Health care providers are often the first point of call for distressed parents or adolescents. They need to know how to identify such abuse and provide an empathetic and supportive response to children and adolescents when they disclose, or show signs of, abuse. Health care providers can also help to connect survivors of abuse to other services that they may need through referrals.
In recognition of this WHO has published new evidence-based guidelines to help front-line health workers respond to children and adolescents who have been sexually abused.
"Sexual abuse often remains hidden in a culture of silence," notes Dr Etienne Krug, Director of the WHO Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention. "The new document Responding to children and adolescents who have been sexually abused: WHO clinical guidelines offers advice on the most appropriate ways to support victims so that they come forward and receive the vital services they need to heal."
Avni Amin, Technical Officer at WHO says, "Children and adolescents who have survived sexual abuse have specific needs, different from adults. These guidelines, grounded in ethical principles and human rights standards give health care providers practical advice on how to put these needs first and provide quality and trauma-informed care."
Consequences of sexual abuse
Boys and girls who are sexually abused face higher risks of lifetime diagnosis of post-traumatic stress disorder, anxiety, depression, sleep disorders, and having thoughts of suicide and self-harm. They are more likely to engage in unsafe sex, abuse of drugs and misuse of alcohol, placing them at higher risk for STIs and HIV and for other negative health outcomes that last into adulthood. For girls there is also increased risk of pregnancy and gynaecological disorders.
Culture of silence
A majority of children and adolescents who experience sexual abuse do not seek or receive any services. A key reason for this is that sexual abuse is often undisclosed by victims who face shame or fear blame and stigma. Therefore, much more needs to be done in homes, schools and communities to support victims to disclose, seek help and access services in a timely manner.
The new guidelines recommend that health care providers:
1. Provide first line support that is child or adolescent-centred and gender sensitive in response to disclosure of sexual abuse.
2. Minimize additional trauma and distress while taking medical history, conducting the examination and documenting the findings.
3. Offer post-rape care that includes HIV post-exposure prophylaxis and adherence support, emergency contraception, STI presumptive treatment where testing is not feasible and Hepatitis B and HPV vaccinations as per national guidance.
4. Consider cognitive behavioural therapy (CBT) with a trauma focus to those who have PTSD symptoms and diagnosis, and where safe and appropriate to do so, involve at least one non-offending caregiver.
5. Where required to report child sexual abuse to designated authorities, health care providers should inform the child or adolescent and their non-offending caregivers about the obligation to report the abuse and the limits of confidentiality before interviewing them.