Towards a comprehensive test specification for normative adolescent fears: a conservation of resources perspective.

OBJECTIVE: This study assessed the extent to which the primary tenets of Conservation of Resources theory provide an adequate basis for categorising and conceptualising normative adolescent fears. METHOD: Initial descriptive research, using data obtained from a sample of South African adolescents (n = 163), used systematic emergent content analysis to develop a test specification (i.e., content domains and manifestations of content domains) relevant to measures of normative adolescent fears, with subsequent a priori content analyses being used to explore the content validity of the test specification with respect to the item-content of selected normative childhood and adolescent fear schedules. RESULTS: Analyses suggest that content domains proposed by Conservation of Resources theory provide an adequate (exhaustive and mutually exclusive) basis for reliably conceptualising and categorising normative adolescent fears and for predicting the valence of specific adolescent fears. CONCLUSIONS: A Conservation of Resources perspective was found to be of heuristic value in exploring content domains relevant to normative adolescent fears, and would appear to hold promise as a useful conceptual framework for future research in the field.

Perpetration, revictimization, and self-injury: traumatic reenactments of child sexual abuse in a nonclinical sample of South African adolescents.

Risk factors for traumatic reenactments of child sexual abuse experiences (perpetration, revictimization, and self-injury) were examined in a sample of 718 South African secondary school adolescents. Logistic regression analyses indicated that the most consistent predictors of reenactments were a history of child sexual abuse (rape and/or indecent assault) and respondents' gender, with males being significantly more likely than females to report perpetration (OR = 13.5) and females being more likely to report revictimization (OR = 3.2) and self-injury (OR = 2.5). An analysis restricted to respondents with a history of child sexual abuse indicated that negative abuse-related cognitions were the most consistent predictor of all forms of traumatic reenactment.

Development and preliminary validation of a screen for interpersonal childhood trauma experiences among school-going youth in Durban, South Africa.

This paper describes the development and preliminary validation of the Developmental Trauma Inventory (DTI), which is a 36-item, retrospective, self-administered screen for interpersonal childhood trauma experiences developed specifically for the South African context. Preliminary validation of the inventory was conducted using a sample of 720 school-going adolescents attending a high school in the Durban Metropolitan area (South Africa). Factor analysis produced the best fit for a 10-factor model (emotional abuse, community assault, domestic assault, poverty, witnessing community violence, witnessing domestic violence, indecent assault, domestic neglect, rape, and domestic injury). Contrary to expectations, items relating to loss and separation (e.g. death of a parent) did not produce a clear factor structure. Identified scales had good internal consistency (0.70 to 0.81), low factor inter-correlations, and high concurrent criterion-related validity in the sense that all scales were significantly correlated with scores on clinical measures of post-traumatic stress disorder (PTSD) and/or complex PTSD. These findings provide preliminary support for the utility of DTI in the South African context.

Professional services for child rape survivors: A child-centred perspective on helpful and harmful experiences.

OBJECTIVE: The aim of this study was to explore child rape survivors' perceptions of helpful and harmful experiences at the hands of professional service providers. METHOD: Focused interviews were conducted with a convenience sample of 20 child rape survivors who had presented for counselling services at a non-governmental organisation located in the coastal region of KwaZulu-Natal, South Africa. For each case, information was obtained regarding children's perceptions of helpful and harmful experiences at the hands of police, medical and criminal justice system personnel. RESULTS: A thematic analysis of children's responses indicated that the concerns expressed by respondents reflected four basic inter-related needs and rights including the need and right: to be given a voice, to be informed and consulted, to be protected from harm, and for competent and efficient service provision. Study findings provided little support to the view that the medico-legal examination or the adversarial nature of legal proceedings are likely to be experienced as particularly distressing or traumatising for the child. CONCLUSIONS: Study findings indicate that the professional services provided to some child rape survivors fail to adequately address the child's basic needs and rights, with there being an associated need for improved codes of practice designed to better serve the interests of child rape survivors.

Where the streets have no names: factors associated with the provision of counselling and social work services for child rape survivors in KwaZulu-Natal, South Africa.

OBJECTIVE: The aim of this study was to audit the provision of state-assisted counselling and social work services to child rape survivors presenting for medico-legal assessment at a state hospital in KwaZulu- Natal, South Africa. METHOD: A prospective design was used to collect data from the social and medical case files of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa). For each case, information was obtained regarding survivor and offender demographics, the nature and duration of abuse, and the extent and nature of counselling and social work services provided. RESULTS: Only 49% of survivors benefited from state-supported counselling and social work services, with the provision of such services being frequently delayed (by periods of up to six months), and with service provision being restricted to a single intake interview in all but one case. Social work service provision was significantly less likely in cases where the survivor resided in an informal dwelling (OR = 0.507) and where the child presented for medico-legal assessment outside of normal working hours (OR = 0.625). From observations made during the study, it would appear that patterns of professional collaboration in relation to service provision for child rape survivors falls somewhat short of the ideal of effective multi-sectoral engagement. CONCLUSIONS: Levels of service provision observed in the study are unacceptably low, with there being a clear need for the development and implementation of carefully considered multi-sectoral protocols which are designed to effectively meet the needs of all child rape survivors.

HIV post-exposure prophylaxis for child rape survivors in KwaZulu-Natal, South Africa: who qualifies and who complies?

OBJECTIVE: Our objective was to audit the provision and utilization of HIV post-exposure prophylaxis (PEP) to child rape survivors in the Province of KwaZulu-Natal, South Africa. METHODS: A prospective design was used to collect data from a convenience sample of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa) in the period October to December 2004. For each case, information was obtained regarding demographic characteristics of the child, the child's HIV status at presentation, any excluding factors for PEP therapy, and the extent of adherence to the antiretroviral therapy regimen. RESULTS: One hundred and twenty children (60%) qualified for PEP provision, with children being excluded because they refused initial HIV testing (1.5%), tested HIV positive at presentation (6.5%), or because of delayed (>72hour) presentation (32%). Of the 113 children who were followed through the PEP provision system, 40 (35.4%) returned for the full 28-day course, and only 4 (3.5%) returned at both 3- and 6-month follow up. CONCLUSIONS: Adherence rates for PEP therapy following child rape in South Africa are extremely low, with low adherence rates being associated with a theoretical risk of both reduced efficacy and drug resistance. In this context, there is a need for further research designed to identify the reasons for such non-adherence as well as a need for secondary prevention programs designed to both encourage more immediate reporting of child rape and to increase adherence to the PEP regimen.

Nonsupportive disclosure in child sexual abuse: confidants' characteristics and reactions.

In a sample of 856 South African child victims of sexual abuse (M age= 10.2 yr., SD=4.2), 26% experienced nonsupportive reactions at initial disclosure, with nonsupportive reactions taking two forms, ignoring the child (16% of cases) and punishing or silencing the child (10% of cases). Nonsupportive disclosure was equally likely when the confidant was a nonoffending guardian (OR= 1.00), another family member (OR= 0.84), or a professional person (OR= 1.07) but significantly more likely in cases where the confidant was a community member (OR=3.41).

Provision of antiretroviral prophylaxis to child rape victims in South Africa: HIV status and delayed reporting.

In a sample of 780 South African child victims of rape (girls under the age of 18 years; age M= 10.5 yr., SD=4.8), 10% did not qualify for antiretroviral prophylaxis because HIV status at presentation was positive and a further 34.1% did not qualify because the rape was reported more than 72 hours after the alleged offense. Regression analyses indicated that child rape victims who reported that they had been sexually active prior to the rape constitute a particularly high risk group for HIV infection and suggest primary and secondary prevention programs should be designed to decrease sexual activity among children and to encourage more immediate reporting of rape among younger children, children who are not sexually active, and children who are incestuously abused.

Sexual abuse of boys in KwaZulu-Natal, South Africa: a hospital-based study.

Objective - The aim of the study was to determine the prevalence and factors associated with child sexual abuse in a total sample of boys referred for medico-legal assessment in a peri-urban area of KwaZulu-Natal, South Africa. Method - A retrospective analysis was undertaken of clinical and social work records for sexually abused boys presenting for medico-legal assessment at the Mahatma Gandhi Memorial Hospital (Phoenix, KwaZulu-Natal) during the period January 2001 to December 2003. Results - In the period reviewed, 131 boys reported an incident of sexual abuse with temporal trends indicating a significant increase in the incidence of reported abuse over the three year period. Most victims fell in the 4-11 year age category, anal penetration constituted the most common form of abuse (86% of cases), and perpetrators were predominantly persons who were known to the child. Conclusion - Study findings indicate that the sexual abuse of boys constitutes a sizeable and emerging problem in peri-urban communities in South Africa. Evidence suggests that increased rates of victimisation are associated with a breakdown in family support networks in the context of rapid urbanisation.

Prevalence and attitudinal predictors of child sexual offending in a nonforensic sample of South African high school males.

Objective - The prevalence, and attitudinal predictors, of sexual aggression were examined in a non-forensic sample of South African high school males. Method - Survey questionnaires were administered to 446 males (aged 16 to 25 years) attending schools in the greater Durban area, South Africa. Results - A history of sexually aggressive behaviour was reported by 66.8% of respondents, with 17.5% reporting an act of sexual aggression that met the legal definition of rape or attempted rape. A multivariate analysis of variance indicated a significant relationship between sexually abusive behaviour and attitudes supportive of both sexual and physical aggression. Additionally, a tendency to attribute blame to the victim of sexual aggression and attitudes reflecting an internalised culture of violence significantly discriminated between respondents who committed rape/attempted rape, indecent assault, and crimen injuria. Conclusions - These findings indicate relatively high rates of sexual offending among South African high school males and suggest that primary prevention programmes are likely to be most effective if they target attitudes supportive of both sexual and physical violence.

Lexical redescription of child sexual abuse in the South African English-language press.

Content analysis of 1,044 child sexual abuse reports over an 8-yr. period in the South African English-language press indicated that 8.5% (n=89) of reports use the language of consensual sexual activity to describe the abuse, with this percentage remaining constant over the 8-yr. period reviewed.

Unsolicited interpretation of child sexual abuse media reports.

OBJECTIVE: The purpose of the study was to investigate the extent and nature of spontaneous attributional activity elicited by a newspaper report of child sexual abuse. METHOD: One hundred and seventy-six respondents, who were recruited through appeals placed in the letters column of a local newspaper, were presented with a newspaper report that described either a stereotype-congruent (rape by stranger in a public place) or a stereotype-incongruent (indecent assault by father at home) abuse incident. Respondents were asked to provide written descriptions of their thoughts and feeling about the abuse incident, which were analysed for attributional content. RESULTS: Ninety-three percent of respondents provided one or more attributional statement, with attributional statements comprising 27% of all statements. Statements implying offender culpability were the most frequently employed attributional category (78% of all attributional judgments) while statements implying victim culpability comprised less than 2% of attributional judgments. Respondents who read the stereotype-incongruent description made more unsolicited causal and moral attributions than did respondents who read the stereotype-congruent description. CONCLUSIONS: The results suggest that newspaper reports of child sexual abuse do elicit spontaneous attributional activity, that statements implying offender culpability are the most frequently employed attributional category, and that attributional activity is inhibited by stereotype congruent depictions of abuse. Implications for research and for prevention are discussed.