The Need for a Prevention Program for Child Sexual Abuse in Brazil: A Report of Shortfall Care to Pedophilia and its Critical Consequences.

From a case report of a person with pedophilic disorder, this paper focuses on the issue of pedophilia, child sexual abuse, and the need for specific prevention and treatment strategies in Brazil. It seems inevitable to increase awareness for this topic within the mental health care system to protect children and reduce the risk for sexual offense in individuals at-risk. This is a case report of an individual, known by medical-psychiatric and forensic facilities for a past history of patricide, who revealed his pedophilic fantasies and behavior belatedly. To assess a pedophilic disorder and screen for other paraphilic contents, a screening questionnaire and clinical interview were used during the patient hospitalization in 2020 for a proper evaluation of sexual history and past offending behaviors. A review of the literature on pedophilia prevention programs was also carried out. WW is a middle-aged man admitted to a psychiatric unit for a severe episode of major depressive disorder and at risk of suicide. During recovery, he reported pedophilic fantasies and behaviors in his life. Sexual fantasies involving children and actual sexual offenses have remained unknown to mental health professionals and unreported to legal authorities. WW's case alarmingly emphasizes the need for the training of health care professionals and for preventive strategies in Brazil for those who are at risk of engaging in offending sexual behaviors in a combined and intensive effort to protect children from sexual offense.

A Cross-Sectional Analysis of Parental Behavior and Adolescent Mental Health in Mexico: Insights into Excessive Alcohol Intake, Tobacco Use, Suicidal Behavior, and Depressive Symptomatology.

Depression, suicidal behavior, excessive alcohol intake, and tobacco use are the main mental health problems in adolescents. To address these problems, it is necessary to understand the many factors associated with them, including parental factors. The aim of this study was to assess the associations between parental behavior and mental health problems in adolescents in Mexico. Data from the National Health and Nutrition Survey (ENSANUT) 2018-2019, representative for Mexico, were used. Households in which a parent-adolescent child pairing was identified (regardless of family type) were selected; n = 8758 households. The four outcomes of interest that were measured in the adolescents were: excessive alcohol intake, tobacco use, suicidal behavior, and depressive symptomatology. Logistic regression models using the adjusted odds ratio (AOR) and 95% confidence interval (95% CI) were estimated. Adolescents whose parents used alcohol or tobacco and reported depressive symptoms and suicidal behavior were more likely to present these behaviors themselves (AOR = 1.47, 95% CI: 1.17-1.85; AOR = 2.26, 95% CI: 1.51-3.39; AOR = 2.61, 95% CI: 1.88-3.61; AOR = 1.74, 95% CI: 1.16-2.61, respectively). Child sexual abuse was also strongly associated with the four outcomes of interest in adolescents (AOR = 1.89, 95% CI: 1.06-3.36 for excessive alcohol intake; AOR = 2.97, 95% CI: 1.49-5.91 for tobacco use; AOR = 5.15, 95% CI: 3.27-8.09 for depressive symptoms; AOR = 6.71, 95% CI: 4.25-10.59 for suicidal behavior). The family constitutes the central nucleus of care for children and adolescents; therefore, any effort to promote adolescent mental health must necessarily involve their parents and family.

Repercussões psicológicas de adultos que sofreram abuso sexual na infância / Psychological repercussions of adults who suffered sexual abuse in childhood

Objetivo: correlacionar o abuso sexual na infância com as repercussões psicológicas na idade adulta, das vítimas e destacar a importância de abordar o despreparo do sistema judiciário, a culpabilização das vítimas e as falhas no acesso à educação e à informação sobre sexualidade. Métodos: uma revisão de literatura foi conduzida utilizando métodos descritivos e analíticos, com a utilização de dados publicados nos últimos 10 anos, nas bases de dados PubMed e Scielo Brasil. Resultados: foram selecionados 13 artigos do PubMed e 10 artigos do Scielo Brasil para análise. Observa-se que o abuso sexual na infância tem repercussões que vão além do nível psicológico e cognitivo, afetando outras áreas, como mudanças na estrutura cerebral, problemas de saúde física, desenvolvimento de comportamentos de risco e dificuldades em estabelecer relações sociais, além de redução na expectativa de vida. Conclusões: são muitos os impactos negativos na vida de vítimas de abuso sexual infantil. O cuidado físico e psicológico voltado às vítimas de abuso infantil vai além da infância, demandando atenção nos anos subsequentes e durante a vida adulta, uma vez que o trauma repercute de formas diferentes, gerando repercussões negativas na qualidade de vida dos abusados. Verifica-se a necessidade de implementação de estratégias de ensino e capacitação para profissionais da área da educação, a fim de identificar e denunciar casos de violência sexual, bem como a imprescindibilidade em criar espaços para abordagem desse tema nas escolas.

Objectives: to correlate sexual abuse in childhood with the psychological repercussions of the victims in adulthood and highlight the importance of addressing the lack of preparation of the judicial system, the blaming of victims, and failures in access to education and information about sexuality. Methods: a literature review was conducted using descriptive and analytical methods using data published in the last ten (10) years in the PubMed and Scielo Brasil databases. Results: 13 articles from PubMed and ten (10) articles from Scielo Brasil were selected for analysis. It is observed that sexual abuse in childhood has repercussions that go beyond the psychological and cognitive level, affecting other areas, such as changes in brain structure, physical health problems, development of risk behaviors, and difficulties in establishing relationships and social benefits, in addition to a reduction in life expectancy. Conclusions: there are many negative impacts on the lives of victims of child sexual abuse. Physical and psychological care aimed at victims of child abuse goes beyond childhood, demanding attention in subsequent years and during adult life since the trauma has repercussions in different ways, generating negative epercussions on the quality of life of those abused. There is a need to implement teaching and training strategies for professionals in the field of education to identify and report cases of sexual violence, as well as the essential need to create spaces to address this issue in schools.

Práticas de avaliação psicológica em suspeitas de abuso sexual infantil intrafamiliar no contexto do judiciário do estado do Rio de Janeiro / Psychological assessment practices in cases of suspected intrafamilial child sexual abuse in the context of the judiciary power in the state of Rio de Janeiro / Les pratique s de l'évaluation psychologique en cas de suspicion d e violence sexuel intrafamilial chez l' enfant dans le contexte judiciaire de l'état de Rio de Janeiro / Prácticas de evaluación psicológica en presuntas víctimas de abuso sexual infantil intrafamiliar en el Poder Judicial del estado de Río de Janeiro

Resumo: O artigo apresenta os resultados da pesquisa que investigou as práticas em avaliação psicológica realizadas pelos psicólogos forenses do judiciário fluminense nos processos judiciais envolvendo suspeita de abuso sexual infantil intrafamiliar. Foram realizadas entrevistas qualitativas com quatro analistas judiciários do Tribunal de Justiça do Estado do Rio de Janeiro (TJRJ) e duas psicólogas peritas judiciais. A partir da análise de conteúdo de Bardin, emergiram três categorias: avaliação psicológica: percepções e recursos; perícias psicológicas em casos de abuso sexual infantil intrafamiliar; e dificuldades dos psicólogos forenses no contexto do TJRJ. Concluiu-se que as práticas avaliativas são diversas e que há pouca abertura por parte dos psicólogos forenses e da instituição judiciária fluminense para a utilização de instrumentos psicológicos além das entrevistas. O espaçamento temporal entre a ocorrência da violência e a perícia, o alto volume de trabalho e os curtos prazos processuais foram complicadores referidos por todos os participantes.

Abstract: This study investigated the practices in Psychological Assessment carried out by Rio de Janeiro judiciary forensic psychologists in judicial proceedings involving suspected intrafamilial child sexual abuse. For that, six forensic psychologists linked to the Court of Justice of the State of Rio de Janeiro were interviewed. Participants included four judicial analysts occupying positions of psychologists and two psychologists who are judicial experts. Based on Bardin's content analysis, three categories emerged. Psychological Assessment: perceptions and resources; psychological expertise in cases of intrafamilial child sexual abuse and difficulties faced by forensic psychologists in the context of the Court of Justice. We found diverse evaluative practices and scarce spaces for the use of psychological instruments besides interviews. The temporal spacing between the occurrence of violence and expertise, the high volume of work, and the short procedural deadlines configured complicating factors according to all participants.

Résumé : L'article expose les résultats de la recherche qui a enquêté sur les pratiques d'évaluation psychologique réalisées par des psychologues légistes de la justice de Rio de Janeiro dans le cadre de procédures judiciaires impliquant des violences sexuels intrafamiliaux présumés chez des enfants. Des entretiens qualitatifs ont été réalisés avec quatre analystes judiciaires du Tribunal de Justiça do Rio de Janeiro (TJRJ) [Cour d'Appel de l'État de Rio de Janeiro] et deux psychologues judiciaires experts. De l'analyse de contenu de Bardin, trois catégories ont émergé : évaluation psychologique : perceptions et ressources ; expertise psychologique dans les cas de violence sexuel intrafamiliaux chez les enfants ; et difficultés des psychologues judiciaires dans le cadre du TJRJ. Nous concluons que les pratiques évaluatives sont diverses et qu'il y a peu d'ouverture pour l'utilisation d'instruments psychologiques en dehors des entretiens. L'espacement temporel entre la survenance de la violence et l'expertise, le volume de travail important et les courts délais de procédure ont été des facteurs de complication mentionnés par tous les participants.

Resumen: Este artículo expone los resultados de la investigación que tuvo como objetivo conocer las prácticas de evaluación psicológica realizadas por psicólogos forenses del Poder Judicial de Río de Janeiro en procesos judiciales que involucran a presuntas víctimas de abuso sexual infantil intrafamiliar. Se realizaron entrevistas cualitativas a cuatro analistas judiciales del Tribunal de Justicia del Estado de Río de Janeiro (TJRJ) y dos peritos psicólogos judiciales. Del análisis de contenido de Bardin surgieron tres categorías: evaluación psicológica: percepciones y recursos; pericia psicológica en casos de abuso sexual infantil intrafamiliar; y dificultades de los psicólogos forenses en el contexto del TJRJ. Se concluyó que las prácticas evaluativas son diversas y que hay poco espacio para el uso de herramientas psicológicas más allá de las entrevistas. El espaciamiento temporal entre la ocurrencia de la violencia y la pericia, el alto volumen de trabajo y los cortos plazos procesales fueron los factores de complicación mencionados por todos los participantes.

Aportes del psicoanálisis a los estudios de abuso sexual infantil: Análisis del discurso de la madre de una niña abusada sexualmente / Contributions of psychoanalysis to studies of child sexual abuse: Mother's speech analysis about her sexually abused daughter

Se presentan los resultados dela tesis doctoral sobre los deseos y defensas (y sus estados) de la madre de una niña abusada sexualmente, con el objetivo de conocer su estructuración subjetiva en este difícil acontecimiento. Se trata de un estudio de caso en el que se usa como método el Algoritmo David Liberman (ADL), en el análisis del discurso de la madre, seleccionadas tres sesiones y una carta manuscrita. El estudio de deseos y defensas puede contribuir a describir y conocer el posicionamiento subjetivo de una madre frente a la situación abusiva de su hija, y como ésta es vivida por ella AU

The results of the doctoral thesis on the wishes and defenses (and their states) of the mother of a sexually abused girl are presented, with the aim of knowing her subjective structuring in this difficult event. This is a case study in which the David Liberman Algorithm (ADL) is used as a method in the analysis of the mother's speech, three sessions and a handwritten letter selected. The study of desires and defenses can contribute to describing and knowing the subjective position of a mother in the face of her daughter's abusive situation, and how it is experienced by her AU

A systematic review of the measurement properties of self-report screening tools to detect risk or exposure to child sexual abuse for children under 12.

Child sexual abuse (CSA) is a substantial public health issue that is challenging to measure epidemiologically due to the "pact of silence" among those involved. Validated tools could contribute to early recognition or risk detection for CSA. We aimed to systematically assess self-report tools' measurement properties and methodological quality that detect risk or exposure to CSA for children under twelve. The search strategy, selection criteria, data extraction, data analysis, and synthesis followed the COSMIN methodology for systematic reviews (2018). PROSPERO 2021 registration CRD42021278465. MEDLINE, COCHRANE, EMBASE, CINAHL, SCOPUS, and ERIC were searched until August 2021, with an updated search on September 23, 2021, and unlimited by language. The inclusion criteria were: to assess risk or exposure to CSA under twelve years old by objective items and self-report tools; sexual violence risk or exposure in the domestic context; the application context should include health facilities (such as hospital emergency rooms, outpatient clinics, pediatric wards, psychology centers, social services), education (such as schools) and community; no language or date restriction. The exclusion criteria were: non-self-report tools studies, comprehensive articles, comments, editorials, expert opinions, and studies of projective techniques. The COSMIN risk of bias checklist was used to evaluate the methodological quality of the included studies. Feasibility aspects were assessed. This study had no funding source; 29 studies describing eight tools met eligibility criteria. No single instrument reported all nine measurement properties outlined by the COSMIN methodology. The strength of the evidence was moderate to high for six out of eight instruments. ICAST-C and JVQ were the tools that obtained the highest number of rated measurement properties and strength of evidence.

Sexual Victimization of Children and Adolescents: A Qualitative Study with Brazilian Undergraduates on Disclosure, Detection, Outcomes, and Consequences.

This qualitative study aimed to discover whether experiences of sexual violence suffered by a sample of adolescents and young-adults at a Brazilian public health had been disclosed or detected, why or why not, and what happened after disclosure or detection. Seventy-one (8.3%) students were victims of sexual violence, and 52 (73.2%) were females. The researchers interviewed 22 participants to obtain an oral history of these abuse experiences. The 22 interviewees had experienced 29 episodes of violence. Acquaintances had perpetrated 26 of these attacks, and of these 26 only four (15.4%) occurrences were never disclosed. Twenty-two experiences were disclosed or detected, of which four (18.2%) were promptly revealed (days after the event), resulting in a discontinuation of the violence. Unfortunately, molestation continued without intervention in nine (41.0%) of the revealed situations, despite disclosure or detection. The authors find that children or adolescents disclosing their experiences of sexual violence cannot end the attacks. This study identifies an urgent need to educate society about how to respond appropriately to revelations of sexual violence. Children or adolescents must be oriented to disclose their abuse and seek help from as many people as necessary until they are heard, believed and the violence is ended.

Quebra do silêncio em grupo on-line de enfrentamento ao abuso sexual infantil / Rompiendo el silencio en un grupo online que enfrenta abuso sexual infantil / Breaking the silence in a group on-line facing child sexual abuse

RESUMO O presente artigo apresenta um recorte dos dados coletados em entrevistas durante pesquisa etnográfica on-line acerca da exposição das vivências de vítimas de violência sexual em grupo no Facebook intitulado 'Luta contra o abuso sexual infantil'. Entendemos que os relatos funcionam como uma possibilidade de quebra do pacto de silêncio e se constituem como o início da elaboração do trauma psíquico. As interações no grupo foram registradas em diário de campo durante o período de quatro meses de acompanhamento e os dados aprofundados em dez entrevistas semiestruturadas com participantes contactadas por meio de convite postado no grupo. As entrevistas aconteceram por vídeochamada e perguntavam sobre o sentido que elas produzem ao utilizar o grupo, refletindo sobre a possibilidade de ultrapassar a condição de vítimas. Verifica-se que o uso da plataforma surge como uma possibilidade de fazer algo que ajude outras vítimas, seja por meio do compartilhamento de histórias ou do fornecimento de informações que auxiliem a romper com o ciclo abusivo. Observa-se que cada vítima lida de forma única com o evento traumático, enfrentando impactos psíquicos da agressão e do momento de revelação permeado pela dinâmica familiar e pela assimetria de poder. Desta forma, fica evidenciada a necessidade de uma escuta qualificada que viabilize a reconstrução subjetiva facilitada por um processo de elaboração do ocorrido.

RESUMEN. El presente artículo presenta una compilación de los datos recolectados durante la investigación etnográfica online realizada acerca de la exposición de las vivencias de víctimas de violencia sexual en el grupo de Facebook intitulado 'Lucha contra el abuso infantil'. Entendemos que los relatos funcionan como una posibilidad de romper el pacto de silencio y constituyen el inicio de la elaboración del trauma psíquico. Las interacciones en el grupo se registraron en un diario de campo durante el período de cuatro meses de seguimiento y los datos se profundizaron en diez entrevistas semiestructuradas con participantes contactados a través de una invitación publicada en el grupo. Las entrevistas se realizaron mediante videollamada y se preguntaron sobre el sentido que producen al utilizar el grupo, reflexionando sobre la posibilidad de superar la condición de víctimas. Verifícase que el uso de la plataforma surge como una posibilidad para hacer algo que ayude a otras víctimas, sea por medio de compartir historias o a través del suministro de informaciones que auxilien a romper el ciclo abusivo. Obsérvase que cada víctima lida de forma única con el evento traumático, enfrentando impactos psíquicos de agresión y del momento de revelación permeado por la dinámica familiar y por la asimetría de poder. De esta manera, se evidencia la necesidad de una escucha cualificada que posibilite una reconstrucción subjetiva facilitada por un proceso de elaboración de lo ocurrido.

ABSTRACT This article presents an excerpt of the data collected in interviews during online ethnographic research about the disclosure of the experiences of victims of sexual violence in a Facebook group entitled 'Fight against child sexual abuse'. This study considered the research's understanding that the reports function as a possible way of breaking the pact of silence and become the basis for the beginning of the psychic trauma elaboration. Interactions in the group were recorded in a field diary during the four-month follow-up period. The data were further analyzed in ten semi-structured interviews with participants contacted through an invitation posted in the group. The interviews were conducted by video call and asked about the meaning they produce when using the group, reflecting on the possibility of overcoming the condition of victims. The use of the platform emerges as a possibility to do something that helps other victims, either by sharing stories or providing information that helps break the abusive cycle. It is observed that each victim deals uniquely with the traumatic event, facing the psychic impacts of the aggression and the moment of disclosure permeated by the family dynamics and power asymmetry. Thus, the need for qualified listening is evident, which enables a subjective reconstruction facilitated by elaborating on what happened.

La terapia narrativa como intervención en jóvenes víctimas de abuso sexual infantil / Narrative therapy as an intervention in young victims of child sexual abuse

La terapia narrativa surge como una propuesta de intervención, debido a que este modelo permite que las personas puedan generar un proceso donde se desarrolle de manera integral lo que han padecido, y, de esa manera, poder resignificarlo; consiguientemente, cada paciente puede, así, superar la experiencia traumática (Ihl y Diaz, 2021). Método: Este trabajo de integración final de diseño teórico de revisión bibliográfica se propuso analizar la posible eficacia de la terapia narrativa como intervención clínica con jóvenes que han sido víctimas del abuso sexual infantil. Síntesis y conclusiones: La terapia narrativa propone un espacio respetuoso, flexible y de contención; se establece un entorno en el que el paciente tiene la oportunidad de contar su experiencia traumática, sin estar obligado a relatarla. Es decir, este abordaje no se enfoca en la exposición del trauma, ni exige que la persona relate la situación de abuso en un momento específico; la terapia narrativa propone trabajar con los efectos y las consecuencias del trauma AU

Narrative therapy emerges as an intervention proposal because this model allows people to generate a process where what they have suffered is developed in an integral way, and, in this way, to resignify it; consequently, each patient can thus overcome the traumatic experience (Ihl & Diaz, 2021). Method: This work offinal integration of theoretical design of bibliographic review was proposed to analyze the possible effectiveness of narrative therapy as a clinical intervention with young people who have been victims of child sexual abuse. Synthesis and conclusions: Narrative therapy proposes a respectful, flexible, and supportive space; an environment is established in which the patient has the opportunity to recount his traumatic experience, without being obliged to recount it. In other words, this approach does not focus on the exposure of the trauma, nor does it require the person to report the situation of abuse at a specific time; Narrative therapy proposes working with the effects and consequences of trauma AU

Revisão Integrativa sobre a Efetividade de Intervenções Preventivas do Abuso Sexual Infantil / Integrative review addressing the effectiveness of child sexual abuse preventive interventions / Revisión integradora de la efectividad de intervenciones preventivas para abuso sexual infantil

A presente revisão integrativa versa sobre intervenções preventivas primárias do abuso sexual infantil, direcionadas para crianças e adolescentes e para profissionais. Para isso, foram revisadas as seguintes bases de dados: PubMed, BVS, SciELO, Scopus e PsycInfo, utilizando as seguintes palavras-chave: "personal safety education" ou "protective behaviors" ou "personal body safety" ou "child assault prevention" ou "protection education" associadas à expressão "child sexual abuse". Incluíram 16 ensaios, sendo nove intervenções com crianças e adolescentes e sete com adultos. As intervenções preventivas direcionadas às crianças e aos adolescentes aumentavam os comportamentos autoprotetivos e o conhecimento sobre abuso sexual infantil. Por sua vez, as intervenções com adultos apresentaram variedades metodológica e de amostragem que dificultam a generalização dos resultados.

This integrative review addresses primary prevention programs to prevent child sexual abuse focusing on children and adolescents and professionals. We used PubMed, Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), Scopus, and PsycInfo, with the following keywords: "personal safety education" or "protective behaviors" or "personal body safety" or "child assault prevention" or "protection education" associated with the term "child sexual abuse". Sixteen trials were included, nine interventions addressed children and adolescents, and seven, adults. The preventive interventions implemented among children and adolescents improved self-protection behaviors and knowledge regarding child sexual abuse. However, the interventions aimed at adults presented methodological variations that hinder generalization of the results

Este estudio tuvo como objetivo llevar a cabo una revisión bibliográfica integradora sobre las intervenciones preventivas primarias del abuso sexual infantil, centradas en niños y adolescentes y profesionales. Se utilizaron las siguientes bases de datos: PubMed, BVS, SciELO, Scopus y PsycInfo, usando las palabras clave en los metadatos de los encabezados de temas médicos, a saber: "educación de seguridad personal" o "comportamientos de protección" o "seguridad del cuerpo personal" o "prevención de agresión infantil" o "educación de protección" asociada con el término "abuso sexual infantil". Se incluyeron dieciséis ensayos, con nueve intervenciones con niños y adolescentes y siete con adultos. Las intervenciones preventivas dirigidas a niños y adolescentes lograron aumentar las conductas de autoprotección y el conocimiento sobre el abuso sexual infantil. Las intervenciones con adultos presentaron variaciones metodológicas que perjudican la generalización de los resultados.

Atuação da Estratégia Saúde da Família em Casos de Violência Sexual contra Crianças e Adolescentes / Family Health Strategy's Performance in Cases of Sexual Violence Against Children and Adolescents / Actuación de la Estrategia de Salud de la Familia en Casos de Violencia Sexual contra Niños/as y Adolescentes

Considerando a cobertura e a posição privilegiada que a atenção básica em saúde ocupa na identificação e enfrentamento da violência sexual contra crianças e adolescentes, o presente estudo teve por objetivo compreender como a equipe de uma Estratégia Saúde da Família intervém nestes casos. Realizou-se um estudo qualitativo, documental e baseado na inserção ecológica. Foram realizadas observações da rotina da Estratégia Saúde da Família, análise de prontuários e entrevistas com os/as profissionais. A análise dos dados foi feita a partir da Análise Temática, sob ótica da Teoria Bieocológica do Desenvolvimento Humano. Os principais resultados indicaram a ausência de protocolo no atendimento às crianças e adolescentes vítimas de violência sexual na Estratégia Saúde da Família estudada, falta de capacitação dos/as profissionais no atendimento e manejo desses casos e fragilidades da rede intersetorial. Assim, a atuação da Estratégia Saúde da Família requer aprimoramentos, como capacitações e elaboração de fluxos de atendimento, garantindo o cuidado integral e continuado das crianças e adolescentes vítimas de violência sexual e de suas famílias.

Considering Primary Health Care's coverage and privileged role on identifying and tackling sexual violence against children and adolescents, the objective of this article was to understand how the team Family Health Strategy intervenes in such cases. This is a qualitative and documental study based in ecological insertion. We observed a Family Health Strategy's routine, analyzed medical records, and interviewed 20 professionals. Data was analyzed by Thematic Analysis in the light of the Bioecological Theory of Human Development. The main results indicate an absence of protocols when working with children and adolescents who were victims of sexual violence in the researched Family Health Strategy, lack of professional capacitation when dealing with these cases, and fragility of the intersectoral network. Thus, Family Health Strateg's performance demands improvement, such as capacitation and the construction of service flows that guarantee integral and continuous care of children and adolescents who were victims of sexual violence and their families.

Teniendo en cuenta la cobertura y la posición privilegiada ocupada por la atención primaria de salud para identificar y hacer frente a la violencia sexual contra niños, ninãs y adolescentes, el objetivo de este estudio fue comprender cómo interviene un equipo de Estrategia de Salud de la Familia en estos casos. Se realizó un estudio documental cualitativo basado en la inserción ecológica. Se realizaron observaciones de la rutina de la Estrategia de Salud de la Familia, análisis de registros médicos y entrevistas con profesionales. El análisis de los datos se realizó a partir del Análisis Temático, bajo la perspectiva de la Teoría Bieocológica del Desarrollo Humano. Los principales resultados indicaron la ausencia de un protocolo en el cuidado de niños, niñas y adolescentes víctimas de violencia sexual en la Estrategia de Salud de la Familia estudiada, la falta de capacitación de profesionales en el cuidado y manejo de estos casos y debilidades en la red intersectorial. Por lo tanto, la actuación de la Estrategia de Salud de la Familia requiere mejoras, como la capacitación y desarrollo de los flujos de asistencia, asegurando una atención integral y continua para los/as niños/as y adolescentes que son víctimas de violencia sexual y sus familias.

The relationship between commercial sexual exploitation of children (CSEC) and childhood sexual abuse (CSA) among boys and girls in Haiti.

To test the hypothesis that childhood sexual abuse (CSA) is a risk factor for commercial sexual exploitation of children (CSEC), we analysed data from the Haiti Violence Against Children Survey (VACS), a population-based sample of adolescents and young adults ages 13-24 (1459 males and 1457 females). Twenty-one percent of males and 25% of females reported CSA; 6% of males and 4% of females reported CSEC. The adjusted odds ratios (AORs) for CSEC based on exposure to CSA were 5.6 (95% confidence interval/CI: 3.1-10.2) for males and 5.9 (CI: 2.6-13.0) for females. For each year earlier that males first experienced CSA, the odds of CSEC increased 60% (AOR 1.6, CI 1.2-2.0). In this first nationally-representative study of lifetime CSEC, both boys and girls victimised by CSA in Haiti were more likely to have also experienced CSEC than other youth, with children who experienced CSA at younger ages at the greatest risk.

Care to female adolescents victims of sexual violence at a referral service in Brazil from 2011 to 2018.

OBJECTIVE: To evaluate the characteristics of aggression, care, and follow-up of sexual violence in adolescent women at a university service in Campinas, São Paulo, Brazil. METHODS: In a retrospective cohort study from 2011 to 2018, we assessed sociodemographic characteristics, type and form of sexual violence perpetration, background and perception of the victim about violence, and characteristics of care and social/legal support during follow-up. RESULTS: Of 521 adolescents 242 (46.5%) were aged 10-14 years, 354 (68%) had not started sexual life, 465 (89%) perceived the violence and they had low prevalence of alcohol (71, 16%) and other psychoactive substance consumption (25, 6%), and 24 (4.6%) had an intellectual disability. Intimidation through physical force, acute abuse, vaginal penetration, acquaintance aggressor, being approached in a public place, and family/acquaintance residence were the most prevalent characteristics of aggression. In the 2017-2018 biennium, we observed a decrease in the prevalence of adolescents who were students (P < 0.001), an increase in the number of acquaintance aggressors (P = 0.008), and medical care after 72 hours (P < 0.033). CONCLUSION: Adolescents were victims of severe sexual violence. There was a decrease in prophylactic treatments and half of the adolescents did not complete outpatient follow-up. The economic worsening over the last decade may have contributed to these results.

Knowledge and Myths About Child Sexual Abuse in Mexican Women.

Child sexual abuse (CSA) is a terrible type of maltreatment that occurs in all countries and social statuses, but due to the shame and taboo that it creates, it is still riddled with myths and false beliefs that make it difficult for the population and the authorities to adequately determine its prevalence. The objective of this work was to explore what Mexican women know about CSA. The participants were Mexican women (N = 499) who filled out a questionnaire comprising ten items referring to truths and myths about CSA, indicating their degree of agreement with them on a Likert scale. The results showed that although Mexican women have quite adequate knowledge about CSA, they still hold wrong beliefs about the child's feelings toward the abuser or the child victim becoming an adult abuser. Likewise, differences were found in the myths and truths about CSA held by women under 40 and over 40 years of age.

Narratives of Mothers Whose Children Had Been Sexually Abused: Maternal Reactions and Comprehension Regarding Child and Adolescent Sexual Abuse.

Child and adolescent sexual abuse is considered to be a serious public health concern and a devastating form of violence with serious physical, mental, and behavioral consequences in the short and long term. This qualitative study aimed to identify maternal reactions to the disclosure of sexual violence and explore the comprehension regarding child and adolescent sexual abuse held by the mothers of child victims. Twelve mothers were interviewed, whose children had experienced a situation of sexual abuse and were receiving psychosocial care in a municipality in southern region of Brazil. The collected data were organized and analyzed using the principles of Grounded Theory with the Atlas.ti 7.5.7 software. From the analysis of the narratives, three main categories emerged: mothers with positive reactions, mothers with ambivalent reactions, and mothers with negative reactions. Mothers that presented positive reactions believed the report and supported their children, showing a comprehension that sexual abuse can occur in different ways and not only when there is penetration. The participants that had ambivalent reactions oscillated between maintaining or breaking off the relationship with the perpetrator of the violence, expressed initial disbelief regarding the report of the abused child, and had a comprehension that sexual abuse could be a form of affection. Mothers that had a negative reaction to the disclosure of abuse presented a contradictory narrative, minimizing the effects of the violence and placing the victims at fault regarding the abuse suffered. The importance of considering the possible relationships between the maternal comprehensions regarding child and adolescent sexual abuse and the reactions of these mothers during the professional intervention was demonstrated.

Child Sexual Abuse and the Complexities of Gender, Power, and Sexuality.

This article contributes to the still limited analysis of gender and sexuality in the exploration of HIV infection in the Caribbean. In Trinidad and Tobago, child sexual abuse was identified as a prevalent behavior. This motivated a gendered exploration of the sociocultural factors underlying child sexual abuse and the link with HIV. Using a qualitative action research methodology, researchers sought to understand the patterns of behavior, sociocultural and gendered meanings, and significance of child sexual abuse; to sensitize stakeholders to these issues; and to develop multidisciplinary community-based interventions and policies. This article reports on the analysis of data collected from the interventions carried out as part of the action research methodology, as well as a range of national and community-specific action research activities including ethnographic case studies, national stakeholders meetings, and a study of service providers. It provides a nuanced understanding of the meanings, underlying assumptions, perceptions, and taboos associated with child sexual abuse in Trinidad and Tobago, as well as new ways of understanding child sexual abuse in the Caribbean. Findings showed that the social and gender context for child sexual abuse involves several interconnecting factors located within a framework of gender ideologies and expressions, sexual expectations and behaviors, and social norms based on patriarchal values. These findings would be of significance for the prevention of child sexual abuse and the associated HIV risk in Trinidad and Tobago, and the management of victims and perpetrators of child sexual abuse.

Análise do perfil e fluxo de atendimento de crianças vítimas de violência sexual em um serviço de referência / Profile and follow-up analysis of sexual abused children in a reference service

Objetivos: Levantar dados sobre o perfil do agressor e da vítima de abuso sexual na infância atendida no pronto-socorro e ambulatório de violência sexual. O estudo visa também avaliar a efetividade do fluxo de encaminhamentos que possibilitam a longitudinalidade do cuidado. Métodos: Trata-se de estudo transversal retrospectivo, em hospital de referência no atendimento a esses pacientes na cidade estudada, no qual foram avaliados 121 prontuários de possíveis vítimas menores de 13 anos em 2018. Foram coletados dados do perfil da vítima e agressor, além de informações sobre encaminhamentos e frequência nas consultas de seguimento. Resultados: Foi realizada uma análise descritiva dos dados, nos quais entre os resultados encontrados destacam-se a predominância do gênero masculino entre os agressores e feminino entre as vítimas. A prevalência do gênero da vítima e do agressor foram semelhantes a outros estudos. A maioria dos abusos aconteceram em residência, o agressor era conhecido. Dentre as 121 crianças atendidas no pronto socorro, 90 foram encaminhadas ao ambulatório e apenas 33 compareceram à consulta. Notou-se uma falha no encaminhamento do paciente acolhido no pronto atendimento ao ambulatório, comprometendo o seguimento longitudinal. Houve uma dificuldade na coleta dos dados devido à inexistência de um prontuário eletrônico único. Conclusão: O perfil da vítima e do agressor nesse estudo foram similares a outros estudos publicados anteriormente sobre violência sexual. Foi percebida uma falha comunicativa entre os atendimentos em que a criança abusada permeia, com uma importante descontinuação do acompanhamento após agressão.

Purpose: The purpose of this study is to raise data on the profile of sexual abused children attended at the emergency room and sexual violence outpatient clinic. It also aims to evaluate the effectiveness of referrals flow that enable care longitudinality. Methods: This was a retrospective crosssectional study in a referral hospital for sexual violence victims, in which 121 medical records of potential victims under 13 years were evaluated in 2018. Data was collected on the profile of victim and offender, along with referrals and attendance at follow-up appointments. Results: A descriptive analysis of data was performed, in which results highlight male predominance among aggressors and females amidst victims. Gender prevalence of victim and offender was similar to other studies. Most abuses took place in residences and the offender was known by the victim. Of the 121 children seen at the emergency room, 90 were referred to outpatient clinic and only 33 attended consultation. A failure in patient referral at the emergency room was pointed out, which compromises ambulatory follow-up. Data collection was difficult due to the lack of a single electronic medical record. Conclusion: The victim and perpetrator profile in this study was similar to other previously published studies on sexual violence. It was also noticed failure between hospital sectors in which the abused child permeates, with an important discontinuation of follow-up after the aggression.

Epidemiología de los niños, niñas y adolescentes derivados a un equipo de referencia en violencia basado en género y generaciones durante la pandemia por el COVID-19: diferencias con el año 2016: CASMU-IAMPP / Epidemiology of children and adolescents referred to a gender violence reference team during the COVID-19 pandemic as compared to 2016: CASMU-IAMPP / Epidemiologia de crianças e adolescentes referidos a uma equipe de referência em violência baseada em gênero durante a pandemia do COVID-19: diferenças com o ano de 2016: CASMU-IAMPP

El maltrato y el abuso sexual infantil constituyen una violación de los derechos humanos y un importante problema de salud mundial. La situación ya era grave y compleja previamente. El aislamiento social por el COVID-19 la volvió una crisis. En marzo de 2020 se tomaron medidas preventivas para mitigar los efectos de la enfermedad. El confinamiento fue una de ellas. El maltrato infantil durante 2020 ascendió de 20% a 32%. Objetivo: conocer las características epidemiológicas de los niños, niñas y adolescentes víctimas de situaciones de maltrato y de probable abuso sexual infantil, asistidos en el Equipo de Referencia en Violencia Basado en Género y Generaciones de una institución, entre el 1 abril de 2020 al 31 julio de 2020, en comparación con el mismo período en 2016. Se realizó un estudio observacional, descriptivo, con los usuarios menores de 18 años derivados a dicho equipo. El total de consultas fue 28 en 2016, y 17 en 2020. Los motivos de consulta en 2016 fueron: 24,5% abuso sexual, 3,5% negligencia y 72% maltrato emocional en el contexto de violencia doméstica. En 2020 fueron 41%, 6% y 53%, respectivamente. En 2016 82% de los casos fueron derivados por el sector de salud, de ellos 36% por el pediatra tratante. En 2020 fueron 76% y 46%, respectivamente. A pesar de existir a nivel internacional múltiples reportes y publicaciones que apuntan a un estado de emergencia infantil por la pandemia del COVID-19, esto no se vio reflejado.

Summary: Child and sexual abuse involve a breach of human rights and a major global health problem. The situation was already serious and complex before the Covid 19 Pandemic, but it has turned it into a crisis. In March 2020, preventive measures were taken to mitigate the effects of the disease, the lockdown was one of them. Child abuse rose from 20% to 32% in 2020. Objective: learn about the epidemiological characteristics of children and adolescent victims of abuse and probable sexual abuse, assisted by the Gender Based Violence Reference Team at one institution, between April 1, 2020 and 31 July 2020, compared to the same period in 2016. An observational, descriptive study was carried out with users under 18 years of age referred to team mentioned above. The total number of consultations was 28 in 2016, and 17 in 2020. The reasons for consultation in 2016 were: 24.5% sexual abuse, 3.5% neglect and 72% emotional abuse within the framework of domestic violence. In 2020 they were 41%, 6% and 53%, respectively. In 2016, 82% of the cases were referred by the health sector, 36% of them by the treating pediatrician. In 2020 76% and 46%, respectively. Despite the multiple global reports and publications that suggest a state of emergency for the case of children and adolescents due to the Covid-19 pandemic, this was not reflected in our figures.

O abuso infantil e o abuso sexual constituem uma violação dos direitos humanos e um grande problema de saúde global. A situação já era grave e complexa antes da pandemia do Covid-19 e o isolamento social transformou ela em uma crise. Em março de 2020, foram tomadas medidas preventivas para mitigar os efeitos da doença. O confinamento foi um deles. O abuso infantil em 2020 aumentou de 20% para 32%. Objetivo: conhecer as características epidemiológicas de crianças e adolescentes vítimas de abuso e provável abuso sexual infantil, atendidos pela Equipe de Referência em Violência Baseada no Gênero numa instituição de saúde entre 1º de abril de 2020 a 31 de julho de 2020, em comparação para o mesmo período de 2016. Foi realizado um estudo observacional, descritivo com usuários menores de 18 anos de idade que tinham sido encaminhados à referida equipe. O número total de consultas foi de 28 em 2016 e 17 em 2020. Os motivos de consulta em 2016 foram: 24,5% abuso sexual, 3,5% negligência e 72% abuso emocional em contexto de violência doméstica. Em 2020 foram 41%, 6% e 53%, respectivamente. Em 2016, 82% dos casos foram referudis pelo setor de saúde, 36% deles pelo pediatra responsável. Em 2020 foram 76% e 46%, respectivamente. Apesar da existência de vários papers e publicações a nível gobal que sugerem um estado de emergência para as crianças devido à pandemia de Covid-19, isso não se refletiu nos nossos dados.

Abuso sexual infantil en tiempos de COVID-19

Introducción: La crisis del COVID-19 representa un fenómeno sanitario mundial que afecta a diversos aspectos de la salud de las personas. Los niños y adolescentes representan a la población más afectada; debido al aumento del maltrato infantil y del abuso sexual, lo cual puede comprender el bienestar y desarrollo integral de la población infantil y adolescente. Objetivo: Examinar la situación actual del abuso sexual infantil durante la pandemia e identificar los factores de riesgo asociado a esta problemática. Métodos: Se realizó una revisión bibliográfica de estudios publicados entre 2010 y 2021 en las bases de datos Pubmed/medline, Science Direct, SciElo, Scopus, Dialnet. Se utilizaron las palabras clave: abuso sexual infantil, maltrato infantil, COVID-19, Pandemia. Análisis y síntesis de la información: Se registró un incremento del abuso sexual y maltrato infantil durante la pandemia por los efectos específicos de la COVID-19. Se identificaron factores de riesgo como los problemas económicos, aislamiento social y acceso a internet. Conclusiones: La pandemia por causa de la COVID-19 propició un aumento de las vulneraciones en los niños y adolescentes. Por estas razones se deben tomar medidas preventivas para disminuir cualquier tipo de agresión física, psicológica y sexual hacia la población infantil.

Introduction: The COVID-19 crisis represents a global health phenomenon that affects various aspects of people's health. Children and adolescents represent the most affected population due to the increase in child maltreatment and sexual abuse, which may include the well-being and integral development of the child and adolescent population. Objective: To examine the current situation of child sexual abuse during the pandemic and identify the risk factors associated with this problem. Methods: A literature review of studies published between 2010 and 2021 in the databases Pubmed/medline, Science Direct, SciELO, Scopus, Dialnet was conducted. The keywords used were: child sexual abuse, child maltreatment, COVID-19, Pandemic. Analysis and synthesis of information: There was an increase in sexual abuse and child maltreatment during the pandemic due to the specific effects of COVID-19. Risk factors such as economic problems, social isolation and internet access were identified. Conclusions: The COVID-19 pandemic led to an increase in violations among children and adolescents. For these reasons, preventive measures must be taken to reduce any type of physical, psychological and sexual aggression towards the child population.

(Re)violências socialmente infligidas a meninos sexualmente abusados por mulheres / Double violence socially inflicted on boys sexually abused by women / (Re)violencia socialmente infligida a niños abusados sexualmente por mujeres

No Brasil, foram reportados aproximadamente 776 casos de abuso sexual infantil (ASI) contra crianças e adolescentes do sexo masculino perpetrado por abusadoras femininas entre 2011 e 2017 (Brasil, 2018). Diversos estudos demonstram evidências de um processo particular na experiência do ASI de meninos, que entravam seu processo de revelação, tornando-o altamente subnotificada. Este artigo pretendeu capturar reações ao ASI de meninos quando cometido por mulheres, pela análise de conteúdo de 292 comentários em reportagens de domínio público que noticiaram casos reais dessa violência. Os resultados demonstraram preponderância do não reconhecimento das práticas sexuais entre mulheres adultas e meninos como abuso (81,5%), contendo ataques depreciativos aos jovens, declarações de impossibilidade de vitimização destes, referências positivas à experiência, entre outras que banalizam a questão. Os múltiplos ataques virtuais registrados e a descaracterização dos casos como abusivos sugerem um processo de (re)vitimização socialmente infligida aos meninos sexualmente violentados, acarretando possíveis danos psicológicos secundários e reforçando estigmas e a subnotificação dessa violência.

In Brazil, approximately 776 cases of child sexual abuse (CSA) against male children and adolescents perpetrated by female abusers were reported between 2011 and 2017 (Brazil, 2018). Several studies demonstrate evidence of a particular process in the boys' CSA experience, which impedes their disclosure process, making it highly underreported. This article aimed to capture reactions to boys' CSA when committed by women, by analyzing the content of 292 comments in public domain news that reported real cases of this violence. The results showed a preponderance of the lack of recognition of sexual practices among adult women and boys as abuse (81.5%), containing derogatory attacks on boys, declarations of their impossibility of victimization, positive references to the experience, among other trivializing trends. The multiple virtual attacks and the mischaracterization of cases as abusive suggest a process of double victimization inflicted on sexually abused boys, causing possible secondary psychological damage, reinforcing stigmas and the underreporting of this violence.

En Brasil, fueron reportados aproximadamente 776 casos de abuso sexual infantil (ASI) contra niños y adolescentes del sexo masculino perpetrados por mujeres abusadoras entre 2011 y 2017 (Brasil, 2018). Varios estudios demuestran evidencias de un proceso particular en la experiencia de ASI de niños, que impide su proceso de divulgación, lo que la hace subnotificada. Este artículo tuvo como objetivo captar las reacciones al ASI de los niños cometida por mujeres, mediante el análisis del contenido de 292 comentarios en informes de dominio público que denunciaron casos reales de esa violencia. Los resultados mostraron una preponderancia del desconocimiento de las prácticas sexuales entre mujeres y niños como abuso (81,5%), conteniendo agresiones despectivas a los jóvenes, declaraciones de imposibilidad de victimización, referencias positivas a la experiencia, entre otras tendencias banalizadoras. Los múltiples ataques virtuales registrados y la caracterización errónea de los casos como no abusivos sugieren un proceso de (re)victimización social infligido a los niños abusados sexualmente, provocando posibles daños psicológicos secundarios, reforzando los estigmas y el subregistro de esa violencia.