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EPIDEMIOLOGY OF SEXUAL ASSAULT
Global and Indian scenario
Dr Faiz Ahmad
INTRODUCTION
Sexual violence occurs throughout the world. Available data suggest
that in some countries nearly one in four women may experience
sexual violence by an intimate partner and up to one-third of
adolescent girls report their first sexual experience as being forced.
Sexual violence has a profound impact on physical and mental health.
As well as causing physical injury, it is associated with an increased
risk of a range of sexual and reproductive health problems, with both
immediate and long-term consequences
Deaths following sexual violence may be as a result of suicide, HIV
infection or murder, occurring either during a sexual assault or
subsequently, as a murder of ‘‘honour’’
Sexual violence can also profoundly affect the social wellbeing of
victims; individuals may be stigmatized and ostracized by their
families and others
Coerced sex may result in sexual gratification on the part of the
perpetrator, though its underlying purpose is frequently the expression
of power and dominance over the person assaulted. Often, men who
coerce a spouse into a sexual act believe their actions are legitimate
because they are married to the woman.
Rape of women and of men is often used as a weapon of war, as a
form of attack on the enemy, typifying the conquest and degradation of
its women or captured male fighters
It may also be used to punish women for transgressing social or moral
codes, for instance, those prohibiting adultery or drunkenness in
public. Women and men may also be raped when in police custody or
in prison.
Forms and contexts of sexual violence
A wide range of sexually violent acts can take place in different circumstances
and settings.
Rape within marriage or dating relationships
Rape by strangers
Systematic rape during armed conflict
Unwanted sexual advances or sexual harassment, including demanding sex in
return for favour
Sexual abuse of mentally or physically disabled people
Sexual abuse of children
Forced marriage or cohabitation, including the marriage of children
Denial of the right to use contraception or to adopt other measures to
protect against sexually transmitted diseases
Forced abortion
Violent acts against the sexual integrity of women, including female
genital mutilation and obligatory inspections for virginity
Forced prostitution and trafficking of people for the purpose of sexual
exploitation
The extent of the problem
Sources of data
Data on sexual violence typically come from police, clinical settings,
nongovernmental organizations and survey research
The relationship between these sources and the global magnitude of
the problem of sexual violence maybe viewed as corresponding to an
iceberg floating in water
Epidemiology of sexual assault
The small visible tip represents cases reported to police
But beneath the surface remains a substantial although unquantified component of
the problem.
In general, sexual violence has been a neglected area of research. The available
data are scanty and fragmented. Police data, for instance, are often incomplete and
limited
Many women do not report sexual violence to police because they are ashamed, or
fear being blamed, not believed or otherwise mistreated.
Data from medico-legal clinics, on the other hand, may be biased towards the
more violent incidents of sexual abuse
The proportion of women who seek medical services for immediate
problems related to sexual violence is also relatively small.
There are also significant differences across cultures in the willingness
to disclose sexual violence to researchers.
Estimates of sexual violence (GLOBAL)
Acquaintance Rape
Sexual assault remains dramatically underreported, according to the
Brennan Center for Justice, eight out of 10 rapes are committed by
someone the victim knows, according to RAINN, (Rape, Abuse &
Incest National Network). This can be a relative, former spouse, teacher,
religious leader, work or school friends, a date or some other
acquaintance.
Perpetrators Know Their Child Victims
In nearly all instances of child sexual assault — 93% — the sexual
abuser knows the victim. Every nine minutes, Child Protective Services
finds evidence for a claim of sexual abuse. In 2016, CPS (Child
protective services) found strong evidence that 57,329 children were
victims of sexual abuse.
False Rape Claims Are Low
The prevalence of false rape claims varies, according to the National
Sexual Violence Resource Center, with estimates anywhere between 2%
and 10% of total claims. In a study of eight communities around the
U.S., researchers found a 7.1% rate of false reports from among 2,059
sexual assault cases. Another study in Boston found a 5.9% false-report
rate among 136 sexual assault cases. Other researchers found a 2.1%
rate of false reports from 2000 to 2003, when they looked at 812 reports
of assault.
Sexual Assault Costs Millions
Sexual assault has economic consequences — some $450 billion worth
annually. Rape alone costs an estimated $127 billion per year (excluding child
sex abuse), with each rape costing around $151,423. These costs are the result
of funding sexual assault services, as well as lost wages over time due to
lower educational attainment (which is common among adolescent assault
survivors) and lost wages due to an inability to work, a frequent consequence
of assault.
Assault in the Military
Assault in the military is alarmingly common. In 2014, there were at
least 20,300 members of the military who were assaulted. Reporting
assault in the military is also low, with 85% of victims not reporting
them in 2014. Moreover, retaliation for reporting is common. More than
60% of military women who reported their assaults were found to have
experienced retaliation.
The Rates Are Falling
The rate of reported sexual assaults has fallen dramatically since 1993,
when there were 4.3 rapes for every 1,000 people in the U.S. The rate in
2016 was 1.2 for every 1,000 people, a 63% decline. Still, each year
there are 60,000 children who were victims of abuse (or showed signs);
80,600 inmates in prisons who were sexually assaulted or raped; and
321,500 Americans 12 years or older who were sexually assaulted or
raped.
Native Americans Are at Higher Risk
Native Americans are two times as likely to be raped or sexually
assaulted as all other races in the U.S. More than 40 percent of sexual
assaults against American Indians are committed by strangers, while
34% are by an acquaintance. Twenty-five percent of rape and sexual
assault among Native Americans is by an intimate partner or family
member.
The Most Vulnerable Age Range
The most vulnerable to be sexually assaulted or raped are women
between 12 to 34 years old. This group makes up 69% of victims.
Transgender College Students Are at Higher Risk
Transgender college students are particularly vulnerable to sexual
violence, with 21% of transgender, genderqueer, and gender-
nonconforming college students having been sexually assaulted. This is
compared to 18% of non-TGQN females and 4% of non-TGQN males.
Bisexual Women Are at Higher Risk
Also at higher risk are bisexual women, 46% of whom report being
raped (22% by an intimate partner) in their lifetime. This is compared to
17% of straight women (9% by an intimate partner) and 13% of
lesbians. And 47% of bisexual men have experienced sexual violence
other than rape, compared to 21% of heterosexual men. Though, 40% of
gay men and 47% of bisexual men have experienced sexual violence as
well.
Most Rape Victims Are Female
A vast majority of rape victims are female. That includes 90% of adult
victims and 82% of all juvenile victims.
Rape and Sexual Assault Are Frequent
It is estimated that every 92 seconds an American is sexually assaulted.
On average, there are 321,500 victims of rape and sexual assault (age 12
or older) in the U.S. every year.
Disability and Sexual Assault
People with disabilities are twice as likely to be victims of rape and
sexual assault than those without disabilities. Females with disabilities
experienced even higher rates of victimization than males. And those
with a type of cognitive-functioning disability were at higher risk for
violent victimization than those with any other type of disability.
Teens Are Most At Risk
Girls and women between the ages of 16 and 19 are four times more
likely than girls and women in other age groups to be assualted or raped. In
general, 48% of rape survivors were sleeping or performing another activity
at home when they were victimized. Nearly 30% were traveling to and from
school or work, or shopping. Some 12% were working when they were
assaulted, 7% were attending school and 5% were doing some other activity.
Survivors Over a Lifetime
One out of every six American women in her lifetime is a victim of attempted or
completed rape (14.8% of all women have experienced attempted rape; 2.8%
completed). One in 33 American men (about 3%) have experienced an attempted or
completed rape in their lifetime.
Little Justice
Out of every 1,000 rapes, 995 perpetrators won't serve any jail time, according to
RAINN. This is because out of every 1,000 rapes, only 230 are reported to police.
Only 46 of those reports lead to an arrest. And of those arrested, only nine cases get
referred to prosecutors. Of those, only five will lead to prosecution and of those five,
only 4.6 lead to imprisonment of any length.
IPC CRIMES 2015-17
Epidemiology of sexual assault
Epidemiology of sexual assault
Epidemiology of sexual assault
Epidemiology of sexual assault
Epidemiology of sexual assault
Epidemiology of sexual assault
What are the risk factors for sexual violence?
Factors increasing women’s vulnerability
Being young
Consuming alcohol or drugs
Having previously been raped or sexually abused
Having many sexual partners
Involvement in sex work
Becoming more educated and economically empowered, at least where sexual violence
perpetrated by an intimate partner is concerned
Poverty
Age
Young women are usually found to be more at risk of rape than older
women
According to data from justice systems and rape crisis centers in Chile,
Malaysia, Mexico, New Guinea, Peru and the United States, between one-
third and two-thirds of all victims of sexual assault are aged 15 years or less
Certain forms of sexual violence like violence taking place in schools and
colleges, and trafficking of women for sexual exploitation are very closely
associated with a young age
Alcohol and drug consumption
Alcohol or drugs makes it more difficult for women to protect
themselves by interpreting and effectively acting on warning signs.
Drinking alcohol may also place women in settings where their
chances of encountering a potential offender are greater
Having previously been raped or sexually abused
There is some evidence linking experiences of sexual abuse in
childhood or adolescence with patterns of victimization during
adulthood
A national study of violence against women in the United States found
that women who were raped before the age of 18 years were twice as
likely to be raped as adults, compared with those who were not raped
as children or adolescents
The effects of early sexual abuse may also extend to other forms of
victimization and problems in adulthood
For instance, a case–control study in Australia on the long-term
impact of abuse reported significant associations between child sexual
abuse and experiencing rape, sexual and mental health problems,
domestic violence and other problems in intimate relationships
Having many sexual partners
Young women who have many sexual partners are at increased risk of
sexual violence
Women who had experienced attempted or completed rape during
childhood or adolescence were more likely to have a higher number of
sexual partners in adulthood, compared with non-abused or moderately
abused women
Similar findings have been reported in longitudinal studies of young women
in New Zealand and Norway
Educational level
The likely explanation is that greater empowerment brings with it
more resistance from women to patriarchal norms, so that men may
resort to violence in an attempt to regain control
Poverty
Poor women and girls may be more at risk of rape in the course of their
daily tasks than those who are better off
For example when they walk home on their own from work late at night, or
work in the fields or collect firewood alone
Children of poor women may have less parental supervision when not in
school, since their mothers may be at work and unable to afford child care
Poverty forces many women and girls into occupations that carry a
relatively high risk of sexual violence
Factors increasing men’s risk of committing rape
Individual factors
Alcohol and drug use
Coercive sexual fantasies and other attitudes and beliefs supportive of sexual
violence
Impulsive and antisocial tendencies
Preference for impersonal sex
Hostility towards women
History of sexual abuse as a child
Witnessed family violence as a child
Relationship factors
Associate with sexually aggressive and delinquent peers
Family environment characterized by physical violence and few
resources
Strongly patriarchal relationship or family environment
Emotionally unsupportive family environment
Family honor considered more important than the health and safety of
the victim
Community factors
Poverty, mediated through forms of crisis of male identity
Lack of employment opportunities
Lack of institutional support from police and judicial system
General tolerance of sexual assault within the community
Weak community sanctions against perpetrators of sexual violence
Societal factors
Societal norms supportive of sexual violence
Societal norms supportive of male superiority and sexual entitlement
Weak laws and policies related to sexual violence
Weak laws and policies related to gender equality
High levels of crime and other forms of violence
Recommendations
Sexual violence has generally been a neglected area of research in most
parts of the world, yet the evidence suggests that it is a public health
problem of substantial proportions. Much more needs to be done both to
understand the phenomenon and to prevent it.
More research
The lack of an agreed definition of sexual violence and the paucity of
data describing the nature and extent of the problem worldwide have
contributed to its lack of visibility on the agendas of policy-makers.
There is a need for substantial further research on almost every aspect
of sexual violence, including
The incidence and prevalence of sexual violence in a range of
settings, using a standard research tool for measuring sexual coercion
 The risk factors for being a victim or a perpetrator of sexual violence
The health and social consequences of different forms of sexual violence
The factors influencing recovery of health following a sexual assault
The social contexts of different forms of sexual violence, including sexual
trafficking, and the relationships between sexual violence and other forms of
violence.
Determining effective responses
Interventions must also be studied to produce a better understanding of what is effective in
different settings for preventing sexual violence and for treating and supporting victims.
The following areas should be given priority:
Documenting and evaluating services and interventions that support survivors or work
with perpetrators of sexual violence.
Determining the most appropriate health sector responses to sexual violence, including
the role of prophylactic antiretroviral therapy for HIV prevention after rape – with
different basic packages of services being recommended for different settings, depending
on the level of resources.
.
Determining what constitutes appropriate psychological support for
different settings and circumstances
Evaluating programs aimed at preventing sexual violence, including
community-based interventions – particularly those focusing on men –
and school-based programs.
Studying the impact of legal reforms and criminal sanctions.
Priority should be given to the following:
• The primary prevention of all forms of sexual violence through programs in communities, schools
and refugee settings;
• Support for culturally sensitive and participatory approaches to changing attitudes and behavior
• Support for programs addressing the prevention of sexual violence in the broader context of
promoting gender equality
• Programs that address some of the underlying socioeconomic causes of violence, including poverty
and lack of education, for example by providing job opportunities for young people
• Programs to improve child rearing, reduce the vulnerability of women and promote more gender-
equitable notions of masculinity
• Addressing sex
Addressing sexual abuse within the health sector
Sexual violence against patients in the health sector exists in many places, but is not
usually acknowledged as a problem.
Various steps need to be taken to overcome this denial and to confront the problem,
including the following
• Incorporating topics pertaining to gender and sexual violence, including ethical
considerations relevant to the medical profession in the curricula for basic and
postgraduate training of physicians, nurses and other health workers
• Actively seeking ways to identify and investigate possible cases of abuse of
patients within health institutions
• Utilizing international bodies of the medical and nursing professions,
and nongovernmental organizations (including women’s
organizations) to monitor and compile evidence of abuse and
campaign for action on the part of governments and health services
• Establishing proper codes of practice and complaints procedures, and
strict disciplinary procedures for health workers who abuse patients in
health care settings.
THANKS

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Epidemiology of sexual assault

  • 1. EPIDEMIOLOGY OF SEXUAL ASSAULT Global and Indian scenario Dr Faiz Ahmad
  • 2. INTRODUCTION Sexual violence occurs throughout the world. Available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner and up to one-third of adolescent girls report their first sexual experience as being forced. Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences
  • 3. Deaths following sexual violence may be as a result of suicide, HIV infection or murder, occurring either during a sexual assault or subsequently, as a murder of ‘‘honour’’ Sexual violence can also profoundly affect the social wellbeing of victims; individuals may be stigmatized and ostracized by their families and others
  • 4. Coerced sex may result in sexual gratification on the part of the perpetrator, though its underlying purpose is frequently the expression of power and dominance over the person assaulted. Often, men who coerce a spouse into a sexual act believe their actions are legitimate because they are married to the woman.
  • 5. Rape of women and of men is often used as a weapon of war, as a form of attack on the enemy, typifying the conquest and degradation of its women or captured male fighters It may also be used to punish women for transgressing social or moral codes, for instance, those prohibiting adultery or drunkenness in public. Women and men may also be raped when in police custody or in prison.
  • 6. Forms and contexts of sexual violence A wide range of sexually violent acts can take place in different circumstances and settings. Rape within marriage or dating relationships Rape by strangers Systematic rape during armed conflict Unwanted sexual advances or sexual harassment, including demanding sex in return for favour
  • 7. Sexual abuse of mentally or physically disabled people Sexual abuse of children Forced marriage or cohabitation, including the marriage of children Denial of the right to use contraception or to adopt other measures to protect against sexually transmitted diseases Forced abortion
  • 8. Violent acts against the sexual integrity of women, including female genital mutilation and obligatory inspections for virginity Forced prostitution and trafficking of people for the purpose of sexual exploitation
  • 9. The extent of the problem Sources of data Data on sexual violence typically come from police, clinical settings, nongovernmental organizations and survey research The relationship between these sources and the global magnitude of the problem of sexual violence maybe viewed as corresponding to an iceberg floating in water
  • 11. The small visible tip represents cases reported to police But beneath the surface remains a substantial although unquantified component of the problem. In general, sexual violence has been a neglected area of research. The available data are scanty and fragmented. Police data, for instance, are often incomplete and limited Many women do not report sexual violence to police because they are ashamed, or fear being blamed, not believed or otherwise mistreated. Data from medico-legal clinics, on the other hand, may be biased towards the more violent incidents of sexual abuse
  • 12. The proportion of women who seek medical services for immediate problems related to sexual violence is also relatively small. There are also significant differences across cultures in the willingness to disclose sexual violence to researchers.
  • 13. Estimates of sexual violence (GLOBAL) Acquaintance Rape Sexual assault remains dramatically underreported, according to the Brennan Center for Justice, eight out of 10 rapes are committed by someone the victim knows, according to RAINN, (Rape, Abuse & Incest National Network). This can be a relative, former spouse, teacher, religious leader, work or school friends, a date or some other acquaintance.
  • 14. Perpetrators Know Their Child Victims In nearly all instances of child sexual assault — 93% — the sexual abuser knows the victim. Every nine minutes, Child Protective Services finds evidence for a claim of sexual abuse. In 2016, CPS (Child protective services) found strong evidence that 57,329 children were victims of sexual abuse.
  • 15. False Rape Claims Are Low The prevalence of false rape claims varies, according to the National Sexual Violence Resource Center, with estimates anywhere between 2% and 10% of total claims. In a study of eight communities around the U.S., researchers found a 7.1% rate of false reports from among 2,059 sexual assault cases. Another study in Boston found a 5.9% false-report rate among 136 sexual assault cases. Other researchers found a 2.1% rate of false reports from 2000 to 2003, when they looked at 812 reports of assault.
  • 16. Sexual Assault Costs Millions Sexual assault has economic consequences — some $450 billion worth annually. Rape alone costs an estimated $127 billion per year (excluding child sex abuse), with each rape costing around $151,423. These costs are the result of funding sexual assault services, as well as lost wages over time due to lower educational attainment (which is common among adolescent assault survivors) and lost wages due to an inability to work, a frequent consequence of assault.
  • 17. Assault in the Military Assault in the military is alarmingly common. In 2014, there were at least 20,300 members of the military who were assaulted. Reporting assault in the military is also low, with 85% of victims not reporting them in 2014. Moreover, retaliation for reporting is common. More than 60% of military women who reported their assaults were found to have experienced retaliation.
  • 18. The Rates Are Falling The rate of reported sexual assaults has fallen dramatically since 1993, when there were 4.3 rapes for every 1,000 people in the U.S. The rate in 2016 was 1.2 for every 1,000 people, a 63% decline. Still, each year there are 60,000 children who were victims of abuse (or showed signs); 80,600 inmates in prisons who were sexually assaulted or raped; and 321,500 Americans 12 years or older who were sexually assaulted or raped.
  • 19. Native Americans Are at Higher Risk Native Americans are two times as likely to be raped or sexually assaulted as all other races in the U.S. More than 40 percent of sexual assaults against American Indians are committed by strangers, while 34% are by an acquaintance. Twenty-five percent of rape and sexual assault among Native Americans is by an intimate partner or family member.
  • 20. The Most Vulnerable Age Range The most vulnerable to be sexually assaulted or raped are women between 12 to 34 years old. This group makes up 69% of victims. Transgender College Students Are at Higher Risk Transgender college students are particularly vulnerable to sexual violence, with 21% of transgender, genderqueer, and gender- nonconforming college students having been sexually assaulted. This is compared to 18% of non-TGQN females and 4% of non-TGQN males.
  • 21. Bisexual Women Are at Higher Risk Also at higher risk are bisexual women, 46% of whom report being raped (22% by an intimate partner) in their lifetime. This is compared to 17% of straight women (9% by an intimate partner) and 13% of lesbians. And 47% of bisexual men have experienced sexual violence other than rape, compared to 21% of heterosexual men. Though, 40% of gay men and 47% of bisexual men have experienced sexual violence as well.
  • 22. Most Rape Victims Are Female A vast majority of rape victims are female. That includes 90% of adult victims and 82% of all juvenile victims. Rape and Sexual Assault Are Frequent It is estimated that every 92 seconds an American is sexually assaulted. On average, there are 321,500 victims of rape and sexual assault (age 12 or older) in the U.S. every year.
  • 23. Disability and Sexual Assault People with disabilities are twice as likely to be victims of rape and sexual assault than those without disabilities. Females with disabilities experienced even higher rates of victimization than males. And those with a type of cognitive-functioning disability were at higher risk for violent victimization than those with any other type of disability.
  • 24. Teens Are Most At Risk Girls and women between the ages of 16 and 19 are four times more likely than girls and women in other age groups to be assualted or raped. In general, 48% of rape survivors were sleeping or performing another activity at home when they were victimized. Nearly 30% were traveling to and from school or work, or shopping. Some 12% were working when they were assaulted, 7% were attending school and 5% were doing some other activity.
  • 25. Survivors Over a Lifetime One out of every six American women in her lifetime is a victim of attempted or completed rape (14.8% of all women have experienced attempted rape; 2.8% completed). One in 33 American men (about 3%) have experienced an attempted or completed rape in their lifetime. Little Justice Out of every 1,000 rapes, 995 perpetrators won't serve any jail time, according to RAINN. This is because out of every 1,000 rapes, only 230 are reported to police. Only 46 of those reports lead to an arrest. And of those arrested, only nine cases get referred to prosecutors. Of those, only five will lead to prosecution and of those five, only 4.6 lead to imprisonment of any length.
  • 33. What are the risk factors for sexual violence? Factors increasing women’s vulnerability Being young Consuming alcohol or drugs Having previously been raped or sexually abused Having many sexual partners Involvement in sex work Becoming more educated and economically empowered, at least where sexual violence perpetrated by an intimate partner is concerned Poverty
  • 34. Age Young women are usually found to be more at risk of rape than older women According to data from justice systems and rape crisis centers in Chile, Malaysia, Mexico, New Guinea, Peru and the United States, between one- third and two-thirds of all victims of sexual assault are aged 15 years or less Certain forms of sexual violence like violence taking place in schools and colleges, and trafficking of women for sexual exploitation are very closely associated with a young age
  • 35. Alcohol and drug consumption Alcohol or drugs makes it more difficult for women to protect themselves by interpreting and effectively acting on warning signs. Drinking alcohol may also place women in settings where their chances of encountering a potential offender are greater
  • 36. Having previously been raped or sexually abused There is some evidence linking experiences of sexual abuse in childhood or adolescence with patterns of victimization during adulthood A national study of violence against women in the United States found that women who were raped before the age of 18 years were twice as likely to be raped as adults, compared with those who were not raped as children or adolescents
  • 37. The effects of early sexual abuse may also extend to other forms of victimization and problems in adulthood For instance, a case–control study in Australia on the long-term impact of abuse reported significant associations between child sexual abuse and experiencing rape, sexual and mental health problems, domestic violence and other problems in intimate relationships
  • 38. Having many sexual partners Young women who have many sexual partners are at increased risk of sexual violence Women who had experienced attempted or completed rape during childhood or adolescence were more likely to have a higher number of sexual partners in adulthood, compared with non-abused or moderately abused women Similar findings have been reported in longitudinal studies of young women in New Zealand and Norway
  • 39. Educational level The likely explanation is that greater empowerment brings with it more resistance from women to patriarchal norms, so that men may resort to violence in an attempt to regain control
  • 40. Poverty Poor women and girls may be more at risk of rape in the course of their daily tasks than those who are better off For example when they walk home on their own from work late at night, or work in the fields or collect firewood alone Children of poor women may have less parental supervision when not in school, since their mothers may be at work and unable to afford child care Poverty forces many women and girls into occupations that carry a relatively high risk of sexual violence
  • 41. Factors increasing men’s risk of committing rape Individual factors Alcohol and drug use Coercive sexual fantasies and other attitudes and beliefs supportive of sexual violence Impulsive and antisocial tendencies Preference for impersonal sex Hostility towards women History of sexual abuse as a child Witnessed family violence as a child
  • 42. Relationship factors Associate with sexually aggressive and delinquent peers Family environment characterized by physical violence and few resources Strongly patriarchal relationship or family environment Emotionally unsupportive family environment Family honor considered more important than the health and safety of the victim
  • 43. Community factors Poverty, mediated through forms of crisis of male identity Lack of employment opportunities Lack of institutional support from police and judicial system General tolerance of sexual assault within the community Weak community sanctions against perpetrators of sexual violence
  • 44. Societal factors Societal norms supportive of sexual violence Societal norms supportive of male superiority and sexual entitlement Weak laws and policies related to sexual violence Weak laws and policies related to gender equality High levels of crime and other forms of violence
  • 45. Recommendations Sexual violence has generally been a neglected area of research in most parts of the world, yet the evidence suggests that it is a public health problem of substantial proportions. Much more needs to be done both to understand the phenomenon and to prevent it.
  • 46. More research The lack of an agreed definition of sexual violence and the paucity of data describing the nature and extent of the problem worldwide have contributed to its lack of visibility on the agendas of policy-makers. There is a need for substantial further research on almost every aspect of sexual violence, including The incidence and prevalence of sexual violence in a range of settings, using a standard research tool for measuring sexual coercion
  • 47.  The risk factors for being a victim or a perpetrator of sexual violence The health and social consequences of different forms of sexual violence The factors influencing recovery of health following a sexual assault The social contexts of different forms of sexual violence, including sexual trafficking, and the relationships between sexual violence and other forms of violence.
  • 48. Determining effective responses Interventions must also be studied to produce a better understanding of what is effective in different settings for preventing sexual violence and for treating and supporting victims. The following areas should be given priority: Documenting and evaluating services and interventions that support survivors or work with perpetrators of sexual violence. Determining the most appropriate health sector responses to sexual violence, including the role of prophylactic antiretroviral therapy for HIV prevention after rape – with different basic packages of services being recommended for different settings, depending on the level of resources. .
  • 49. Determining what constitutes appropriate psychological support for different settings and circumstances Evaluating programs aimed at preventing sexual violence, including community-based interventions – particularly those focusing on men – and school-based programs. Studying the impact of legal reforms and criminal sanctions.
  • 50. Priority should be given to the following: • The primary prevention of all forms of sexual violence through programs in communities, schools and refugee settings; • Support for culturally sensitive and participatory approaches to changing attitudes and behavior • Support for programs addressing the prevention of sexual violence in the broader context of promoting gender equality • Programs that address some of the underlying socioeconomic causes of violence, including poverty and lack of education, for example by providing job opportunities for young people • Programs to improve child rearing, reduce the vulnerability of women and promote more gender- equitable notions of masculinity • Addressing sex
  • 51. Addressing sexual abuse within the health sector Sexual violence against patients in the health sector exists in many places, but is not usually acknowledged as a problem. Various steps need to be taken to overcome this denial and to confront the problem, including the following • Incorporating topics pertaining to gender and sexual violence, including ethical considerations relevant to the medical profession in the curricula for basic and postgraduate training of physicians, nurses and other health workers • Actively seeking ways to identify and investigate possible cases of abuse of patients within health institutions
  • 52. • Utilizing international bodies of the medical and nursing professions, and nongovernmental organizations (including women’s organizations) to monitor and compile evidence of abuse and campaign for action on the part of governments and health services • Establishing proper codes of practice and complaints procedures, and strict disciplinary procedures for health workers who abuse patients in health care settings.