7 seXual abuse

Child sexual abuse is a global phenomenon that occurs across cultures and socio-economic groupings with profound long-term physical and mental health consequences. Little is known about its prevalence and its treatment and prevention is under-researched. Globally, estimates show that between 7-37% of females and 5-10% of male children have experienced sexual abuse. In South Africa, one in six of all reported chronic sexual abuse cases is a girl under the age of 12 years. The social context of child sexual abuse in South Africa hinges on inequality and patriarchal constructions of masculinities which reinforces male dominance over women and girls, thereby increasing their vulnerability. Unequal power relations promote notions of male sexual entitlement and often lead to abuse without fear of its consequences. Parenting practices, harsh discipline, as well the unwavering respect for elders all provide the space for such acts to occur without resistance. Although sexual violence is predominantly perpetrated by men against women and girls, sexual abuse of young boys is a growing concern internationally. Very little is known about the scale and nature of sexual abuse of boys, however, emerging research in South Africa estimate that one in 10 men in adulthood, report having been sexually abused by other men. The consequences of sexual abuse of boys and girls can be severe, and may include Post-Traumatic Stress Disorder (PTSD) symptoms, depression, suicidal notions and attempts and inappropriate sexualised behaviour. The lack of an integrated service at health facilities and insensitive caregiver responses, as well as stigma of child sexual abuse, hampers access to effective treatment. Although South Africa has enabling legislation, policy frameworks and guidelines, these address sexual abuse mostly from a medico-legal perspective and do not address therapeutic responses to provide for the psycho-social or emotional needs of the child and his/her family. Limited resources and limited or lack of skills at health facilities in South Africa impact on the ability to deliver effective treatment. South Africa urgently requires a government-backed coherent, multi-sectoral response based on effective models of care in low economic settings to achieve effective long-term recovery for survivors. keywords: child sexual abuse, mental health consequences, multi-sectoral responses 1 To whom correspondence may be addressed: Shanaaz Mathews, Gender and Health Research Unit, Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa. Email: [email protected].