Emergency Care for Children and Adolescents after Sexual Violence, in Brazil’s Capital, Brasilia

Objective: Sexual violence affects women of all ages but, more commonly, children and adolescents. This study aimed to identify the extent to which services are being provided at the hospitals responsible for the emergency care of children and adolescents who have suffered sexual violence and to determine whether there is any difference in the provision of such services as a function of the victim’s age. Method: This cross-sectional study investigated differences in the care received by female children and adolescents who are victims of sexual violence in a capital city, comparing the treatment given to girls under 15 with that given to adolescents of 15 to 19 years of age. The data were extracted from the State Department of Health database between 01/01/2012 and 31/12/2016. Results: Children under 15 were much less likely to receive prophylaxis against HIV, sexually transmitted infections and hepatitis B, with the number of adolescent girls treated adequately corresponding to between twice and almost three times the number of children treated prophylactically. Only 10% of girls under 15 received emergency contraception. Conclusion: The lack of standard care established by the Ministry of Health highlights the need for urgent debates both locally and probably throughout the country, as the situation may be similar in other regions of the country.

Perpetrators of Sexual Violence against Minors in Casamance (Senegal)

Introduction: The causes of sexual delinquency against children are multifactorial and the motivations that drive the perpetrators of sexual assault are diverse. Nowadays, there is still no consensus on a single portrait of child sex offenders and studies that focus on sex offenders are still rare in Senegal and Africa. Objectives: To determine the profile of the perpetrators and to identify the circumstances of sexual violence against minors in Casamance. Materials and Methods: A retrospective descriptive and analytical study from April 1, 2014 to October 31, 2019 was conducted. The study population was made up of perpetrators of sexual violence against minors whose legal proceedings were dealt with at the Ziguinchor High Court. The data were entered into an Excel spreadsheet and then analyzed using Epi InfoTM 7 software. Results: A total of 106 cases of sexual violence against minors were collected for 113 aggressors and 106 victims. Rape accounted for 66.03% of sexual violence. Male aggressors were 98.23%. Female victims accounted for 95.28%. The average age of the attackers was 32.52 years (±13.68). Offenders over the age of 35 committed the most rape (p = 0.043). The average age of the victims was 12.62 years (±3.42). Victims aged ten and over (p = 0.015) and who had a low level of education (p = 0.016) were more exposed to rape. The assault took place during the day (65.71%) and at the home of the aggressor (62.26%). Victims knew their attackers (84.47%). Victims were assaulted more than once by the same assailant (40.57%). Those aged 10 years and over (p = 0.0037) and who knew their attackers (p = 0.014) were more at risk of being repeatedly sexually abused. Conclusion: In Senegal, sexual violence against minors is perpetrated by young adult men, single, with little or no education and exercising low-income professions. Rape is the type of aggression preferred by perpetrators, most of whom were known to their victims. The policy to fight sexual violence against children must integrate sex education at school and community level, public awareness, monitoring of child sex offenders and possibly, their medico-psychological care.

Sexual Violence in the Zinder Region, about 441 Cases in Reference Motherhoods

Background: Niger is one of the countries that have the highest fertility rate in the world, with 7, 6 children per woman. Zinder is the most populated region of Niger with 5 million inhabitants that is 1/5 of Niger population. The demographic impact that has affected Niger the last 10 years: unemployment poverty and drug use, spawned violence of all kinds in Zinder region (physical and sexual violence). Sexual abuse is a major risk for poor psychiatric and physical outcomes. As sexual violence has serious consequences on the life and future of women and the community and it concerns our field of intervention, we initiated this study whose objective was to determine the socio-epidemiological and lesional aspects, the consequences and appropriate solutions of sexual violence in the Zinder. Methodology: This was a retrospective collection study of all cases of alleged sexual violence received over a 12-year period from 1 January 2009 to 30 June 2021 in Zinder’s referral maternity wards. Results: During the study period, 441 cases of sexual violence were collected;an annual average of 36 cases (441/12). The frequency is 1.29% on the 34,186 consultations. The mean age was 12.31 years with age extremes of 3 to 43 years. Students accounted for 25.39%. Street vendors were found in 224 cases or 50.79%. The predominant reason for admission is rape in 64.63%. The defloration was 52.15%. Pregnancy was found in 118 cases or 26.75%. HIV serology was positive in 1 victim. School dropout was 26.75%. Conclusion: The victims of sexual violence were minors, mostly street vendors and school children. The lack of means of repression at the time allowed the expansion of this violence. The consequences of sexual violence were severe. Advocacy has improved the phenomen on of sexual violence in Zinder.

Survival after Sexual Violence and Genocide: Trauma and Healing for Yazidi Women in Northern Iraq

Introduction: In August 2014, the Yazidi community of Sinjar, in the Nineveh Governorate of Northern Iraq, was brutally targeted by the so-called Islamic State of Iraq and Syria (ISIS) for annihilation through murder, torture, and the systematic and premeditated use of rape and sexual slavery of Yazidi women. In 2016, the United Nations High Commissioner for Human Rights concluded that ISIS was committing genocide, crimes against humanity, and war crimes against Yazidis. Methods: Using current international literature, which includes reviews, qualitative interviews of survivors, and reports from medical and humanitarian actors, this paper explores the short and potentially long-term physical and mental health consequences of the extreme physical and sexual violence and atrocities perpetrated against Yazidi women. Results: Yazidi women survivors of kidnapping, sex slavery, and rape experienced significant levels of physical ailments, chronic pain, and mental health conditions. All women reported feelings of guilt, stress, insomnia, and severe flashbacks. The incidence of post-traumatic stress disorder (PTSD) ranged from 42% to 90%. Sixty-seven percent suffered from a somatoform disorder, 53% had depression, 39% experienced anxiety, and 28% suffered from dissociation. Conclusions: Sexual violence against women is a common tool systematically employed during wars and genocide. In recent ISIS attacks, intentional perpetration of mass rapes of women and execution of men was a strategy to destroy an entire population. PTSD and depression are common after traumatic stress. For disaster responders and humanitarian workers, training and education to understand, try to prevent, and plan for interventions when gender-based violence and sexual exploitation occurs must become a mandatory part of emergency preparedness.

Drug Addictions and Sexual Violence in Childhood and Adolescence： Analyzing Life Stories

The sexual abuse suffered in childhood and adolescence, in addition to damage to physical and psychological health of the victim, is considered as an important risk factor for alcohol and drugs addiction, development of psychopathology and psychosocial damage in adulthood. In addition to the pain and humiliation that are submitted by the abuse, children and adolescents also experience shame and guilt which require them toadopt coping strategies to endure those feelings. The use of psychoactive substances is a recognized way of dealing with the pains of living. This work, which is of narrative style, analyses and discusses, through five case reports, chemical dependency as a result of sexual abuse suffered in childhood and/or adolescence. The eight subjects in this study are male and have suffered sexual violence in this age period of life. Their ages range from 23 years to 39 years, and all are admitted to a therapeutic community in a city in the interior of Sao Paulo state, in Brazil, for treatment of chemical dependency, being met by the Department of Psychology. The reasons for the choice of the participants for treatment modality for patients are： difficult to stop using drugs, even unwilling to take it, they have easy access to it; the feeling of losing control over their lives; by successive losses as a result of drug use, and for fear that their lives had a tragic ending. With the exception of two participants, the others do not classify that as a child suffered sexual violence. However, all attribute that facilitated their entry into the world of drugs. Seven participants experienced such violence in childhood （between 7 years and 9 years） and adolescence （age 14）. The attackers were people closed to the victims--in the case of two victims, their families, with the exception of one participant who was raped by a stranger. Six participants declared themselves as homosexual. Another participant does not claim to be homosexual, but presents difficulties in terms of sexuality. Two participants are H1V positive. The start of psychoactive substances use occurred during adolescence （12 years to 17 years）. The participants see drugs as an anesthetic to the pain of the soul, a way to get pleasure, but they get charged expensively, as it increases the feeling of emptiness, guilt, helplessness, worthlessness and hopelessness. Although participants have sought help to deal with addiction it is noted that throughout the life course the issue of sexual violence was not treated. It was noted that the patients have a double stigma in society： the issue of drugs addiction and the orientation of sexual desire, because the majority of participants are homosexual. The results reinforce the need for effective action geared to accommodate the victims of sexual violence and effective preventive measures to prevent children and adolescents from being abused.

Cinememory： Sexualized Trauma and Coming of Age in Holocaust-Related Israeli Films

Since 1978 Israeli Holocaust-related narrative films have associated the violence experienced during the Holocaust, including sexual violence, with the violence permeating Israeli society. In keeping with Marianne Hirsch＇s notion of ＂postmemory＂, this paper argues that cinema, as a visual form of artistic mediation, has an especially strong impact on the spectator, because it triggers affective, tactile, and bodily responses. Hence, the efficacy of generating an ethics of remembrance of sexually-related violence, based on cinematic aesthetics, which the author terms here ＂cinememory＂. The paper focuses on a sub-genre of Holocaust-related films： coming-of-age films, which explore in different ways the lasting implications of growing-up in the shadow of sexualized trauma; the unconscious transmission of memories and tactile experiences, related to the ubiquity of sexual violence during the Holocaust.

Characteristics and Obstetrical Outcomes of Post-Rape Pregnancies among Adolescent Girls in Post Conflict Context in Eastern DR Congo

Introduction: In conflicts such as the Democratic Republic of the Congo, sexual violence is systematically perpetrated against children and adolescent girls. Unwanted pregnancy is one of the complications with a myriad of consequences for the victim, the newborn, and society. This study aims to draw up characteristics and obstetrical outcomes of post-rape pregnancies of victims under 18 years old treated at Panzi General Referral Hospital (PGRH) in Eastern DR Congo. Methods: A single-centre prospective descriptive study was conducted at PGRH over two years (June 2020 to June 2022). This study included 140 adolescent girls who became pregnant post sexual assault. They were followed from confirmation of pregnancy to delivery. Sociodemographic, psycho-affective and clinical parameters were recorded and analyzed using XLSTAT 2014 software. Results: 76.4% came from rural areas, with a median age of 16 [13-17]. Pregnancy was continued in 50.7% and terminated in 20%. The victims were casual acquaintances of the perpetrators in 33.6% and unknown in 26.4%. 57.9% attended regular antenatal consultations. 74.3% had an individual birth plan/preparation for labor, with the primary route of delivery being vaginal (69.3%). The frequency of caesarean sections was 30.7%. Some psychological symptoms were identified during labor in 52.9% like agitation (10.7%) and hypersensitivity (8.6%). Conclusion: Pregnancy post rape is a public health problem affecting adolescents between 13 and 17 years of age. These pregnancies require closer follow-up with multi-disciplinary shared care, including psychology, obstetrics, and community input, to improve mother and newborn antenatal, intrapartum, and postpartum outcomes. In addition, long-term psychological sequelae of these pregnancies can be mitigated through supportive care in this high-risk period.