ResearchPad - rape-and-sexual-assault https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Exploring stress, cognitive, and affective mechanisms of the relationship between interpersonal trauma and opioid misuse]]> https://www.researchpad.co/article/elastic_article_14719 People with a history of interpersonal trauma, including intimate partner violence, sexual assault, and adverse childhood experiences, are disproportionately affected by the current opioid epidemic. Interpersonal trauma has been shown to increase risk for chronic pain conditions, prescription opioid use, and opioid misuse. Stress, cognition, and affective function have been examined as potential mechanisms that may influence opioid misuse among individuals with a history of interpersonal trauma. However, no studies have examined these factors simultaneously, despite their interrelatedness.ObjectiveThe purpose of this study was to 1) examine perceived stress, perceived cognitive function, depressive symptoms, and PTSD symptoms as potential mechanisms of opioid misuse among individuals with a history of interpersonal trauma, 2) examine the types of interpersonal trauma that are associated with opioid misuse, and 3) assess the mediating role of pain and opioid prescription.MethodsA cross-sectional, observational study design was conducted. Data were collected through a confidential self-report online survey using validated instruments (n = 230). A series of regression analyses were conducted to identify mechanistic factors and interpersonal trauma types associated with opioid misuse, opioid prescription, and pain intensity. Structural equation modeling was used to examine mediating effects of pain intensity and opioid prescription.ResultsOpioid prescription, depressive symptoms, and intimate partner violence increased the odds of reporting opioid misuse. Pain intensity and adverse childhood experiences increased the odds of opioid prescription. Higher levels of perceived stress and depressive symptoms were associated with increased pain intensity. Pain intensity emerged as a mediator of the relationship between depressive symptoms and opioid misuse.ConclusionsOur work shows that there are likely several pathways through which interpersonal trauma can lead to opioid misuse. Interventions aimed at improving depressive symptoms and coping with traumatizing events should be included as part of comprehensive trauma-informed pain management practices. ]]> <![CDATA[Prospective Study of Rape Perpetration by Young South African Men: Incidence & Risk Factors]]> https://www.researchpad.co/article/5989d9f0ab0ee8fa60b6e4bb

Background

There has been very little prospective research on rape perpetration among men. This paper describes the incidence and risk factors for new rape and attempted rape events among young South African men in an HIV prevention trial.

Methods

We followed 1,147 men aged 15–26 years who enrolled into a cluster randomised controlled trial to evaluate the HIV prevention behavioural intervention Stepping Stones. Incidence rate ratios for factors associated with incident rape were derived from Poisson models.

Results

The young men reported 217 incident rapes (completed or attempted) of a girl or woman over 1,914 person years of follow up, yielding a rape incidence of 11.2 per 100 person years. Overall 24.9% of men had previously raped at baseline, and 18.9% did so during the follow up. Among the latter, 61.3% raped for the first time, and 38.7% re-offended. Multivariable Poisson modelling showed a higher incidence of rape perpetration among men who had ever used drugs (IRR 1.86 95%CI 1.39, 2.49), had eight or more lifetime partners (IRR 1.48 95% CI 1.09, 2.01), had been physically violent toward a female partner (IRR 1.50 95%CI 1.11, 2.03) and had disclosed rape perpetration at baseline (IRR 1.45 95%CI 1.07, 1.97). A lower incidence was found among those with greater resistance to peer pressure (IRR 0.85 95%CI 0.74, 0.97).

Conclusions

The findings highlight the importance of male gender socialisation and addressing delinquent youth sub-cultures in rape prevention. Prevention requires change in hegemonic masculinity, with its emphasis on gender hierarchy, exaggerated performance of heterosexuality and control of women. Interventions are needed to address male socialisation with delinquent peers, by reducing exposure to childhood trauma and strengthening opportunities for gainful employment (in work or recreation).

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<![CDATA[A Qualitative Analysis of Disclosure Patterns among Women with Sexual Violence-Related Pregnancies in Eastern Democratic Republic of Congo]]> https://www.researchpad.co/article/5989da36ab0ee8fa60b8670e

The Democratic Republic of the Congo (DRC) has experienced nearly two decades of civil conflict in the Eastern regions of North and South Kivu. This conflict has been notorious for the use of sexual violence as a weapon of war, leading in many cases to pregnancy after rape. The objectives of this analysis were: 1) to describe patterns of sexual violence-related pregnancy (SVRP) disclosure; 2) to consider why survivors chose to disclose to particular individuals; and 3) to examine the dialogue around SVRPs between women with SVRPs and their confidants. In South Kivu Province, Democratic Republic of Congo, two sub-groups of sexual violence survivors completed qualitative interviews, those currently raising a child from an SVRP (parenting group, N = 38) and those who had terminated an SVRP (termination group, N = 17). The findings show that a majority of SVRPs were conceived when participants were held in sexual captivity for prolonged periods of time. The SVRPs were disclosed to friends, family members, other sexual violence survivors, community members, spouses, health care providers, or perpetrators. The confidants were most often chosen because they were perceived by the participants as being discreet, trusted, and supportive. The confidants often provided advice about continuing or terminating the SVRP. Trust and discretion are the most important factors determining to whom women with SVRPs disclose their pregnancies. The vital role of confidants in giving support after disclosure cannot be overlooked. Providing opportunities for survivors to safely disclose their SVRPs, including to health care providers, is a necessary first step in allowing them to access safe and comprehensive post-assault care and services.

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<![CDATA[The contribution of gender-based violence and network trauma to gender differences in Post-Traumatic Stress Disorder]]> https://www.researchpad.co/article/5989db51ab0ee8fa60bdc281

Background

Posttraumatic stress disorder (PTSD) occurs twice as commonly amongst women as men. Two common domains of trauma, network trauma and gender based violence (GBV), may contribute to this gender difference in PTSD rates. We examined data from a nationally representative sample of the Australian population to clarify the characteristics of these two trauma domains in their contributions to PTSD rates in men and women.

Methods

We drew on data from the 2007 Australian National Survey of Mental Health and Well-being to assess gender differences across a comprehensive range of trauma domains, including (1) prevalence of lifetime exposure; (2) identification of an index trauma or DSM-IV Criterion A event; and (3) the likelihood of developing full DSM-IV PTSD symptoms once an index trauma was identified.

Results

Men reported more traumatic events (TEs) overall but women reported twice the prevalence of lifetime PTSD (women, 13.4%; men, 6.3%). Women reported a threefold higher level of exposure to GBV and were seven times more likely to nominate GBV as the index trauma as compared to men. Women were twice more likely than men to identify a network trauma as the index trauma and more likely to meet full PTSD symptoms in relation to that event (women, 20.6%; men, 14.6%).

Conclusion

Women are more likely to identify GBV and network trauma as an index trauma. Women’s far greater exposure to GBV contributes to their higher prevalence of PTSD. Women are markedly more likely to develop PTSD when network trauma is identified as the index trauma. Preventing exposure to GBV and providing timely interventions for acute psychological reactions following network trauma may assist in reducing PTSD rates amongst women.

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<![CDATA[Nakalanga Syndrome: Clinical Characteristics, Potential Causes, and Its Relationship with Recently Described Nodding Syndrome]]> https://www.researchpad.co/article/5989db54ab0ee8fa60bdd0d2

Nakalanga syndrome is a condition that was described in Uganda and various other African countries decades ago. Its features include growth retardation, physical deformities, endocrine dysfunction, mental impairment, and epilepsy, amongst others. Its cause remains obscure. Nodding syndrome is a neurological disorder with some features in common with Nakalanga syndrome, which has been described mainly in Uganda, South Sudan, and Tanzania. It has been considered an encephalopathy affecting children who, besides head nodding attacks, can also present with stunted growth, delayed puberty, and mental impairment, amongst other symptoms. Despite active research over the last years on the pathogenesis of Nodding syndrome, to date, no convincing single cause of Nodding syndrome has been reported. In this review, by means of a thorough literature search, we compare features of both disorders. We conclude that Nakalanga and Nodding syndromes are closely related and may represent the same condition. Our findings may provide new directions in research on the cause underlying this neurological disorder.

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<![CDATA[Prescription of Non-Occupational Post-Exposure HIV Prophylaxis by Emergency Physicians: An Analysis on Accuracy of Prescription and Compliance]]> https://www.researchpad.co/article/5989db4eab0ee8fa60bdb52a

We conducted a retrospective analysis of data from a prospective nPEP (non-Occupational Post Exposure Prophylaxis) registry based on patients consulting at one academic Emergency department located in Brussels, Belgium. We review here 1,357 cases consulting from January 2011 to December 2013.The objective of the study is to determine whether emergency physicians prescribe nPEP according to national guideline with support from IDS (infectious disease specialists). As this intervention has a high cost we wanted to verify correct allocation of treatment to high risk patients. Moreover we wanted to determine whether compliance to nPEP when prescribed by an Emergency Physician was different from literature reports. Finally we wanted to describe the population consulting for nPEP at our center. Emergency physicians prescribed nPEP more frequently in high risk exposures (98.6%) compared to intermediate risk exposures (53.2%); adequately allocating resources from a public health perspective. Appropriateness of prescription when evaluated according to nPEP Belgian guidelines was 98.8%.Compliance with nPEP prescribed by Emergency physicians was 60% in our study. Compliance was the highest in MSM (Men who have Sex with Men) while sexual assault victims showed the lowest compliance. Altogether this study suggests that Emergency physicians can safely and adequately prescribe nPEP when supported by a comprehensive guideline. Recognizing intrinsic differences within heterogeneous populations consulting for nPEP may improve compliance to this high-cost public health intervention.

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<![CDATA[Conflict, Crisis, and Abuse in Dharavi, Mumbai: Experiences from Six Years at a Centre for Vulnerable Women and Children]]> https://www.researchpad.co/article/5989dabeab0ee8fa60bafdc0

Nayreen Daruwalla and colleagues describe the Centre for Vulnerable Women and Children, which serves clients coping with crisis and violence in the urban setting of Dharavi, Mumbai.

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<![CDATA[Condom Negotiation, HIV Testing, and HIV Risks among Women from Alcohol Serving Venues in Cape Town, South Africa]]> https://www.researchpad.co/article/5989db4bab0ee8fa60bda20a

Background

Women in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection.

Purpose

To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women.

Method

Women (N = 1333) residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens) completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV.

Results

Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex.

Conclusions

For women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues.

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<![CDATA[Gender Inequitable Masculinity and Sexual Entitlement in Rape Perpetration South Africa: Findings of a Cross-Sectional Study]]> https://www.researchpad.co/article/5989daa1ab0ee8fa60ba5b4f

Objective

To describe the prevalence and patterns of rape perpetration in a randomly selected sample of men from the general adult population, to explore factors associated with rape and to describe how men explained their acts of rape.

Design

Cross-sectional household study with a two- stage randomly selected sample of men.

Methods

1737 South African men aged 18–49 completed a questionnaire administered using an Audio-enhanced Personal Digital Assistant. Multivariable logistic regression models were built to identify factors associated with rape perpetration.

Results

In all 27.6% (466/1686) of men had raped a woman, whether an intimate partner, stranger or acquaintance, and whether perpetrated alone or with accomplices, and 4.7% had raped in the last 12 months. First rapes for 75% were perpetrated before age 20, and 53.9% (251) of those raping, did so on multiple occasions. The logistic regression model showed that having raped was associated with greater adversity in childhood, having been raped by a man and higher maternal education. It was associated with less equitable views on gender relations, having had more partners, and many more gender inequitable practices including transactional sex and physical partner violence. Also drug use, gang membership and a higher score on the dimensions of psychopathic personality, namely blame externalisation and Machiavellian egocentricity. Asked about why they did it, the most common motivations stemmed from ideas of sexual entitlement.

Conclusions

Perpetration of rape is so prevalent that population-based measures of prevention are essential to complement criminal justice system responses. Our findings show the importance of measures to build gender equity and change dominant ideas of masculinity and gender relations as part of rape prevention. Reducing men's exposure to trauma in childhood is also critically important.

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<![CDATA[Prevalence and Risk of Violence and the Physical, Mental, and Sexual Health Problems Associated with Human Trafficking: Systematic Review]]> https://www.researchpad.co/article/5989da1fab0ee8fa60b7e4ee

Siân Oram and colleagues conduct a systematic review of the evidence on the health consequences of human trafficking. They describe a limited and poor-quality evidence base, but some evidence suggests a high prevalence of violence and mental distress among women and girls trafficked for sexual exploitation, among other findings.

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<![CDATA[Forced Sexual Experiences as Risk Factor for Self-Reported HIV Infection among Southern African Lesbian and Bisexual Women]]> https://www.researchpad.co/article/5989daa5ab0ee8fa60ba7289

Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.

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<![CDATA[Disclosure bias for group versus individual reporting of violence amongst conflict-affected adolescent girls in DRC and Ethiopia]]> https://www.researchpad.co/article/5989db53ab0ee8fa60bdccc5

Methodologies to measure gender-based violence (GBV) have received inadequate attention, especially in humanitarian contexts where vulnerabilities to violence are exacerbated. This paper compares the results from individual audio computer-assisted self-administered (ACASI) survey interviews with results from participatory social mapping activities, employed with the same sample in two different post-conflict contexts. Eighty-seven internally displaced adolescent girls from the Democratic Republic of the Congo and 78 Sudanese girls living in Ethiopian refugee camps were interviewed using the two methodologies. Results revealed that the group-based qualitative method elicited narratives of violence focusing on events perpetrated by strangers or members of the community more distantly connected to girls. In contrast, ACASI interviews revealed violence predominantly perpetrated by family members and intimate partners. These findings suggest that group-based methods of information gathering frequently used in the field may be more susceptible to socially accepted narratives. Specifically, our findings suggest group-based methods may produce results showing that sexual violence perpetrated by strangers (e.g., from armed groups in the conflict) is more prevalent than violence perpetrated by family and intimate partners. To the extent this finding is true, it may lead to a skewed perception that adolescent GBV involving strangers is a more pressing issue than intimate partner and family-based sexual violence, when in fact, both are of great concern.

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<![CDATA["Passive victim – strong survivor"? Perceived meaning of labels applied to women who were raped]]> https://www.researchpad.co/article/5989db5aab0ee8fa60bdf728

Three experiments (total N = 464) were conducted in parallel with English- and German-speaking participants to examine the perceived meanings and effects of the labels "victim" versus "survivor" (and their German equivalents) when applied to a woman who was raped. In Study 1 (N = 179), participants read a rape vignette and then rated the meaning of the label it contained (either "victim" or "survivor") on a 15-item semantic differential. Independent of language and participant gender, "survivor" was perceived more positively overall (e.g., as strong, brave, active) than was "victim" (weak, passive, but also innocent). In Study 2 (N = 95), labels were varied within items assessing judgments of an acquaintance-rape case (e.g., "Does the victim [survivor]carry a certain responsibility for what happened?"), focusing on short-term outcomes. Significant interaction effects of label and participants’ gender emerged on case-related judgments. Participants in both language samples judged "survivor" to be a less appropriate term than "victim". In Study 3 (N = 190), participants read a text in which a woman who had been raped labeled herself as either "victim" or "survivor", focusing on the coping with sexual violence. As in Study 2, German-language participants showed no significant effects of the label on their case judgments but rejected the term "survivor" as inappropriate; English-language participants, by contrast, perceived the woman describing herself as "survivor" to be more psychologically stable and regarded the use of both labels as appropriate. Results are discussed in terms of their applied relevance for communicating about sexual violence.

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<![CDATA[Understanding the Relationships between Gender Inequitable Behaviours, Childhood Trauma and Socio-Economic Status in Single and Multiple Perpetrator Rape in Rural South Africa: Structural Equation Modelling]]> https://www.researchpad.co/article/5989da65ab0ee8fa60b91bf9

Background

Interventions to prevent rape perpetration must be designed to address its drivers. This paper seeks to extend understanding of drivers of single and multiple perpetrator rape (referred to here as SPR and MPR respectively) and the relationships between socio-economic status, childhood trauma, peer pressure, other masculine behaviours and rape.

Method

1370 young men aged 15 to 26 were interviewed as part of the randomised controlled trial evaluation of Stepping Stones in the rural Eastern Cape. We used multinomial to compare the characteristics of men who reported rape perpetration at baseline. We used structural equation modelling (SEM) to examine pathways to rape perpetration.

Results

76.1% of young men had never raped, 10.0% had perpetrated SPR and 13.9% MPR. The factors associated with both MPR and SPR (compared to never having raped) were indicators of socio-economic status (SES), childhood trauma, sexual coercion by a woman, drug and alcohol use, peer pressure susceptibility, having had transactional sex, multiple sexual partners and being physically violent towards a partner. The SEM showed the relationship between SES and rape perpetration to be mediated by gender inequitable masculinity. It was complex as there was a direct path indicating that SES correlated with the masculinity variable directly such that men of higher SES had more gender inequitable masculinities, and indirect path mediated by peer pressure resistance indicated that the former pertained so long as men lacked peer pressure resistance. Having a higher SES conveyed greater resistance for some men. There was also a path mediated through childhood trauma, such that men of lower SES were more likely to have a higher childhood trauma exposure and this correlated with a higher likelihood of having the gender inequitable masculinity (with or without the mediating effect of peer pressure resistance).

Discussion

Both higher and lower socio-economic status were associated with raping. Prevention of rape perpetration must focus on changing men’s gender ideals, entitlements and inequitable practices. Reducing poverty and adverse childhood experiences should also be of benefit.

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<![CDATA[Knowledge, Practices, and Attitudes of Emergency Contraception among Female University Students in KwaZulu-Natal, South Africa]]> https://www.researchpad.co/article/5989da44ab0ee8fa60b8b4a4

Objective

The purpose of this study is to investigate the knowledge, practices, and attitudes among female university students in South Africa regarding emergency contraceptives (EC).

Methods

A cross-sectional study was conducted among 582 female university students who were selected using multi-stage sampling techniques. Multivariate logistic regression analysis was used to find significant predictors for EC awareness.

Results

The average age of the female students was 20.9 years (SD = 3.0) and 57.2% were presently sexually active. Overall, 49.8% of the participants reported having heard about EC prior to the study. Regarding sexual activities among the female students, 53.2% reported to have sex, and 21.2% of the sexually experienced students used EC prior to the study. Regarding the effectiveness of EC, 29.5% students said it could be used up to 72 hours after unprotected sexual intercourse, and 8% said it could be used just before sex. About two-thirds (61.8%) would recommend the use of EC and 63.2% would use it if they needed. The multivariate analysis indicated that students who were older (>20 years), presently sexually active, and living with their parents were more likely to be aware of EC (p<0.05).

Conclusion

The students’ knowledge and utilization of EC were low. Health education and promotion should be targeted towards these students, and the EC services should be offered on campus.

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<![CDATA[Violence as a Barrier for HIV Prevention among Female Sex Workers in Argentina]]> https://www.researchpad.co/article/5989d9f4ab0ee8fa60b6fa3b

Background

Violence against female sex workers (FSWs) has been increasingly reported as an important determinant of HIV infection risk. This study explores the frequency of different violent experiences (sexual abuse, rejection, beating and imprisonment) among FSWs in Argentina and its association with condom use and HIV and T. pallidum prevalence.

Methods

A convenience sample of 1255 FSWs was included in a cross-sectional study conducted between October 2006 and November 2009.

Results

Sexual abuse was reported by 24.1% (219/907) of women. A total of 34.7% (42/1234) reported rejection experiences, 21.9% (267/1215) reported having been beaten and 45.4% (561/1236) stated having been arrested because of their sex work activity. There was a higher frequency of inconsistent condom use with clients among FSWs who had experienced sexual abuse, rejection, and police detention. A higher frequency of HIV and T. pallidum infection was detected among FSWs who reported having been arrested by the police.

Conclusion

The study shows for the first time the frequency of different violent situations among FSWs in Argentina. The association between violence against sex workers, condom use and STI prevalence demonstrated here calls for measures to reduce stigma and violence against FSWs. Such violent experiences may increase vulnerability to STI through coerced unprotected sex.

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<![CDATA[Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science]]> https://www.researchpad.co/article/5989da3bab0ee8fa60b880c6

Background

Flashbacks are the hallmark symptom of Posttraumatic Stress Disorder (PTSD). Although we have successful treatments for full-blown PTSD, early interventions are lacking. We propose the utility of developing a ‘cognitive vaccine’ to prevent PTSD flashback development following exposure to trauma. Our theory is based on two key findings: 1) Cognitive science suggests that the brain has selective resources with limited capacity; 2) The neurobiology of memory suggests a 6-hr window to disrupt memory consolidation. The rationale for a ‘cognitive vaccine’ approach is as follows: Trauma flashbacks are sensory-perceptual, visuospatial mental images. Visuospatial cognitive tasks selectively compete for resources required to generate mental images. Thus, a visuospatial computer game (e.g. “Tetris”) will interfere with flashbacks. Visuospatial tasks post-trauma, performed within the time window for memory consolidation, will reduce subsequent flashbacks. We predicted that playing “Tetris” half an hour after viewing trauma would reduce flashback frequency over 1-week.

Methodology/Principal Findings

The Trauma Film paradigm was used as a well-established experimental analog for Post-traumatic Stress. All participants viewed a traumatic film consisting of scenes of real injury and death followed by a 30-min structured break. Participants were then randomly allocated to either a no-task or visuospatial (“Tetris”) condition which they undertook for 10-min. Flashbacks were monitored for 1-week. Results indicated that compared to the no-task condition, the “Tetris” condition produced a significant reduction in flashback frequency over 1-week. Convergent results were found on a clinical measure of PTSD symptomatology at 1-week. Recognition memory between groups did not differ significantly.

Conclusions/Significance

Playing “Tetris” after viewing traumatic material reduces unwanted, involuntary memory flashbacks to that traumatic film, leaving deliberate memory recall of the event intact. Pathological aspects of human memory in the aftermath of trauma may be malleable using non-invasive, cognitive interventions. This has implications for a novel avenue of preventative treatment development, much-needed as a crisis intervention for the aftermath of traumatic events.

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<![CDATA[Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence]]> https://www.researchpad.co/article/5989da78ab0ee8fa60b9787e

Background

There is a scarcity of data on the association of sexual violence and women's subsequent obstetric outcomes. Our aim was to investigate whether women exposed to sexual violence as teenagers (12–19 years of age) or adults present with different obstetric outcomes than women with no record of such violence.

Methods

We linked detailed prospectively collected information on women attending a Rape Trauma Service (RTS) to the Icelandic Medical Birth Registry (IBR). Women who attended the RTS in 1993–2010 and delivered (on average 5.8 years later) at least one singleton infant in Iceland through 2012 formed our exposed cohort (n = 1068). For each exposed woman's delivery, nine deliveries by women with no RTS attendance were randomly selected from the IBR (n = 9126) matched on age, parity, and year and season of delivery. Information on smoking and Body mass index (BMI) was available for a sub-sample (n = 792 exposed and n = 1416 non-exposed women). Poisson regression models were used to estimate Relative Risks (RR) with 95% confidence intervals (CI).

Results

Compared with non-exposed women, exposed women presented with increased risks of maternal distress during labor and delivery (RR 1.68, 95% CI 1.01–2.79), prolonged first stage of labor (RR 1.40, 95% CI 1.03–1.88), antepartum bleeding (RR 1.95, 95% CI 1.22–3.07) and emergency instrumental delivery (RR 1.16, 95% CI 1.00–1.34). Slightly higher risks were seen for women assaulted as teenagers. Overall, we did not observe differences between the groups regarding the risk of elective cesarean section (RR 0.86, 95% CI 0.61–1.21), except for a reduced risk among those assaulted as teenagers (RR 0.56, 95% CI 0.34–0.93). Adjusting for maternal smoking and BMI in a sub-sample did not substantially affect point estimates.

Conclusion

Our prospective data suggest that women with a history of sexual assault, particularly as teenagers, are at increased risks of some adverse obstetric outcomes.

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<![CDATA[One Size Fits All? Standardised Provision of Care for Survivors of Sexual Violence in Conflict and Post-Conflict Areas in the Democratic Republic of Congo]]> https://www.researchpad.co/article/5989db30ab0ee8fa60bd1fa4

Background

Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).

Methods

A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.

Results

In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.

Conclusion

This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.

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<![CDATA[Perceptions and Experiences of Research Participants on Gender-Based Violence Community Based Survey: Implications for Ethical Guidelines]]> https://www.researchpad.co/article/5989da3aab0ee8fa60b8789d

Objective

To explore how survey respondents perceived their experiences and the impact of participating in a survey, and to assess adverse consequences resulting from participation.

Design

Qualitative study involving purposefully selected participants who had participated in a household-based survey.

Methods

This qualitative study was nested within a survey that investigated the prevalence of gender-based violence perpetration and victimization with adult men and women in South Africa. 13 male- and 10 female-in-depth interviews were conducted with survey respondents.

Results

A majority of informants, without gender-differences, perceived the survey interview as a rare opportunity to share their adverse and or personal experiences in a 'safe' space. Gender-differences were noted in reporting perceptions of risks involved with survey participation. Some women remained fearful after completing the survey, that should breach of confidentiality or full survey content disclosure occur, they may be victimized by partners as a punishment for survey participation without men's approval. A number of informants generally discussed their survey participation with others. However, among women with interpersonal violence history or currently in abusive relationships, full survey content disclosure was done with fear; the partner responses were negative, and few women reported receiving threatening remarks but none reported being assaulted. In contrast no man reported adverse reaction by others. Informants with major life adversities reported that the survey had made them to relive the experiences causing them sadness and pain at the time. No informant perceived the survey as emotionally harmful or needed professional support because of survey questions. Rather the vast majority perceived benefit from survey participation.

Conclusion

Whilst no informant felt answering the survey questions had caused them emotional or physical harm, some were distressed and anxious, albeit temporarily. Research protocols need to put in place safeguards where appropriate so that this group receives support and protection.

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