Risk of Sexual Violence: Perspectives and Experiences of Women in a Hospital in the Democratic Republic of Congo

A Scoping Review of Factors Associated with HIV Acquisition in the Context of Humanitarian Crises

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings.

Image-Based Sexual Abuse Associated Factors: A Systematic Review

Purpose

Image-Based Sexual Abuse (IBSA) is a recently studied form of violence and abuse perpetrated using technology. This systematic review aims to examine and systematize studies exploring factors associated with IBSA (e.g., victimization, perpetration, and propensity to perpetrate).

Method

Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, 17 articles were included.

Results

The results of this study highlighted conceptual and methodological limitations in the literature on IBSA. Aside from these limitations, this systematic review identified factors associated with IBSA, focusing on four macro-areas: victimization, perpetration, propensity to perpetrate IBSA, and IBSA implications. The results demonstrated the role of psychological, relational, and social variables, although the effect sizes observed in the quantitative studies were small or in few cases moderate.

Conclusions

These results suggest further research should be carried out to explore the multidimensionality of IBSA and its associated factors, which may assist in guiding interventions to promote preventive and rehabilitative methods to lower the prevalence of this crime and its consequences.

Assessing the care of doctors, nurses, and nursing technicians for people in situations of sexual violence in Brazil

This study aimed to assess the quality of care for people in situations of sexual violence in health services, identifying positive and negative indicators, and suggest solutions. This is a cross-sectional study with a quantitative approach and convenience sampling. The sample consisted of 134 professionals (doctors, nurses, and nursing technicians) working in public health services. Three instruments were used, namely, a structure evaluation form, a questionnaire, and a process evaluation form. The results revealed eight positive indicators (adequate infrastructure; rooms for patient assistance; gynecological bed; visual and auditory privacy; waiting rooms; a professional team comprising physicians, nurses, nursing technicians, and receptionists; adequate training of staff to provide health services to people in situations of sexual violence; and most healthcare professionals asking their patients about possible sexual violence situations) and nine negative indicators (reduced number of rooms for patient assistance with toilets; absence of protocols to identify and assist people in situations of sexual violence; absence of leaflets, posters, and other materials on sexual violence; absence of a referral flow chart (specific for people in situations of sexual violence) to specialized services; reduced number of consultations with suspected and/or confirmed cases of sexual violence; non-use of specific protocols; not referral of these patients to the specialized care network; most professionals consider the health unit where they work as unable to help people in situations of sexual violence; a decrease in attendance at health facilities that do not have a protocol for assisting people in situations of sexual violence), making clear the interventions necessary to promote the provision of quality health services that meet the specific needs of people in situations of sexual violence. These indicators are expected to provide subsidies for the improvement of public policies aimed at listening, welcoming, identifying, and treating people in situations of sexual violence.

Clinical agreement with self-report of physical violence and torture in women seeking asylum in France

Women are a particularly vulnerable group among persons seeking asylum but are still required to provide clinical evidence of acts of violence inflicted against them. In this study the authors describe patient histories, dermatological lesions and other injuries arising from physical violence and torture in female asylum-seekers attending a specialist outpatient service in France. Twenty-seven women were assessed during 2016-2018. Clinical corroboration of lesions with patients' self-reports was affirmative in >90% (25/27) of cases. Health care services in recipient countries must be configured and resourced to support women seeking asylum, and health care professionals must be receptive and sensitive to women's self-reported histories.

Violence and sexually transmitted infections in pregnancy

OBJECTIVE

To synthesize the knowledge produced in studies about the association between violence and STI during pregnancy.

METHODS

In this systematic review, we conducted basic activities of identification, compilation, and registration of the trials. The instruments of data collection were studies that investigated, explicitly, relationships between violence, gestation, and STI, from July 2012 to July 2017, using PubMed, Cochrane Library, SciELO, and LILACS.

RESULTS

In all, 26 articles were chosen to form the basis of the analysis of this study. The relationship between violence and STI was observed in 22 of the 26 studies, and in eight of them, the violence was practiced during the gestation period. In two studies, there was no evidence of this relationship. In one study, the lack of care for STI was attributed to the unpreparedness of health professionals. Mental disorders were cited as resulting from STI in three articles and in another as a result of violence. One study found more frequent violence against adolescents, while two others cited gestation as a protective factor.

CONCLUSIONS

IPV combines characteristics that have a different expression when the woman is in the gestational period. The literature points to a relationship between IPV against women and the presence of STI. The monitoring of pregnancy, whether in the prenatal or postpartum period, offers unique opportunities for the health professional to identify situations of violence and thus provide assistance.

Virginity Requirement Versus Sexually-Active Young People: What Girls and Boys Think About Virginity in South Kivu, Democratic Republic of Congo

This article aims to explore Congolese male and female high school students' cultural attitudes concerning virginity. The study employed a qualitative approach to collect data from 56 boys and girls aged 16-20 years old. Eight focus group discussions and 40 individual interviews were conducted among participants from two urban and two rural high schools in South Kivu province. Findings indicate that men are disappointed when they marry non-virgin girls. In fact, most male and female participants perceived girls who were virgins as trustworthy individuals. They believe that the girl's virginity loss brings shame to her family. However, some female participants clearly dissociate from societal views or norms about virginity, and remark that virginity itself is not the key to a successful household nor a guarantee for remaining faithful after marriage. Such traditional norms-in the context of high levels of rape-place enormous pressure on young women and cause them to lie about virginity because they fear losing their fiancés. They indicated that they would lie about it regardless of any consequences they may encounter. In fact, some traditional beliefs need to be challenged and modified.

Forced sexual intercourse and its association with HIV status among people attending HIV Voluntary Counseling and Testing in a healthcare center in Kinshasa (DRC)

INTRODUCTION

Sexual violence, an HIV determinant, is an integrated behavior in the D.R.Congo. We aimed to analyze the prevalence of forced sexual intercourse (FSI) among people receiving HIV Voluntary Counseling and Testing in a hospital in Kinshasa, and its association with socio-demographics, behaviors and HIV status.

METHODOLOGY

Case-control study (2010-2012). Two-hundred and seventy-four cases with a new HIV+ test and 1,340 controls with an HIV- test were interviewed about HIV-related knowledge, attitudes and behaviors, including FSI.

RESULTS

Thirty-four percent of the participants declared having had FSI (38% of women and 32% of men). Being a woman, aged 25-49 and reporting multiple sexual partners were associated with reporting FSI. For men, being single was protective against FSI; and cohabiting, having a high socioeconomic status, and alcohol consumption increased the odds. For women, being single, divorced/separated and widow was associated with reporting FSI. A significant positive association was found between FSI and an HIV positive test.

CONCLUSION

Among our Congolese population, FSI was strongly associated with HIV infection and it was also associated with alcohol consumption and multiple sexual partnerships, other key HIV determinants. These behaviors need to be identified as potential risk factors of FSI during counseling interventions. Researchers, practitioners and decision-makers should work together to get violence prevention integrated into health, social and educational policies.