of 1500 people living with HIV (PLHIV) in contact with local CBO were recruited in 2011 (300 in each country). Face-to-face interviews were performed using a 125-item questionnaire covering HIV status disclosure to 23 potential disclosure targets and related issues (including personal history with HIV, people's reaction to disclosure, sexuality). A principal component analysis and a hierarchical cluster analysis were performed, in order to identify the main components of HIV disclosure, create measures and classify participants into profiles.

RESULTS

Patterns of disclosure were summarized using two main measures: direct and indirect disclosure. Disclosure to sexual partners, whether steady or not, was different from patterns of disclosure to other targets. Among the participants, three profiles emerged - labelled Restricted disclosure, Mainly indirect disclosure and Mainly direct disclosure, respectively representing 61%, 13% and 26% of the total sample. The profiles were associated with different aspects of PLHIV's lives, including self-efficacy, functional limitations and social exclusion. Patterns varied across the five studied countries.

CONCLUSION

Results suggest that multi-dimensional constructs should be used to measure disclosure in order to improve understanding of the disclosure process.