Addressing Child Sexual Abuse in Latin America as a Means to Stop HIV/AIDS

Monday, 27 July 2015: 9:10 AM

Clifton P. Thornton, MSN, BSN, BS, RN, CNMT
Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
Tener Goodwin Veenema, PhD, MSN, MPH, BSN, RN, CPNP, FAAN
Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD

Purpose: The purpose of this integrative review of peer-reviewed data and key documents is to elucidate the means by which children are identified as victims; present prevalence data on victimization in Latin America; to identify themes contributing to CSA (and ultimately, HIV) in these countries; and to compare this data to current literature. To date, such a review has not been published that specifically focuses upon Latin American populations.

Methods: An integrative review of the literature using a structured search strategy was performed to capture and describe all factors associated with detecting and reporting CSA in Latin America. The framework for conducting an integrative review as outlined by Whittemore and Knalf (2005) was used for this study. Combining past empirical or theoretical literature allows researchers to achieve a more comprehensive understanding of a phenomenon (Broome, 1993). When well executed, the integrative review process produces sound nursing science that may inform future research endeavors, influence policy, and change practice initiatives (Whittemore & Knafl, 2005).

PubMed, CINAHL Plus, Embase, PsychINFO, and Web of Science were searched to identify original peer-reviewed sources. The terms “prevalence or incidence” were combined with “child sexual” and “abuse, assault, victimization, violence, exploitation, and trafficking” to find any study on identifying victims of CSA. Medical Subject Headings (MeSH) for child sexual abuse were utilized in compatible databases. Results were narrowed by adding search terms for every country included in Latin America as determined by the World Bank (2014). The titles, abstracts, and entire publications were reviewed by both authors for relevance to this review. Inclusion criteria for review was a focus on identifying the incidence or prevalence of child sexual abuse in a Latin American country. The study type, method of data collection, statistical results, and associative findings from each publication were noted and synthesized for presentation in this paper. A summary of the search strategy and inclusion process are outlined in table 1 and figure 1 respectively.

Additionally, databases of key organizations in refugee and parentless children were reviewed in order to better understand how the current U.S. Southwest Border crisis may relate to CSA and HIV transmission. Peer-reviewed literature did not speak to this phenomenon, most likely because the issue only received national attention shortly before this investigation began. The UN Refugee Agency, US Department of Health and Human Services (Administration for Children and Families), UNICEF, and Save the Children documents were searched for information pertaining to this matter. Thematic analysis was conducted using a six step process to identify, code and name themes for all non-peer reviewed documents.

Results: Fourteen articles were identified for inclusions in the study once duplicates were removed; no article was excluded based on language. Two publications were in Portuguese and one was in Spanish and were translated by graduate students at the Johns Hopkins University fluent in English and the published language. Publications represented nine out of 24 Latin American countries. There was no restriction based on publication dates, included articles were published between 1992 and 2013. 

Statistical reports of the prevalence of CSA vary by country, study methodology, definitions of CSA, and outcome measures. Even studies within the same host country and region report largely varied CSA prevalence and incidence statistics.

One primary culturally-driven theme identified in this literature review stems from the notion of machismo found in Latin American countries. Machismo is the cultural ideal of masculinity; it is associated with pride and inherent value in the man’s ability to protect, support, and provide for his family. This cultural expectation of males to be strong and resilient creates a roadblock for males who experience CSA by making it more difficult for them to report the incident due to fear of being perceived as weak or feminine.

The results of this study suggest that the negative health effects of CSA including increased risk of HIV/AIDS exist for Latin American children. Sexual coercion of males and females is associated with a decreased knowledge of sexual topics, increased rate of STIs, increased prevalence of HIV, and increased engagement in activities that may lead to HIV infection. Those with a past history of CSA had higher rates of early sexual debut, increased number of partners, and increased rates of condom avoidance. Other risky sexual behaviors are the result of early exposure to sexual practices leading to an onset of consensual sex at younger ages, increased number of lifetime partners, and partners with elaborate sexual histories.

Literature addressing characteristics of perpetrators suggest that most aggressors are males well known to the family with variability in perpetrator characteristics when comparing male and female victims. Many male victims report a female perpetrator and report being subjected to more physically violent acts of sexual abuse.

While much of the published literature shows that females are affected by CSA disproportionately more than males, data from this review indicate that this may not always hold true. Multiple studies show that males are usually affected as frequently or more than female children. Overall, there is a lack of research and knowledge relating to the experience and understanding of male victims of child sexual abuse.

Rates of unaccompanied youth entering the United States from Latin America have dramatically increased in numbers over the past 2 years. Many children flee their home countries without money or parental guidance due to violence and have reported histories of physical and sexual abuse while in their home countries. Refugee minors are among some of the most vulnerable populations and are at an increased risk for sexual violence due to child labor, sex trafficking, and a lack of supervision.

Conclusion: Children who experience sexual abuse have an increased life-long risk for contracting HIV. The only identified culturally-specific issue related to CSA in Latin America is the machismo attitudes and beliefs held by many Latin families. Similar to other publications, this review also identified that the most frequent perpetrator of CSA is often a male who is well known to the family.

This review highlights the role that gender plays in CSA and questions the notion that most victims of sexual abuse are female. Several studies included in this review found that males were sexually abused as frequently or more frequently than females. This may indicate that previous methodologies of studying CSA may not be adequately designed to identify males who have been sexually abused. Machismo attitudes may build barriers to reporting by males because it sets a social expectation for boys and young men to be strong and resilient.

Nurses as trusted clinicians sit in a unique position to identify victims of child abuse and halt the spread of HIV in Latino populations. HIV has spanned the globe because of biological susceptibility and specific human interactions that spread the infection. As such, nursing needs to be involved in international efforts and work with international aid organizations to prevent the further spread of HIV.

Nursing is best suited to address this critical issue because of its holistic approach to health issues and appreciation for cultural nuances in rendering care. The World Health Organizations’ revised HIV guidelines promote international task-shifting of the management and prevention of HIV/AIDS from physicians to nurses. Child sexual assault and the spread of HIV are not discrete events, but exist in a complicated and intertwined relationship. In order to stop the spread of HIV nurses must address the social and cultural situations and events that potentiate new infections.

If the number of children without guardians who enter the country continues to increase without a response from child welfare organizations, the capacity for the country to protect these children will continue to diminish; placing them at risk for sexual abuse and HIV transmission.