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This paper identifies the interpretative and qualification legal problems posed by the criminalisation of rape offences in Peru by examining the most contemporary case law and specialised literature. Through a teleological and systematic legal interpretation of these offences and applying a gender perspective, preliminary alternative solutions are constructed. The main legal conclusion reached is that, with the incorporation of the modality of "taking advantage of any other environment that prevents the person from giving free consent" in the offence of rape in its basic modality (article 170 of the Criminal Code), the Peruvian legal system has incorporated a model based mainly on the absence of consent for sex offences. This model, in turn, is close to the "yes means yes" approach to consent, based on a conventional, constitutional and teleological interpretation of the wording of the criminal offence. This paper also reaches other important legal conclusions about the criminal offence of rape, such as the feasibility of its coverage of cases of stealthing, the legal viability of its commission by compenetration and not only penetration, by improper omission and without requiring lewd intent in addition to regular intent, among others. Finally, considering these conclusions, articles 171, 172, 173, 174 and 175 of the Peruvian Criminal Code are systematically examined and congruent legal interpretations are proposed. One of the most relevant is the unconstitutionality of the criminal offence of rape by deception (article 175) and the rationale for its redirection to article 170, as the former could be used to argue that deception is not a suitable modality for committing rape against an adult or adolescent victim over the age of 13, preventing the adequate protection of sexual autonomy. [ABSTRACT FROM AUTHOR]

The attrition of rape cases within the criminal justice system is driven by different factors. We aimed to describe the patterns of rape case attrition and associated factors in South Africa. We analysed a national sample of 3,952 cases reported in 2012. We found that 35 per cent of cases were closed by police, 31 per cent were declined by the prosecutors, 16 per cent were enrolled but later struck off the roll, 19 per cent went on trial and 9 per cent were finalised with conviction. Aggravating circumstances, availability of forensic evidence and success at perpetrator arrests were key for case progression and increased likelihood of convictions. Thorough police investigations and continual training which addresses negative gender or other rape stereotyping are critical to ensure rape convictions. [ABSTRACT FROM AUTHOR]

This study uses a diverse sample that is nationally representative with regards to race and gender (N = 2,000) in an attempt to replicate and confirm Stoll, Lilley, and Pinter's previous finding that gender-blind sexism is correlated with rape myth acceptance. As in the original study, we hypothesized that higher scores on the Gender-Blind Sexism Inventory (GBSI) would be predictive of higher scores on Stoll et al.'s Rape Myth Acceptance Scale (RMA). Gender-blind sexism builds on previous models of contemporary sexism such as hostile and benevolent sexism, modern sexism, and neosexism. It also represents an extension of racialized social system theory that explores the ways contemporary sexism operates in an era of post-racial and post-gender politics via four frames: abstract liberalism, naturalization, cultural sexism, and minimization of sexism. Unlike in the original study, however, our sample also allowed us to control for scores on the Ambivalent Sexism Inventory (ASI), the Modern Sexism Scale (MS), and the Neosexism Scale (NS) in testing this relationship. Our analysis confirmed the hypothesis that gender-blind sexism is predictive of higher rape myth acceptance among participants. Moreover, this study indicates that the GBSI offers additional value over the ASI, MS, and NS, as it was the only index of sexism tested that revealed gender-group differences within its relationship to RMA. Compared to men, women's acceptance of rape myths was more responsive to shifts in the GBSI. We discuss the implications of our findings in terms of rape and sexual assault prevention and policy. We also provide some suggestions for how the GBSI could be used in future studies. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study are to 1) estimate the burden of physical, sexual, and psychological violence among migrants in transit through Mexico to the US; and 2) examine the associations between experiencing violence and sociodemographic characteristics, migratory background, and health status in this vulnerable population. Method: A cross-sectional study combining qualitative and quantitative methods was carried out from 2009 to 2015 with a sample of 12,023 migrants in transit through Mexico to the US. Information on gender (male, female, and transsexual, transgender and transvestite -TTTs-); nationality; health status; migratory background; and experiences with violence was obtained. Fifty-eight migrants participated in in-depth interviews to explore any experiences of violence during their journey. A descriptive analysis was performed and a probit regression model was applied to analyze the factors associated with violence. Qualitative information was analyzed to understand experiences, meanings and responses to violence. Results: The overall prevalence of suffering from any form of violence was 29.4%. Nearly 24% reported physical violence, 19.5% experienced psychological violence, and approximately 2% reported sexual violence. TTTs experienced a significantly greater burden of violence compared to men and women. Violence occurred more frequently among migrants from Central American (30.6%) and other countries (40.0%) than it did among Mexican migrants (20.5%). Experiences involving sexual, physical and psychological violence as well as theft and even kidnapping were described by interviewees. Migrants mistrust the police, migration authorities, and armed forces, and therefore commonly refrain from revealing their experiences. Conclusion: Migrants are subjected to a high level of violence while in transit to the US. Those traveling under irregular migratory conditions are targets of even greater violence, a condition exacerbated by gender inequality. Migrants transiting through Mexico from Central American and other countries undergo violence more frequently than do Mexican migrants. Protective measures are urgently needed to ensure the human rights of these populations. [ABSTRACT FROM AUTHOR]

Non-consensual condom removal (NCCR) is the removal of a condom before or during sexual intercourse without one’s partner's consent. Despite considerable news and media attention devoted to the trend (as stealthing), little empirical research to date has examined people’s views of the practice. The present study aimed to contribute toward generating empirical evidence to guide the discussion surrounding NCCR. We asked participants about whether or not they felt NCCR is wrong, whether there should be consequences for its perpetration, and contextualized responses within legal context. A total of 592 undergraduate students took part in an online survey inquiring about their experiences with and views of NCCR. We used descriptive statistics to determine sample prevalence and outcomes of NCCR and qualitatively analyzed responses to open-ended questions asking about perceptions of NCCR. Of participants who had engaged in penetrative sexual intercourse with a male partner using an external condom, 18.7%, 95% CI [14.4, 22.7] reported that they had NCCR perpetrated against them. The majority of these participants reported that they experienced NCCR negatively and encountered related consequences; several reported contracting an STI, experiencing an unplanned pregnancy, or both. Nearly all participants expressed that NCCR is wrong, citing reasons that included the lack of consent, possibility of unplanned or unwanted outcomes, and a betrayal of trust. In this study, we found that there was agreement that NCCR is wrong, but variability in responses regarding the circumstances under which there should be consequences for the action. These perceptions reflect the current uncertainty in law. We recommend researchers refer to the phenomenon as NCCR (rather than stealthing) and discuss related issues to encourage future research to adopt consistent and accurate labels and definitions for NCCR. We hope that our findings will guide future research and spur public and legal discussion on NCCR. [ABSTRACT FROM AUTHOR]

Background: Gender-based violence (GBV) is a crucial global health problem among all age groups, including adolescents. This study describes incidences of GBV, as well as factors associated with sexual assault, among female adolescents in class six living in urban informal settlements in Nairobi, Kenya. Methods: Study participants were interviewed using a structured survey instrument focusing on experiences of GBV, including emotional, physical, and sexual violence, and corresponding perpetrators, as well as gender attitudes, alcohol use, self-efficacy, and previous sexual experiences. Summary statistics and clustered bootstrap confidence intervals were calculated for social behaviors and violence rates. Stepwise logistic regression identified variables associated with an adolescent's experience of sexual assault. Findings: In this population 7·2% of adolescent girls reported being raped in the prior twelve months, with 11·1% of these rape victims reporting over five experiences. Among the 21·3% who report having had a boyfriend, 38·1% reported emotional, physical, and/or sexual intimate partner violence (IPV). Boyfriends were identified most often as perpetrators, accounting for 46·3% of reported lifetime rapes. Previous experience of physical (p = <0·001) or emotional (p<0·001) IPV and home violence (p<0·001) were risk factors for being raped, while high self-efficacy (p<0·001) was a protective factor. Interpretation: Sexual assault and GBV are major challenges in this highly-disadvantaged population. Novel prevention efforts are needed for this age group, as prevention is often targeted at older adolescents. Prevention efforts should focus on assaults by perpetrators known to adolescents, especially boyfriends, and may need to account for the adolescents' previous experience of, and exposure to, violence. [ABSTRACT FROM AUTHOR]

A single focus optical tweezer is formed when a laser beam is launched through a high numerical aperture immersion objective. This objective focuses the beam down to a diffraction-limited spot, which creates an optical trap where cells suspended in aqueous solutions can be held fixed. Spermatozoa, an often probative cell type in forensic investigations, can be captured inside this optical trap and dragged one by one across millimeter-length distances in order to create a cluster of cells which can be subsequently drawn up into a capillary for collection. Sperm cells are then ejected onto a sterile cover slip, counted, and transferred to a tube for DNA analysis workflow. The objective of this research was to optimize sperm cell collection for maximum DNA yield, and to determine the number of trapped sperm cells necessary to produce a full STR profile. A varying number of sperm cells from both a single-source semen sample and a mock sexual assault sample were isolated utilizing optical tweezers and processed using conventional STR analysis methods. Results demonstrated that approximately 50 trapped spermatozoa were required to obtain a consistently full DNA profile. A complete, single-source DNA profile was also achieved by isolating sperm cells via optical trapping from a mixture of sperm and vaginal epithelial cells. Based on these results, optical tweezers are a viable option for forensic applications such as separation of mixed populations of cells in forensic evidence. [ABSTRACT FROM AUTHOR]

We inquire whether there are race and gender differences in the recovery of missing children. We argue that race and gender differences may arise due to differential media attention, socio-economic background and police resources. Datasets used in previous research lack the representativeness and longitudinal character necessary for probing victim demographic effects on recovery success. Here we use official New York State Division of Criminal Justice Services records of all children reported missing in the period 2007–2010 containing exact dates of disappearance and recovery. In event-history analysis of these data we find that missing boys and girls have comparable daily recovery chances. Black children, however, on average remain missing longer and are more likely to still be missing by the end of our observation period than non-black children. [ABSTRACT FROM AUTHOR]

Background: Non-consensual removal of condoms, colloquially referred to as ‘stealthing’, is the removal of a condom during sex by a sexual partner when consent has been given for sex with a condom only. Methods: We conducted a cross-sectional survey to determine how commonly women and men who have sex with men (MSM) attending Melbourne Sexual Health Centre had experienced stealthing, and analysed situational factors associated with the event. Responses were linked to demographic information extracted from patient files. Results: 1189 of 2883 women (41.2%), and 1063 of 3439 MSM (30.9%) attending the clinic during the study period completed the survey. Thirty-two percent of women (95% CI: 29%,35%) and 19% of MSM (95% CI: 17%,22%) reported having ever experienced stealthing. Women who had been stealthed were more likely to be a current sex worker (Adjusted Odds Ratio [AOR] 2.87, 95% CI: 2.01,4.11, p <0.001). MSM who had experienced stealthing were more likely to report anxiety or depression (AOR 2.13, 95% CI: 1.25,3.60, p = 0.005). Both female and male participants who had experienced stealthing were three times less likely to consider it to be sexual assault than participants who had not experienced it (OR 0.29, 95% CI: 0.22,0.4 and OR 0.31, 95% CI: 0.21,0.45 respectively). Conclusions: A high proportion of women and MSM attending a sexual health service reported having experienced stealthing. While further investigation is needed into the prevalence of stealthing in the general community, clinicians should be aware of this practice and consider integrating this question into their sexual health consultation. Understanding situational factors would assist in the development of preventive strategies, particularly female sex workers and MSM. [ABSTRACT FROM AUTHOR]

Background: China has witnessed a surge in violence against medical personnel, including widely reported incidents of violent abuse, riots, attacks, and protests in hospitals, but little is known about the impact of gender differences on the workplace violence against physicians of obstetrics and gynecology. The aim of this study was to analyse gender differences in workplace violence against physicians of obstetrics and gynecology in China. Methods: Printed questionnaires were sent to participants of a national congress of obstetricians and gynecologists. The questionnaire consisted of items relevant to epidemiologic characteristics, workplace violence experienced in the past 12 months, participants’ attitudes toward violence and physician–patient relationship. Data from female and male physicians were compared in univariate and multivariate analyses. Results: We sent out 1,425 questionnaires, and 1,300 (91.2%) physicians responded. Among 1,247 participants with specified gender, female and male physicians consisted of 162 (13.0%) and 1,085 (87.0%), respectively. Over the past 12 months, about two-thirds of these physicians suffered verbal abuse in the workplace, gender difference aside. After adjustment for education status, working hospital and subspecialty, male physicians had suffered more physical assaults than female colleagues (18.8% vs. 10.5%, adjusted odds ratio [OR] 2.3, 95% confidence interval [CI], 1.4–3.7), most attacks without apparent physical injuries (adjusted OR 2.3, 95% CI, 1.4–3.7). Male physicians also suffered more sexual assaults than female colleagues (5.0% vs. 1.3%, adjusted OR 4.8, 95% CI, 1.8–13.3), nearly all of verbal harassment. There were only two sexual attacks on female physicians, and no rapes occurred. Although almost all physicians regarded the current circumstance as “unhealthy and stressful”, more than half of them would take various active initiatives to create and maintain healthy and friendly physician–patient relationships. Conclusion: Male physicians of obstetrics and gynecology in China suffered the same number of verbal abuse incidents but more physical and sexual assaults than their female colleagues. Both genders had similar opinions about causes, consequences and management about work violence against physicians, and had the same pessimistic perspectives but innovative wishes for the physician–patient relationship. [ABSTRACT FROM AUTHOR]

Purpose: College-bound young people experience sexual assault, both before and after they enter college. This study examines historical risk factors (experiences and exposures that occurred prior to college) for penetrative sexual assault (PSA) victimization since entering college. Methods: A cross-sectional study, including an online population-based quantitiative survey with undergraduate students was conducted in spring 2016. Bivariate analyses and multivariable regressions examined risk and protective factors associated with ever experiencing PSA since entering college. Concurrently-collected in-depth ethnographic interviews with 151 students were reviewed for information related to factors identified in the survey. Results: In bivariate analyses, multiple historical factors were significantly associated with PSA in college including adverse childhood experiences and having experienced unwanted sexual contact before college (for women) and initiation of alcohol, marijuana, and sexual behaviors before age 18. Significant independent risk factors for college PSA included female gender, experiencing unwanted sexual contact before college, first oral sex before age 18, and “hooking up” (e.g., causual sex or sex outside a committed partnership) in high school. Receipt of school-based sex education promoting refusal skills before age 18 was an independent protective factor; abstinence-only instruction was not. In the ethnographic interviews, students reported variable experiences with sex education before college; many reported it was awkward and poorly delivered. Conclusions: Multiple experiences and exposures prior to college influenced the risk of penetrative sexual assault in college. Pre-college comprehensive sexuality education, including skills-based training in refusing unwanted sex, may be an effective strategy for preventing sexual assault in college. Sexual assault prevention needs to begin earlier; successful prevention before college should complement prevention efforts once students enter college. [ABSTRACT FROM AUTHOR]

Research suggests that poverty is a key driver of intimate partner violence (IPV), however detailed analysis suggests that this relationship is not clear, either for women’s experience or men’s perpetration of IPV. We explored associations between poverty and IPV using cross-sectional data from the Stepping Stones and Creating Futures cluster randomized control trial, in urban informal settlements in Durban, South Africa, with young (18–30) people. Using logistic regression and structural equation modelling we assess associations between poverty and women’s experience and men’s perpetration of physical and/or sexual IPV in the past 12 months. 680 women and 677 men were recruited into the study between September 2015 and September 2016. The analyses highlight how specific forms or measures of poverty intersecting with gender identities shape IPV. For men we found indicators of economic provision were associated with IPV perpetration, while for women food-insecurity was key to IPV experience. We also found similarities between women and men. First, food-insecurity and childhood traumas shaped pathways to substance misuse and poor mental health that increased IPV. Second, there was a resilience pathway in both models, whereby those with more education had increased gender equitable attitudes and fewer controlling behaviours, which reduced IPV. Interventions to reduce IPV need to work to reduce household food insecurity, but these need to be combined with gender transformative interventions. Interventions should also focus on reducing the impact of mental health and substance misuse. Finally, working to increase educational attainment is a long-term critical intervention to reduce IPV. Trial registration: . Registered 13 January 2017, retrospectively registered. [ABSTRACT FROM AUTHOR]

Sexual aggression is prevalent and damaging in our culture, and sources of support or blame following an attack of this kind can be important influences on the recovery process. This pair of studies investigate the nature of women’s blame reactions towards survivors of sexual aggression, as well as the potential for provision of sympathy and support. Specifically, we focused on the previously neglected role of female self-objectification. It was expected that increased self-objectification would lead to decreased sympathy and support, and more rape victim blame. However, results of Study 1 showed that chronic self-objectification was actually related to higher levels of sympathy and support for a rape victim. Study two built upon the limitations of study one, and examined similar questions. It was expected that women who engaged in greater self-objectification would again show greater sympathy and support for the victim, replicating study one’s results, and this was supported with a different scale. The overall relationship between self-objectification and sympathy and support was driven by body-relevant control beliefs. Implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Somatization is a major post-traumatic symptom in sexually abused children. Thus, the present study aimed to determine the relationship between post-traumatic stress disorder (PTSD) symptoms and somatization, and between intelligence and somatization in child sexual abuse victims and to elucidate whether type of abuse had an effect on the relationship between PTSD symptoms and somatization. Methods: This study evaluated the somatizations (Child Behavioral Checklist/6–18 [CBCL]), PTSD symptoms (Trauma Symptom Checklist for Children [TSCC]), and intelligence levels of 63 sexually abused children. Correlation and regression analyses were performed to predict somatization based on PTSD symptoms, intelligence, age, and type of sexual abuse, and to find moderating effect of type of abuse on the effect of PTSD symptom on somatization. Results: PTSD symptoms (β = 0.471, p = 0.001) and intelligence (β = 0.327, p = 0.021) were associated with somatization. Type of abuse was not, by itself, correlated with somatization (β = 0.158, p = 0.281), but it did have a moderating effect on the effect of PTSD symptoms on somatization (Type of abuse*PTSD symptoms, β = -0.299, p = 0.047). PTSD symptoms were associated with somatization only among those who experienced the molestation type of abuse. Conclusions: Somatization in sexually abused children was influenced by the severity of PTSD symptoms and intelligence, and the effect of the PTSD symptoms on somatization was moderated by type of abuse. Specifically, the rape type of abuse may attenuate the effect of post-traumatic symptoms on somatization. [ABSTRACT FROM AUTHOR]

It has been hypothesized that uneven sex ratios in the population could lead to increased violence. The objective of this analysis is to explore the relationship between uneven sex ratios in the population and violence. This analysis uses data collected from men in six Asian countries about their experiences and perpetration of violence. We combine this with region- and age specific sex ratios calculated from Census data to explore the relationship between sex ratios and violence using multilevel models. We find that men from region-age brackets with higher ratios of men to women are significantly more likely to report ever having raped a woman, having perpetrated intimate partner violence, or having used a weapon. We find no evidence for an association between sex ratios and reports of ever having raped a man. [ABSTRACT FROM AUTHOR]

Context: An increasing body of research has linked the geographic distribution of lead with various indicators of criminal and antisocial behavior. Objective: The current study, using data from an ongoing project related to lead exposure in St. Louis City, MO, analyzed the association between aggregate blood lead levels and specific indicators violent crime within the city. Design: Ecological study. Setting: St. Louis, Missouri. Exposure measure: Blood lead levels. Main outcome measure: Official reports of violent crimes were categorized as 1) crimes involving a firearm (yes/no), 2) assault crimes (with or without a firearm), 3) robbery crimes (with or without a firearm), 4) homicides and 5) rape. Results: With the exception of rape, aggregate blood-lead levels were statistically significant predictors of violent crime at the census tract level. The risk ratios for each of the outcome measures were as follows: firearm crimes 1.03 (1.03–1.04), assault crimes 1.03 (1.02–1.03), robbery crimes 1.03 (1.02–1.04), homicide 1.03 (1.01, 1.04), and rape 1.01 (0.99–1.03). Conclusions: Extending prior research in St. Louis, results suggest that aggregated lead exposure at the census tract level predicted crime outcomes, even after accounting for important sociological variables. Moving forward, a more developed understanding of aggregate level crime may necessitate a shift toward studying the synergy between sociological and biological risk factors such as lead exposure. [ABSTRACT FROM AUTHOR]

In Canada, Indigenous women are more likely than non-Indigenous women to be survivors of sexual assault and experience sexual assaults that are more serious in terms of physical injury and other health-related consequences. Despite their related needs for care and support, there is a paucity of research to date that has examined their uptake of specialized acute health services post sexual assault. To address this gap, we explored the presentation, sociodemographic, assailant, assault, and service use characteristics of Indigenous women, as compared to non-Indigenous adult and adolescent women aged 12 and older presenting to 30 of 35 hospital-based sexual assault treatment centres in Ontario from 2009 to 2011, using bivariate analyses. Of the 948 women in our sample, 116 (12%) identified as being Indigenous. Indigenous survivors differed significantly from non-Indigenous survivors on many presentation, sociodemographic, and assault characteristics. For example, they were more likely to present to a hospital within 24 hours of being assaulted and a treatment centre serving a primarily rural population. They tended to be younger, were more likely to be living in an institutional setting, report community or group affiliations and government or community services as sources of social support, and be assaulted by a parent, guardian, or other relative. In terms of receipt of services, they were more likely to have undergone safety planning and to be referred to child protection or community agencies. They reported high levels of satisfaction with the services received, however, were less likely than non-Indigenous survivors to rate the overall care provided as excellent or good. On the whole, the results of our study suggest that Indigenous women value acute hospital-based sexual assault services. However, they experience sexual assaults in contexts different from non-Indigenous survivors. It is important for health care providers to be attuned to this so that they can appropriately respond to their unique needs. [ABSTRACT FROM AUTHOR]

Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate students from Columbia University and Barnard College in New York City, using evidence based methods to maximize response rates and sample representativeness, and behaviorally specific measures of sexual assault to accurately capture victimization rates. This paper focuses on student experiences of different types of sexual assault victimization, as well as sociodemographic, social, and risk environment correlates. Descriptive statistics, chi-square tests, and logistic regression were used to estimate prevalences and test associations. Since college entry, 22% of students reported experiencing at least one incident of sexual assault (defined as sexualized touching, attempted penetration [oral, anal, vaginal, other], or completed penetration). Women and gender nonconforming students reported the highest rates (28% and 38%, respectively), although men also reported sexual assault (12.5%). Across types of assault and gender groups, incapacitation due to alcohol and drug use and/or other factors was the perpetration method reported most frequently (> 50%); physical force (particularly for completed penetration in women) and verbal coercion were also commonly reported. Factors associated with increased risk for sexual assault included non-heterosexual identity, difficulty paying for basic necessities, fraternity/sorority membership, participation in more casual sexual encounters (“hook ups”) vs. exclusive/monogamous or no sexual relationships, binge drinking, and experiencing sexual assault before college. High rates of re-victimization during college were reported across gender groups. Our study is consistent with prevalence findings previously reported. Variation in types of assault and methods of perpetration experienced across gender groups highlight the need to develop prevention strategies tailored to specific risk groups. [ABSTRACT FROM AUTHOR]

Background: Violence against women is often exacerbated by war, but most civilian research has investigated short term impact. We describe the conflict experiences of men and women from the general population of Bougainville Papua New Guinea, perceptions of the enduring impact of conflict, and the associations between these and the major health and development problems on the islands: mental ill-health and violence against women. Methods: Fourteen years after the end of the decade long civil war, we conducted a household survey with a random sample of adult (n = 864) men and (n = 879) women living in Bougainville. The interviews were mostly conducted face-to-face, with very sensitive questions self-completed. Results: Mental ill-health was highly prevalent, 37.8% of women and 32% of men had high levels of depressive symptomatology, 34.4% of men abused alcohol and 15.1% of women and 24.6% of men had high levels of PTSD symptoms. Among women, 23.3% had been raped in the year prior to the interview and 33.3% had experience physical or sexual partner violence. The prevalence of exposure to trauma during the civil war was very high and many of the men and women experienced lingering impact of conflict. Multiple logistic regression models showed that war trauma was associated with PTSD symptoms in women and PTSD symptoms, alcohol abuse and depressive symptoms in men. The perceived enduring impact of conflict was associated with depressive symptoms in men and women, problem drinking and suicidal thoughts in women and drug use in men. The perceived enduring conflict impact was associated with perpetration of past year rape and physical and/or sexual partner violence. Discussion: The Bougainville civil war had a devastating impact on the population’s lives. Reversing this legacy is essential but requires addressing what is perceived as the enduring social, economic and psychological impact of the conflict and a major focus on prevention of violence against women. [ABSTRACT FROM AUTHOR]

Sexual homicides of women and children are extreme forms of violence against women and children and are located within the broader context of gender inequality and social norms that condone sexual violence and gender based violence against women and children. The aim of this study is to describe the prevalence and characteristics of sexual homicide of women and children nationally in South Africa. Methods: We conducted a retrospective national mortuary based study to identify all adult female homicides (18 years and older) and all child homicides (boys and girls < 18 years) in 2009 in a randomly selected, proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three processes: from the mortuary register, the autopsy report and from police with the identification of sexual homicides validated across the data collection processes. Findings: Among the 2670 (95% CI: 2311–2979) adult women killed in 2009, 494 (95% CI: 406–574) were identified as sexual homicides which was 19.8% (95% CI: 17.6–22.0) of all adult female homicides and among 1277 (95% CI: 1091–1462) children killed in SA, sexual homicides were found in 104 (95% CI: 77–132) of the child homicides which was 8.7% (95% CI: 10.9–11.2%) of these murders. Strangulation was the most common cause of death for both children and adult females. A distinct age and sex pattern was found among children with only 1% boy child death identified as a sexual homicide and 92% of all the child sexual homicides were among girls. Strangulation was the most common manner of death among children (35.5%) and perpetrators were seldom strangers. However, no difference in the proportion of convictions between the sexual homicides and non-sexual homicides were found for both adult females and children. Conclusion: Rape homicide is not a rare event in South Africa, with one in five female homicides and nearly one in ten child homicides identified with an associated sexual crime. These high prevalences are amongst the highest levels reported in the literature with our study among the few reporting on the epidemiology of child sexual homicide. Reducing mortality is an important policy goal for South Africa and for the rest of the world and the prevention of female and child homicide is an important part of attaining this goal. [ABSTRACT FROM AUTHOR]

Introduction: In South Africa, the rate of HIV in the sex worker (SW) population is exceedingly high, but critical gaps exist in our understanding of SWs and the factors that make them vulnerable to HIV. This study aimed to estimate HIV prevalence among female sex workers (FSWs) in Soweto, South Africa, and to describe their sexual behavior and other factors associated with HIV infection. Methods: A cross-sectional, respondent-driven sampling (RDS) recruitment methodology was used to enroll 508 FSWs based in Soweto. Data were collected using a survey instrument, followed by two HIV rapid tests. Raw and RDS adjusted data were analyzed using a chi-squared test of association and multivariate logistic regression to show factors associated with HIV infection. Findings: HIV prevalence among FSWs was 53.6% (95% CI 47.5–59.9). FSWs were almost exclusively based in taverns (85.6%) and hostels (52.0%). Less than a quarter (24.4%) were under 25 years of age. Non-partner violence was reported by 55.5%, 59.6% of whom were HIV-infected. Advancing age, incomplete secondary schooling, migrancy and multiple clients increased the likelihood of HIV acquisition: >30 years of age was associated with a 4.9 times (95% CI 2.6–9.3) increased likelihood of HIV; incomplete secondary schooling almost tripled the likelihood (AOR 2.8, 95% CI 1.6–5.0); being born outside of the Gauteng province increased the likelihood of HIV 2.3 times (95% CI 1.3–4.0); and having more than five clients per day almost doubled the likelihood (AOR 1.9, 95% CI 1.1–3.2). Conclusion: Our findings highlight the extreme vulnerability of FSWs to HIV. Advancing age, limited education and multiple clients were risk factors associated with HIV, strongly driven by a combination of structural, biological and behavioral determinants. Evidence suggests that interventions need to be carefully tailored to the varying profiles of SW populations across South Africa. Soweto could be considered a microcosm of South Africa in terms of the epidemic of violence and HIV experienced by the SW population, which is influenced by factors often beyond an individual level of control. While describing a hitherto largely undocumented population of FSWs, our findings confirm the urgent need to scale up innovative HIV prevention and treatment programs for this population. [ABSTRACT FROM AUTHOR]

Study goals: To describe the differences between clients presenting after rape and clients who have consented to sex as a minor to an SGBV clinic in Harare, Zimbabwe, and how these differences affect their care requirements. Background: Adolescents and adults presenting at the specialized Sexual and Gender Based Violence clinic in Harare are offered a standardised package of free medical and psychosocial care. Zimbabwe has an HIV prevalence of 14%, so prevention of HIV infection using PEP for those that present within 72 hours is a key part of the response. STI treatment, emergency contraceptive pills, referral for termination of pregnancy, psychological, social and legal support is also provided. Methods: This is a retrospective descriptive study of routine programmatic data collected at the Edith Opperman polyclinic in Mbare SGBV clinic from 2011 to 2014. Chi-square tests and logistic regression were used to describe the different experiences and the differences in uptake of care between clients presenting for rape compared to those who consented to sex as a minor. Results: During the study period a total of 3617 clients presented to the clinic. 2242 (62%) sought care after rape, 602 (17%) for having consented to sex as a minor and 395 (11%) for suspected sexual abuse. 1615 (45%) of people presenting were 12–15 year olds. Minors who consented to sex compared to survivors of rape were less likely to report within 72 hours– 156 (26%) vs 894 (40%) p<0.001; less likely to report that they delayed due to fear– 68 (17%) vs 472 (40%) p<0.001, less likely to have experienced accompanying violence– 9 (1%) vs 176 (8%) p<0.001 or physical trauma—34 (6%) vs 427 (19%) p<0.001; and less likely to display psychological symptoms at presentation 51 (8%) vs 411 (18%) p<0.001. Minors who consented to sex compared to those who were raped were less likely to start PEP if eligible—123 (80%) vs 751 (93%) p<0.001, less likely to take emergency contraceptives if eligible—125 (81%) vs 598 (88%) p<0.001, more likely to be pregnant– 132 (23%) vs 241 (15%) p<0.001; less likely to request a termination of pregnancy if pregnant—10 (8%) vs 74 (31%) p<0.001; and less likely to come for at least one follow up 281 (47%) vs 1304 (58%) p<0.001. Conclusion: The experiences of those who consent to sex as a minor and those that have experienced forced sex were very different. The standardised SGBV medical response does not fully meet the needs to protect minors who have consented to sex from HIV or unwanted pregnancies. Clients who present for having consented to sex as a minor might benefit more from being offered long-term family planning or being assessed as a sero-discordant couple rather than simply PEP and ECP as is relevant for clients who have been raped. More provision of health care is needed for minors to ensure they have access to enough information and protection from HIV, other STIs and unwanted pregnancy, before they decide to engage in sexual intercourse, rather than as an emergency at an SGBV clinic. [ABSTRACT FROM AUTHOR]

Background: Understanding the past-year prevalence of male-perpetrated intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention and monitoring progress to Sustainable Development Goal (SDG) 5.2, but so far, population-based research on this remains very limited. The objective of this study is to compare the population prevalence rates of past-year male-perpetrated IPV and nonpartner rape from women's and men's reports across 4 countries in Asia and the Pacific. A further objective is to describe the risk factors associated with women's experience of past-year physical or sexual IPV from women's reports and factors driving women's past-year experience of partner violence.Methods and Findings: This paper presents findings from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. In the course of this study, in population-based cross-sectional surveys, 5,206 men and 3,106 women aged 18-49 years were interviewed from 4 countries: Cambodia, China, Papua New Guinea (PNG), and Sri Lanka. To measure risk factors, we use logistic regression and structural equation modelling to show pathways and mediators. The analysis was not based on a written plan, and following a reviewer's comments, some material was moved to supplementary files and the regression was performed without variable elimination. Men reported more lifetime perpetration of IPV (physical or sexual IPV range 32.5%-80%) than women did experience (physical or sexual IPV range 27.5%-67.4%), but women's reports of past-year experience (physical or sexual IPV range 8.2%-32.1%) were not very clearly different from men's (physical or sexual IPV range 10.1%-34.0%). Women reported much more emotional/economic abuse (past-year ranges 1.4%-5.7% for men and 4.1%-27.7% for women). Reports of nonpartner rape were similar for men (range 0.8%-1.9% in the past year) and women (range 0.4%-2.3% in past year), except in Bougainville, where they were higher for men (11.7% versus 5.7%). The risk factor modelling shows 4 groups of variables to be important in experience of past-year sexual and/or physical IPV: (1) poverty, (2) all childhood trauma, (3) quarrelling and women's limited control in relationships, and (4) partner factors (substance abuse, unemployment, and infidelity). The population attributable fraction (PAF) was largest for quarrelling often, but the second greatest PAF was for the group related to exposure to violence in childhood. The relationship control variable group had the third highest PAF, followed by other partner factors. Currently married women were also more at risk. In the structural model, a resilience pathway showed less poverty, higher education, and more gender-equitable ideas were connected and conveyed protection from IPV. These are all amenable risk factors. This research was cross-sectional, so we cannot be sure of the temporal sequence of exposure, but the outcome being a past-year measure to some extent mitigates this problem.Conclusions: Past-year IPV indicators based on women's reported experience that were developed to track SDG 5 are probably reasonably reliable but will not always give the same prevalence as may be reported by men. Report validity requires further research. Interviews with men to track past-year nonpartner rape perpetration are feasible and important. The findings suggest a range of factors are associated with past-year physical and/or sexual IPV exposure; of particular interest is the resilience pathway suggested by the structural model, which is highly amenable to intervention and explains why combining economic empowerment of women and gender empowerment/relationship skills training has been successful. This study provides additional rationale for scaling up violence prevention interventions that combine economic and gender empowerment/relationship skills building of women, as well as the value of investing in girls' education with a view to long-term violence reduction. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to evaluate the efficacy of four pretrial jail release mechanisms (i.e., bond types) commonly used during the pretrial phase of the criminal justice process in terms of their ability to discriminate between defendants failing to appear in court (i.e., bond forfeiture). These include attorney bonds, cash bonds, commercial bail bonds, and release via a pretrial services agency. Methods: A multi-treatment propensity score matching protocol was employed to assess between-release-mechanism differences in the conditional probability of failure to appear/bond forfeiture. Data were culled from archival state justice records comprising all defendants booked into the Dallas County, Texas jail during 2008 (n = 29,416). Results: The results suggest that defendants released via commercial bail bonds were less likely to experience failure to appear leading to the bond forfeiture process compared to equivalent defendants released via cash, attorney, and pretrial services bonds. This finding held across different offense categories. The study frames these differences within a discussion encompassing procedural variation within and between each release mechanism, thereby setting the stage for further research and dialog regarding potential justice reform. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Denis Mukwege and Marie Berg describe the One Stop Centre at Panzi Hospital in Eastern Democratic Republic of Congo that provides care for girls and women who have been raped in combination with extreme bodily harm. [ABSTRACT FROM AUTHOR]

Vaginal swabs taken in rape cases usually contain epithelial cells from the victim and sperm from the assailant and forensic DNA analysis requires separation of sperm from these cell mixtures. PH-20, which is a glycosylphosphatidylinositol-anchored hyaluronidase located on the head of sperm, has important functions in fertilization. Here we describe a newly developed method for sperm isolation using anti-PH-20 antibody-coupled immunomagnetic beads (anti-PH-20 IMBs). Optical microscopy and scanning electron microscopy showed the IMBs recognized the head of sperm specifically and exhibited a great capacity to capture sperm cells. However, we found it necessary to incubate the IMB–sperm complex with DNase I before sperm lysis in order to remove any female DNA completely. We compared the sensitivity of anti-PH-20 IMBs in sperm and epithelial cell discrimination to those coated with a different anti-sperm antibody (anti-SP-10, anti-ADAM2 or anti-JLP). Only the anti-PH-20 IMBs succeeded in isolating sperm from cell mixtures at a sperm/epithelial cell ratio of 103:105. Further, our method exhibited greater power and better stability for sperm isolation compared to the traditional differential lysis strategy. Taken together, the anti-PH-20 IMB method described here could be effective for the isolation of sperm needed to obtain a single-sourced DNA profile as an aid to identifying the perpetrator in sexual assault cases. [ABSTRACT FROM AUTHOR]

Background: Levels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings. Methods: supported health services for survivors in Lae, PNG from 2008–2013. Routine monitoring data from August 2010-April 2013 were used to describe patient and service characteristics. Results: 5,892 individuals received care over 6,860 presentations, the majority self-referred or referred by friends and family. Presentations were attributed to intimate partner violence(62%), non-partner sexual violence(15%), other forms of violence(3%), and past (but not current) violence(21%). 97% were female; an estimated 4.9% (95%CI:4.8–5.0%) of females resident in the catchment area presented to the programme during the 2.8years analysed. Of presentations for non-partner sexual violence, 79% knew their abuser and 50% were children <16 years. 92% of presentations reporting current violence received medical treatment for injuries. The majority of patients who received multiple counselling sessions reported improved functioning and decreased severity of psycho-social complaints. Conclusions: Community awareness of the availability of free, best-practice, accessible, confidential medical and counselling services for sexual and gender-based violence in Lae, PNG resulted in many survivors presenting for care. High levels of ongoing intimate partner violence and child sexual abuse by known abusers indicates that alongside comprehensive medical care, access to effective services in non-health sectors such as policing, protection and legal services are needed if survivors are to escape the cycle of violence. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Screening for violence during pregnancy is one of the strategies for the prevention of abuse against women. Since violence is difficult to measure, it is necessary to validate questionnaires that can provide a good measure of the phenomenon. The present study analyzed the psychometric properties of the World Health Organization Violence Against Women (WHO VAW) instrument for the measurement of violence against pregnant women. Methods: Data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA) were used. The sample consisted of 1,446 pregnant women from São Luís and 1,378 from Ribeirão Preto, interviewed in 2010 and 2011. Thirteen variables were selected from a self-applied questionnaire. Confirmatory factor analysis was used to investigate whether violence is a uni-or-multidimensional construct consisting of psychological, physical and sexual dimensions. The mean-and-variance-adjusted weighted least squares estimator was used. Models were fitted separately for each city and a third model combining data from the two settings was also tested. Models suggested from modification indices were tested to determine whether changes in the WHO VAW model would produce a better fit. Results: The unidimensional model did not show good fit (Root mean square error of approximation [RMSEA]  = 0.060, p<0.001 for the combined model). The multidimensional WHO VAW model showed good fit (RMSEA = 0.036, p = 0.999 for the combined model) and standardized factor loadings higher than 0.70, except for the sexual dimension for SL (0.65). The models suggested by the modification indices with cross loadings measuring simultaneously physical and psychological violence showed a significantly better fit compared to the original WHO model (p<0.001 for the difference between the model chi-squares). Conclusions: Violence is a multidimensional second-order construct consisting of psychological, physical and sexual dimensions. The WHO VAW model and the modified models are suitable for measuring violence against pregnant women. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Following the declaration that President Mwai Kibaki was the winner of the Kenyan presidential election held on December 27, 2007, a period of post-election violence (PEV) took place. In this study, we aimed to identify whether the period of PEV in Kenya was associated with systematic changes in sexual assault case characteristics. Methods and Findings: Medical records of 1,615 patients diagnosed with sexual assault between 2007 and 2011 at healthcare facilities in Eldoret (n = 569), Naivasha (n = 534), and Nakuru (n = 512) were retrospectively reviewed to examine characteristics of sexual assault cases over time. Time series and linear regression were used to examine temporal variation in case characteristics relative to the period of post-election violence in Kenya. Key informant interviews with healthcare workers at the sites were employed to triangulate findings. The time series of sexual assault case characteristics at these facilities were examined, with a specific focus on the December 2007–February 2008 period of post-election violence. Prais-Winsten estimates indicated that the three-month period of post-election violence was associated with a 22 percentage-point increase in cases where survivors did not know the perpetrator, a 20 percentage-point increase in cases with more than one perpetrator, and a 4 percentage-point increase in cases that had evidence of abdominal injury. The post-election violence period was also associated with an 18 percentage-point increase in survivors waiting >1 month to report to a healthcare facility. Sensitivity analyses confirmed that these characteristics were specific to the post-election violence time period. Conclusion: These results demonstrate systematic patterns in sexual assault characteristics during the PEV period in Kenya. [ABSTRACT FROM AUTHOR]

Objective: Building a successful combination prevention program requires understanding the community’s local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. Method: The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO’s Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. Results: We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. Conclusions: Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four ‘themes’ identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation. [ABSTRACT FROM AUTHOR]

Little is known about the climate of the scientific fieldwork setting as it relates to gendered experiences, sexual harassment, and sexual assault. We conducted an internet-based survey of field scientists (N = 666) to characterize these experiences. Codes of conduct and sexual harassment policies were not regularly encountered by respondents, while harassment and assault were commonly experienced by respondents during trainee career stages. Women trainees were the primary targets; their perpetrators were predominantly senior to them professionally within the research team. Male trainees were more often targeted by their peers at the research site. Few respondents were aware of mechanisms to report incidents; most who did report were unsatisfied with the outcome. These findings suggest that policies emphasizing safety, inclusivity, and collegiality have the potential to improve field experiences of a diversity of researchers, especially during early career stages. These include better awareness of mechanisms for direct and oblique reporting of harassment and assault and, the implementation of productive response mechanisms when such behaviors are reported. Principal investigators are particularly well positioned to influence workplace culture at their field sites. [ABSTRACT FROM AUTHOR]

Objectives: Intimate partner violence (IPV) is associated with increased risk of HIV among women globally. There is limited evidence and understanding about IPV and potential HIV risk pathways among sex workers (SWs). This study aims to longitudinally evaluate prevalence and correlates of IPV among street and off-street SWs over two-years follow-up. Methods: Longitudinal data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010–2012). Prevalence of physical and sexual IPV was measured using the WHO standardized IPV scale (version 9.9). Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine interpersonal and structural correlates of IPV over two years. Results: At baseline, 387 SWs had a male, intimate sexual partner and were eligible for this analysis. One-fifth (n = 83, 21.5%) experienced recent physical/sexual IPV at baseline and 26.2% over two-years follow-up. In multivariable GEE analysis, factors independently correlated with physical/sexual IPV in the last six months include: childhood (<18 years) sexual/physical abuse (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI]: 1.14–3.69), inconsistent condom use for vaginal and/or anal sex with intimate partner (AOR = 1.84, 95% CI: 1.07–3.16),