1. AIDSTAR-One
The Clinical Management of Children and
Adolescents Who Have Experienced Sexual
Violence: Technical Considerations for
PEPFAR Programs
Melissa Sharer & Marcy Levy
John Snow, Inc. (JSI)
AIDS Support and Technical Assistance Resources Project, Sector 1, Task Order 1
(AIDSTAR-One)
USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008

2. Background
•Estimated 150 million girls and 73 million boys under 18
have experienced sexual violence and exploitation
•Estimated 10 to 20 percent of child sexual violence and
exploitation cases are reported to authorities
•Overarching consequences that can affect immediate and
long-term health and well-being
•Services often not tailored to the unique needs of children
and adolescents, nor to those of girls and boys

3. Gender-based Violence Activities/Resources
(children/adolescent specific)
•The Clinical Management of Children and Adolescents
Who Have Experienced Sexual Violence (Technical
Considerations for PEPFAR Programs) - 2012
•Assessments on post-rape care and referrals/linkages (in
Lesotho and Mozambique)
•Forensic nurses mentorship in Swaziland
•A Step-by-Step Guide to Strengthening Sexual Violence
Services in Public Health Facilities: Lessons and Tools
•Case studies from Vietnam, Ecuador, and Swaziland
describing GBV services

5. Technical Considerations
• No global guidance
• AIDSTAR-One led collaborative process
• Focus on a comprehensive response
• Be adaptable and generalizable – serve as a resource for
countries

6. Guiding Principles
• Promote the child’s best
interest
• Ensure the child’s safety
• Comfort the child
• Ensure appropriate
confidentiality
• When possible, involve
the child in decisionmaking
• Strengthen the child’s
resilience
• Have appropriately
trained healthcare
providers with experience
in sexual violence
• Health and welfare takes
precedence over
evidence collection
• Reporting to police
should not be a
prerequisite for obtaining
care
• Person-first approach

8. What Is Included
•Minimum standards for facilities providing care
•The program planning and development process
•Medical management
•The role of psychosocial and community support services

9. Medical Management
•
•
•
•
•
Signs and symptoms
Co-occurring issues
Acute exams
Non-acute exams
Communicating with
children
• Consent
• Taking a developmentally
appropriate medical
history
• Psychological
assessment
• Physical exam
• Ano-genital exam in the
pre and post pubertal
child
• Special considerations
• Evidence collection
• Interpretation of findings
• STIs, HIV and pregnancy
• Reporting
• Follow-up and referrals

10. Community Support
• Establishing and
strengthening
infrastructure
• Education of
healthcare
• Education of law
enforcement
• Education of child
protection workers
• Ensuring access to
HIV care
• Establishing and
connecting
resources for
referrals
• Education of and
raising support
within the
community

11. Annexes
• Glossary
• Clinical site prep and set up
job aid
• Understanding informed
consent
• “Top to toe” physical exam
• Describing physical injuries
• Medical management job
aid
• Clinician’s role in evidence
collection job aid
• Sample history and exam
form
• Body maps
• Nurses, doctors and
social workers checklist
• Providers role in linking
community resources job
aid
• Promising practices
• Care algorithm

12. Practical Application and Next Steps
• In September, hosted first country-level
meeting in Tanzania
• Identify elements from the Technical
Considerations and develop preliminary plans
on developing post-rape care guidelines and
protocols
• Relevant to your programs

13. For more information, go to www.aidstar-one.com
Contact: Melissa Sharer (msharer@jsi.com) or Marcy Levy (mlevy@jsi.com)