Associations between mental distress, poly-victimisation, and gender attitudes among adolescent girls in Cambodia and Haiti: an analysis of Violence Against Children surveys.

This study aims to explore the effects of poly-victimisation (defined as the experience of multiple different forms of violence, including physical, emotional, and/or sexual) and gender attitudes on mental distress and suicidal ideation among adolescent girls, using cross-sectional nationally representative household survey data from Cambodia and Haiti. Data used were from 555 and 675 adolescent girls aged 13 to 19 from the 2013 Cambodia and 2012 Haiti Violence Against Children Surveys, respectively. Weighted bivariate and multivariate logistic regression analyses were used to assess the relationship between poly-victimisation and gender attitudes with severe mental distress and suicidal ideation, controlling for a range of factors. The results suggest that poly-victimisation is associated with severe mental distress and suicidal ideation among adolescent girls in both countries. Gender attitudes can serve as either a risk or protective factor. For example, in Haiti, respondents who agreed that women should tolerate violence to keep their family together were more likely to experience mental distress, but less likely to have had suicidal thoughts. The study's findings illustrate the need for further research on how gender norms and attitudes as well as experiences of multiple different forms of violence impact adolescent mental health.

Sex and age effects in past-year experiences of violence amongst adolescents in five countries.

PURPOSE: To date, there has been insufficient focus on age and sex differences in studies of violence amongst adolescents and young adults in low- and middle-income countries. As adolescence is a formative period during which experiencing violence can have both short- and long-term consequences, we aim to investigate experiences of violence by age and sex across five countries. METHODS: Incidences of past-year violence victimization were estimated by sex across two-year age bands (13-24 years) using Violence Against Children Survey datasets from Cambodia, Haiti, Kenya, Malawi, and Tanzania. Analyses were conducted separately for each country. The presence of an association with age and each type of violence was identified using logistic regressions separately by sex. Sex was then added to the models as an interaction term and adjusted Wald tests were used to assess differences between males and females in age effects. RESULTS: Risk of physical violence by both an adult caregiver and a community member decreased with age for both sexes in all countries. In contrast, risk of IPV increased with age for both sexes in all countries. Although some countries displayed a steeper increase in risk of IPV and sexual violence with age for males, females face higher overall levels of risk for these forms of violence. CONCLUSION: Findings highlight how adolescents' and young adults' risk of violence changes with age and type of violence. The analysis underscores the importance of collecting violence data disaggregated by age and sex to best inform policies and programming. IMPLICATIONS AND CONTRIBUTIONS: We analyzed five Violence Against Children Surveys (VACS) and found age effects for physical, sexual, and intimate partner violence for adolescents 13-24 years old. Age effects for sexual violence are stronger among females than males. Future policies targeting adolescents should consider how age and gender influence risk of violence.

Prevalence of sexual violence against children and use of social services - seven countries, 2007-2013.

Sexual violence against children erodes the strong foundation that children require for leading healthy and productive lives. Globally, studies show that exposure to violence during childhood can increase vulnerability to a broad range of mental and physical health problems, ranging from depression and unwanted pregnancy to cardiovascular disease, diabetes, and sexually transmitted diseases, including human immunodeficiency virus (HIV). Despite this, in many countries, the extent of sexual violence against children is unknown; estimates are needed to stimulate prevention and response efforts and to monitor progress. Consequently, CDC, as a member of the global public-private partnership known as Together for Girls, collaborated with Cambodia, Haiti, Kenya, Malawi, Swaziland, Tanzania, and Zimbabwe to conduct national household surveys of children and youth aged 13-24 years to measure the extent of violence against children. The lifetime prevalence of experiencing any form of sexual violence in childhood ranged from 4.4% among females in Cambodia to 37.6% among females in Swaziland, with prevalence in most countries greater than 25.0%. In most countries surveyed, the proportion of victims that received services, including health and child protective services, was ≤10.0%. Both prevention and response strategies for sexual violence are needed.

Preventing sexual violence and HIV in children.

BACKGROUND: Evidence linking violence against women and HIV has grown, including on the cycle of violence and the links between violence against children and women. To create an effective response to the HIV epidemic, it is key to prevent sexual violence against children and intimate partner violence (IPV) against adolescent girls. METHODS: Authors analyzed data from national household surveys on violence against children undertaken by governments in Swaziland, Tanzania, Kenya, and Zimbabwe, with support of the Together for Girls initiative, as well as an analysis of evidence on effective programmes. RESULTS: Data show that sexual and physical violence in childhood are linked to negative health outcomes, including increased sexual risk taking (eg, inconsistent condom use and increased number of sexual partners), and that girls begin experiencing IPV (emotional, physical, and sexual) during adolescence. Evidence on effective programmes addressing childhood sexual violence is growing. Key interventions focus on increasing knowledge among children and caregivers by addressing attitudes and practices around violence, including dating relationships. Programmes also seek to build awareness of services available for children who experience violence. DISCUSSION: Findings include incorporating attention to children into HIV and violence programmes directed to adults; increased coordination and leveraging of resources between these programmes; test transferability of programmes in low- and middle-income countries; and invest in data collection and robust evaluations of interventions to prevent sexual violence and IPV among children. CONCLUSIONS: This article contributes to a growing body of evidence on the prevention of sexual violence and HIV in children.

Meeting the family planning needs of women living with HIV in US government global health programs.

The integration of health programs, including HIV and voluntary family planning, is a priority for US government foreign assistance. One critical component of family planning and HIV integration that has significant positive health outcomes is ensuring that all women living with HIV have access to both a full range of contraceptives and safe pregnancy counseling. This article outlines the US government global health strategy to meet the family planning needs of women living with HIV based on three key principles: a focus on reproductive rights through voluntarism and informed choice, quality service provision through evidence-based programming, and development of partnerships.