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1.
The challenges facing children in the 21st century are immense and will need to be faced if we are to achieve the goal of child protection for all. Three specific constraints on child protection are examined in this article, namely poverty, HIV/AIDS infection, and war. The authors use their experience in Africa to raise issues of resilience and adaptation, dangers to child protection programs, and possible solutions. Poverty can be both financial and psychological, and this affects the effect of prevention programs. In many African and Asian countries, the AIDS pandemic has changed the social structure of society with AIDS orphans and children infected and affected by HIV/AIDS becoming more common. The impact has devastating effects on the way we view child protection and in particular child sexual abuse. The consequences of post-traumatic stress resulting from war needs to be addressed, and the development of programs that place children in the center of relief programs to foster a culture of child protection is essential. Finally, the article notes that the picture is not overly pessimistic and the examines the achievements in the field of children's rights which underpin all programs aimed at protecting children and the future need to consolidate successes achieved.  相似文献   

2.
OBJECTIVE: Most research on child abuse in Tanzania and Kenya is unpublished in the international literature. The purpose of this paper is to examine the various commentaries and reports extant, toward an overview of the nature and frequency of child sexual abuse in Tanzania and Kenya. METHODS: Contacts were made with academics, government departments, NGOs, and UN agencies. This was followed by a field trip in the summer of 2001 where all available reports were examined and a wide range of interviews conducted. RESULTS: Little empirical data exist on child sexual abuse in Tanzania. It is widely perceived that it may be increasing as a result of AIDS sufferers' attempts to "cleanse" themselves. The breakdown of traditional childcare systems, foreign influences, poverty, and the lowly position of girls in society are also implicated. More research has been conducted in Kenya. It is clear that first coitus occurs at a young age for many Kenyan children and adolescents. Also, a degree of force, trickery, or material exchange is not uncommon in adolescent sexual relations. CONCLUSIONS: Child sexual abuse is under-researched in Tanzania and Kenya. Studies by UN agencies such as United Nations Children's Fund (UNICEF) and the International Labour Organisation (ILO) have focused on the commercial sexual exploitation of children, to the neglect of more pervasive abuse in children's own communities by family, relatives, and neighbors. Nationwide surveys of the general population are required for an empirical understanding of this topic. Given the high incidence of AIDS/HIV in both countries, it is important to know if the epidemic is increasing the risk of rape or incest for children.  相似文献   

3.
OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS: One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.  相似文献   

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5.
Childhood sexual abuse of boys was examined in a longitudinal cohort in South Africa, with data on abuse collected at six age points between 11 and 18 years. Potential personal and social vulnerability of male sexual abuse victims was explored and mental health outcomes of sexually abused boys were examined at age 22–23 years. Reports of all sexual activity – touching, oral and penetrative sex – increased with age and sexual coercion decreased with age. Almost all sexual activity at 11 years of age was coerced, with the highest rates of coercion occurring between 13 and14 years of age; 45% of reports of coerced touching were reported at age 14, 41 percent of coerced oral sex at age 13, and 31% of coerced penetrative sex at age 14. Sexual coercion was perpetrated most frequently by similar aged peers, and although gender of the assailant was less often reported, it can be presumed that perpetration is by males. Boys who experienced childhood sexual abuse tended to be smaller (shorter) and from poorer families. No relationships to measured childhood intelligence, pubertal stage, marital status of mother or presence of the father were found. There was no significant association between reports of childhood sexual abuse and mental health in adulthood and when personal and social vulnerabilities were taken into account.  相似文献   

6.
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.  相似文献   

7.
A retrospective overview of 28 sexually-abused children evaluated at a university-based child guidance clinic is reported. These 28 cases are scrutinized and empirical data are culled on the following sociodemographic and clinical variables: age, gender, race, family composition, referral source, presenting complaints, type of referral, psychiatric history of the child and family, diagnosis, disposition, type and duration of treatment, and a severity rating (done by parents) of the child's behavioral maladjustment. Historical information about the sexual abuse is presented: molester, type of abuse, duration of abuse and recency of sex abuse. The sociodemographic findings reveal the sex-abused child prototype to be a white girl, 9 years old, from a working class family headed by both parents or by mother alone. She was abused by an adult male relative. If a boy, abuse was by a male age-mate. Genital abuse was the most frequent type with sexual intercourse of very high frequency for children of all ages. Many psychiatric difficulties were reported in the families of these children. Some children had more than one molester. The clinical findings show psychic suffering among all studied children—most of moderate levels, behavior reactions. All but 3 children had therapy recommended to them. Presenting difficulties were for sexual abuse per se and/or for a wide-ranging variety of symptom complaints. The socioclinical overview of sexually molested children compells researchers to look closer at broader, extra-familial, cultural and socio-economic issues in the lives of these children and not just at psychopathologies of individual molesters and family units.  相似文献   

8.
BackgroundSibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit age-appropriate curiosity. SSA may be the most prevalent, longest lasting form of intrafamilial sexual abuse – and the least reported, studied and treated.ObjectiveThis exploratory qualitative study examined the experience of intervention with SSA survivors from the perspective of mental health professionals, and explored their major therapeutic challenges.Participants and settingThe sample consisted of 20 Jewish Israeli mental health professionals working in private clinics or public social welfare services who had experience with SSA.MethodsSemi-structured interviews focusing on the characteristics of SSA events, perceptions about the effects of abuse, intervention priorities and therapeutic challenges compared to other types of child abuse.ResultsProfessionals working with SSA survivors are preoccupied with the need to provide them with physical and emotional protection, as well as to help them process the abuse narrative. They also find themselves dealing with survivors who do not experience themselves as victims despite external evidence of abuse, or with the need to reconcile their perception of the sexual relationship as mutual, as opposed to the formal requirement to differentiate between “offender” and “victim”. In either case, the reality of these survivors can be just as painful as in other SSA cases.ConclusionsThe complexity of SSA calls for unique intervention skills, including working with survivor narratives that do not fit the victim/offender dichotomy on one hand and that do not minimize the potentially harsh consequences of SSA on the other.  相似文献   

9.
HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18–45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.  相似文献   

10.
OBJECTIVE: This study compared experiences of children sexually abused by peers to those of children abused by adolescents/adults. Variables examined included perceived negativity of the abuse, self-reported outcomes, overall psychological functioning, and disclosure. METHOD: An archival data set containing retrospective reports of childhood sexual experiences was culled for instances of sexual abuse by child peers and adolescents/adults. An equivalent nonabused comparison group was identified. The Self-Report Outcome Checklist (SROC; Gilbert, 1994b), the MMPI-Hugo Short Form (Hugo, 1971) and a disclosure survey were also retrieved from these data. RESULTS: Compared to abuse by peers, abuse perpetrated by adolescents/adults was more intrusive and intrafamilial. Both groups rated their experiences as equally negative, and reported equally pervasive outcomes. Those abused by adolescents/adults reported significantly higher scores on the Psychopathic Deviate, Psychasthenia, and Schizophrenia scales compared to nonabused controls; similar findings did not emerge for those abused by child peers. Less than a fourth in either abuse group reported disclosing their experience to a parent. Among those who did not disclose, participants abused by child peers anticipated less support from both parents and more anger from their mothers. CONCLUSIONS: The findings suggest that child peer sexual abuse may be associated with adverse outcomes.  相似文献   

11.
OBJECTIVE: The current study examines multiple empirically based perspectives (i.e., child, caregiver, and clinician) of behavior and functioning as they contribute to the clinical and psychosocial profile of children (aged 5 to 17.5 years) with reported histories of sexual abuse.METHOD: A large, multi-site data set of children referred into Comprehensive Community Mental Health Services both with and without reported histories of sexual abuse, was examined. Seven hundred and fifty-nine children with a reported history of sexual abuse were compared to 2722 without such a history on caregiver and child reported behavior, clinician rated functioning, diagnosis, demographic variables, and life challenges.RESULTS: The multiple perspectives contributed unique and specific information to regression models: caregiver-reported behavior contributed information about externalizing behavior while child-reported behavior added information about internalizing behavior and clinician ratings about self-harmful behavior. Children with reported histories of sexual abuse were also more likely to be female, Caucasian, and have reported histories of life challenges (e.g., physical abuse, substance use, running away). Child sexual abuse was associated with higher rates of depression and anxiety diagnoses, and lower rates of substance abuse, conduct, and attention deficit disorder diagnoses.CONCLUSIONS: The findings indicate that the profile of children entering into Comprehensive Community Mental Health Services with reported histories of sexual abuse, as compared to those without such histories, is complex and best understood via multiple perspectives. Caregiver, child and clinician rated information, when taken together, provide a comprehensive clinical and psychosocial profile around which to plan and implement individualized service plans.  相似文献   

12.
BACKGROUND: In 2002, Georgia had the United States' eighth highest number of persons living with AIDS. Human immunodeficiency virus (HIV) transmission as a result of sexual abuse is uncommon but definitely occurs. In certain circumstances of sexual abuse, antiretroviral post-exposure prophylaxis (ARV-PEP) has been suggested as a means to decrease the risk of HIV infection. Our objective was to assess the utilization of ARV-PEP in patients being evaluated for sexual abuse at a pediatric emergency department in a city with high HIV prevalence. METHODS: A retrospective survey of the characteristics of sexual abuse victims was conducted using information abstracted from sexual abuse report forms of minors examined in 2002 at an inner-city Atlanta children's hospital. RESULTS: Of 227 victims, aged 9 months to 18 years, most were Black, inner-city residents; 190 (84%) patients were female. Only 87 of 227 (38.3%) were seen within 72 h of the abuse, the time frame for offering ARV-PEP. Twenty-three of the 87 had anogenital trauma or bleeding. Five (5.7%), were provided ARV-PEP, whereas 60 (69%) received antibiotic prophylaxis for non-HIV diseases. Those assaulted by strangers were greater than 10 times more likely to be provided ARV-PEP than others (p=.02). Assailants of the 82 victims who did not receive ARV-PEP included 22 strangers and 60 "acquaintances" of unknown serostatus. CONCLUSIONS: For a high HIV prevalence area, the proportion of sexual abuse victims prescribed ARV-PEP was small in relation to those at risk of HIV sexual exposure. Clinicians should be provided guidance on interpretation of community HIV and sexual abuse victim data to assess the appropriateness of ARV-PEP.  相似文献   

13.
OBJECTIVE: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children's homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.  相似文献   

14.
The incidence of human immunodeficiency virus (HIV) infection acquired by children through sexual abuse is presently unknown. A telephone survey of 63 practitioners of pediatric sexual abuse (PSA) assessment in the five U.S. regions with highest prevalence of HIV infection was conducted to determine the present status of guidelines for HIV antibody testing of PSA victims. No formal protocol was used by any of those surveyed, and a literature review found no existing guidelines for HIV antibody testing of PSA victims. A standard set of clinical situations was presented to practitioners to assess whether a consensus exists of indications for HIV antibody testing of abused children. Seven clinical profiles with 12 criteria were presented including HIV antibody status, AIDS/ARC clinical profile, and behavioral profile of the assailant; clinical profile of the victim; pre-assault victim behavioral profile compatible with high risk of HIV infection (exclusively adolescents); parent/guardian anxiety/psychosocial profile; and profile of the assaultive act with respect to potential transmissibility of HIV. We found an 85% or greater consensus for 6 testing criteria, and based upon these propose an interim set of HIV antibody testing guidelines for PSA victims. There was no consensus about five testing criteria, but their frequent citation merits further consideration. Clinical application of interim guidelines and design of prospective studies to quantitatively evaluate them are reviewed.  相似文献   

15.
From the child psychiatry outpatient department of a university medical center, 64 charts were reviewed in two phases: 29 were randomly selected from outpatient files, and 35 were examined after clinicians were asked to directly query sexual abuse. Although the reported sexual abuse rate for randomly selected charts was quite low (6.9%), reference to sexual abuse history in charts of children who were asked about molestation was 4.5 times more frequent (31.4%; 11.5% of all boys, 50% of all girls). Children with an identified sexual abuse history reported more psychological symptoms, had made more suicide attempts in the past, and were more likely than nonabused children to receive a diagnosis of major depression.  相似文献   

16.
OBJECTIVE: This study examined the utility of sexual behavior problems as a diagnostic indicator of sexual abuse. The hypothesis was that sexual behavior problems are multiply determined and consequently are variably related to sexual abuse in a clinical sample. METHOD: A sample of 247 children evaluated for sexual abuse at a multidisciplinary forensic child abuse evaluation clinic were included. Results from the Child Behavior Checklist (CBCL) and the Child Sexual Behavior Inventory (CSBI) were analyzed and compared to the results of a structured abuse assessment performed independent of these scores. RESULTS: The forensic team assessment found evidence of sexual abuse in 25% of cases, and no evidence in 61%. Children in this sample exhibited an elevated level of both sexual and nonsexual behavior problems. However, considerable variability was noted in sexual behavior problem scores. Thus, in this study a high score or a low score had no relationship to the diagnosis of sexual abuse. Indeed, nonsexually abused children were just as likely to have high CSBI scores as sexually abused children. CONCLUSIONS: This study found no significant relationship between a diagnosis of sexual abuse and the presence or absence of sexual behavior problems in a sample of children referred for sexual abuse evaluation. The finding suggests that community professionals should use caution in relying on sexual behavior problems as a diagnostic indicator of abuse.  相似文献   

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18.
OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.  相似文献   

19.
A review of the short-term effects of child sexual abuse   总被引：6，自引：2，他引：6  
This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.  相似文献   

20.
OBJECTIVE: The goal of the present study was to investigate the consistency of children's reports of sexual and physical abuse. METHOD: A group of 222 children, ages 3-16 years, participated. As part of legal investigations, the children were interviewed twice about their alleged experiences of abuse. The consistency of children's reports of sexual and physical abuse was examined in the two interviews, in relation to age, type of abuse, gender, memory, suggestibility, and cognitive capabilities. RESULTS: Older children were more consistent than younger children in their reports of sexual and physical abuse. Children were more consistent when reporting sexual abuse than physical abuse. Girls were more consistent than boys in sexual abuse reports. Consistency in sexual abuse reports was predicted by measures of memory, whereas consistency in physical abuse reports was not. Cognitive abilities did not predict consistency in sexual abuse or physical abuse reports. CONCLUSIONS: Implications for understanding children's allegations of abuse are discussed.  相似文献   

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