The Who, What, Why and When of Gynaecological Referrals for Refugee Women.

Refugees have health needs relating to unstable living situations and poor access to care. We examined the nature of health problems requiring gynaecological referrals for refugee women in Toronto. A retrospective cohort design was used to examine gynaecologic referrals of women at a refugee clinic between December, 2011 and June, 2016. The primary outcome measure was the indications for gynaecological referral. 125 out of 1040 women received a gynaecologic referral for 131 unique concerns. The most common referrals were for abnormal uterine bleeding and cervical dysplasia. Fibroids were prevalent amongst African patients, while referrals for LARCs/sterilization were absent from Middle Eastern patients. 26% of patients referred had a sexual violence history. Refugee women exhibit gynaecologic needs similar to the broader population. Needs vary by geographic origins. As global conflicts shift, so too will this population's needs. High rates of sexual violence history reflect the need for further understanding and intervention.

"Taca cachaça que ela libera": violência de gênero nas letras e festas de forró no Nordeste do Brasil / "Give her booze and she'll loosen up": gender violence in Northeast Brazilian forró lyrics and parties / "Tómate una cachaza que te libera": violencia de género en las letras y fiestas del forró de Nordeste de Brasil

A violência contra a mulher é, antes de tudo, uma questão de valores culturais hierárquicos de gênero produzidos socialmente. Desse modo, esta pesquisa buscou compreender os sentidos atribuídos à violência sexual contra a mulher expressa nas letras de forró por rapazes adolescentes residentes na periferia de Fortaleza, Ceará, Brasil. Partimos da etnomusicologia, cuja teoria considera que estudos de músicas regionais e suas performances transpõem o espaço geográfico de sua execução, na medida em que descortinam práticas universalmente disseminadas de legitimação de violências. A pesquisa foi realizada em escolas estaduais do bairro Bom Jardim, na periferia de Fortaleza. Esse bairro registra os piores índices de violências contra as mulheres do município. Foram realizados grupos focais com seis a oito participantes, em que foram debatidas três músicas de forró cujas letras remetiam à violência sexual. Os resultados demonstraram como as músicas reproduzem e influenciam ideologias patriarcais entre os jovens nordestinos. Observa-se nas falas o discurso do "estupro reverso", que busca justificar a violência sexual por meio da inversão de papeis de gênero, ignorando assimetrias socialmente construídas. O forró se demonstra uma arena de gênero, onde gladiadores competem para registrar ideias de masculinidade, sexualidade e relações de gênero, replicando o sexismo dominante na sociedade contemporânea e contribuindo para a perpetuação da violência contra a mulher.

Violence against women is primarily a socially produced issue of gender-hierarchy cultural values. This study aimed to unveil the meanings assigned to sexual violence against women in the forró lyrics by adolescent boys living on the outskirts of Fortaleza, Ceará State, Brazil. Our point of departure was ethnomusicology, the theory of which contends that studies of regional songs and their performances transcend the geographic space in which they are performed, to the extent that they reflect universally disseminated practices in the legitimation of violence. The study was conducted in state public schools in the Bom Jardim neighborhood on the outskirts of Fortaleza. This neighborhood has the highest rates of violence against women in the city. Focus groups were conducted with six to eight participants each, debating three forró songs whose lyrics referred to sexual violence. The results showed that the lyrics reproduce and influence patriarchal ideologies among Northeast Brazilian youth. Quotes by the boys reveal the discourse of "reverse rape", which seeks to condone sexual violence through the reversal of gender roles, ignoring socially constructed asymmetries. Forró proves to be a gender arena in which gladiators compete to flaunt notions of manhood, sexuality, and gender relations, replicating the dominant sexism in contemporary Brazilian society and contributing to the perpetuation of violence against women.

La violencia contra la mujer es, ante todo, una cuestión de valores culturales jerárquicos de género producidos socialmente. Por ello, esta investigación procuró comprender los sentidos atribuidos a la violencia sexual contra la mujer, expresada en las letras del forró por parte de chicos adolescentes, residentes en la periferia de Fortaleza, Ceará, Brasil. Partimos de la etnomusicología, cuya teoría considera que los estudios de músicas regionales y sus representaciones traspasan el espacio geográfico de su ejecución, en la medida en que desvelan prácticas universalmente diseminadas de legitimación de la violencia. La investigación se realizó en escuelas estatales del barrio de Bom Jardim, en la periferia de Fortaleza. Este barrio registra los peores índices de violencia contra las mujeres del municipio. Se crearon grupos focales de seis a ocho participantes, en los que se debatieron tres canciones de forró, cuyas letras remitían a la violencia sexual. Los resultados demostraron de qué forma las canciones reproducen e influencian ideologías patriarcales entre los jóvenes nordestinos. Se observa en las intervenciones el discurso de la "violación inversa", que busca justificar la violencia sexual mediante la inversión de los papeles de género, ignorando las asimetrías socialmente construidas. El forró demuestra ser la arena de un coliseo del género, donde los gladiadores compiten para registrar ideas de masculinidad, sexualidad y relaciones de género, replicando el sexismo dominante en la sociedad contemporánea y contribuyendo a la perpetuación de la violencia contra la mujer.

A review of the health effects of sexual assault on African American women and adolescents.

OBJECTIVE: To review the research findings for mental and physical health outcomes and health behaviors of African American women and adolescents after sexual assault. DATA SOURCES: Searches of the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO, and PubMed from January 2001 through May 2012 using the terms Blacks, African Americans, sexual abuse, sexual offenses, and rape. STUDY SELECTION: Criteria for inclusion included (a) results of primary research conducted in the United States and published in English, (b) African American females age 13 and older, (c) sexual assault or sexual abuse reported as distinct from other types of abuse, and (d) health status as an outcome variable. Twenty-one publications met inclusion criteria. DATA EXTRACTION: Articles were reviewed for the mental and physical health and health behavior outcomes associated with sexual assault of African American women and adolescents. DATA SYNTHESIS: Sexual assault was associated with increased risk of poor mental and physical health outcomes in the general population of women and adolescents. There was an increased risk of unhealthy behaviors (e.g., drinking, drug use, risky sexual behaviors) for all women and adolescents, with the highest risk reported for African American women and adolescents. Help seeking from family and friends demonstrated conflicting results. Cumulative effects of repeated assaults appear to worsen health outcomes. CONCLUSION: Sexual assault has significant effects on the physical and mental health and health behaviors of women and adolescents in the general population. Less evidence is available for differences among African American women and adolescents. More research is needed to understand the influence of race on women's and adolescents' responses to assault.

Mexican immigration to the U.S., the occurrence of violence and the impact of mental disorders

Objective: To study immigration, U.S. nativity, and return migration as risk factors for violence among people of Mexican origin in the U.S. and Mexico. Methods: Cross-sectional surveys in the United States (2001-2003; n=1,213) and Mexico (2001-2002; n=2,362). Discrete time survival models were used. The reference group was Mexicans living in Mexico without migrant experience or a migrant relative. Results: Mexican immigrants in the U.S. have lower risk for any violence (hazard ratio [HR] = 0.5, 95% confidence interval [95%CI] 0.4-0.7). U.S.-born Mexican-Americans were at higher risk for violence victimization of a sexual nature (for sexual assault, HR = 2.5, 95%CI 1.7-3.7). Return migrants were at increased risk for being kidnapped or held hostage (HR = 2.8, 95%CI 1.1-7.1). Compared to those without a mental disorder, those with a mental disorder were more likely to suffer any violence (HR = 2.3, 95%CI 1.9-2.7), regardless of the migrant experience. Conclusions: The impact of immigration on the occurrence of violence is more complex than usually believed. Return migrants are more likely to suffer violence such as being held hostage or beaten by someone other than a partner. .

Sexual and reproductive health of persons aged 10-24 years - United States, 2002-2007.

This report presents data for 2002-2007 concerning the sexual and reproductive health of persons aged 10-24 years in the United States. Data were compiled from the National Vital Statistics System and multiple surveys and surveillance systems that monitor sexual and reproductive health outcomes into a single reference report that makes this information more easily accessible to policy makers, researchers, and program providers who are working to improve the reproductive health of young persons in the United States. The report addresses three primary topics: 1) current levels of risk behavior and health outcomes; 2) disparities by sex, age, race/ethnicity, and geographic residence; and 3) trends over time. The data presented in this report indicate that many young persons in the United States engage in sexual risk behavior and experience negative reproductive health outcomes. In 2004, approximately 745,000 pregnancies occurred among U.S. females aged <20 years. In 2006, approximately 22,000 adolescents and young adults aged 10-24 years in 33 states were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and approximately 1 million adolescents and young adults aged 10-24 years were reported to have chlamydia, gonorrhea, or syphilis. One-quarter of females aged 15-19 years and 45% of those aged 20-24 years had evidence of infection with human papillomavirus during 2003-2004, and approximately 105,000 females aged 10--24 years visited a hospital emergency department (ED) for a nonfatal sexual assault injury during 2004-2006. Although risks tend to increase with age, persons in the youngest age group (youths aged 10--14 years) also are affected. For example, among persons aged 10-14 years, 16,000 females became pregnant in 2004, nearly 18,000 males and females were reported to have sexually transmitted diseases (STDs) in 2006, and 27,500 females visited a hospital ED because of a nonfatal sexual assault injury during 2004-2006. Noticeable disparities exist in the sexual and reproductive health of young persons in the United States. For example, pregnancy rates for female Hispanic and non-Hispanic black adolescents aged 15-19 years are much higher (132.8 and 128.0 per 1,000 population) than their non-Hispanic white peers (45.2 per 1,000 population). Non-Hispanic black young persons are more likely to be affected by AIDS: for example, black female adolescents aged 15-19 years were more likely to be living with AIDS (49.6 per 100,000 population) than Hispanic (12.2 per 100,000 population), American Indian/Alaska Native (2.6 per 100,000 population), non-Hispanic white (2.5 per 100,000 population) and Asian/Pacific Islander (1.3 per 100,000 population) adolescents. In 2006, among young persons aged 10-24 years, rates for chlamydia, gonorrhea, and syphilis were highest among non-Hispanic blacks for all age groups. The southern states tend to have the highest rates of negative sexual and reproductive health outcomes, including early pregnancy and STDs. Although the majority of negative outcomes have been declining for the past decade, the most recent data suggest that progress might be slowing, and certain negative sexual health outcomes are increasing. For example, birth rates among adolescents aged 15-19 years decreased annually during 1991-2005 but increased during 2005-2007, from 40.5 live births per 1,000 females in 2005 to 42.5 in 2007 (preliminary data). The annual rate of AIDS diagnoses reported among males aged 15-19 years has nearly doubled in the past 10 years, from 1.3 cases per 100,000 population in 1997 to 2.5 cases in 2006. Similarly, after decreasing for >20 years, gonorrhea infection rates among adolescents and young adults have leveled off or had modest fluctuations (e.g., rates among males aged 15-19 years ranged from 285.7 cases per 100,000 population in 2002 to 250.2 cases per 100,000 population in 2004 and then increased to 275.4 cases per 100,000 population in 2006), and rates for syphilis have been increasing (e.g., rates among females aged 15-19 years increased from 1.5 cases per 100,000 population in 2004 to 2.2 cases per 100,000 population in 2006) after a significant decrease during 1997-2005.

The link between recent sexual abuse and drug use among African American male college students: it's not just a female problem in and around campus.

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p < or = 0.001) and past 30 day (OR = 5.0, p < or = 0.001) drug use.

Prevalence and correlates of interpersonal violence victimization in a junior enlisted Navy cohort.

This study assesses the prevalence and correlates of interpersonal violence victimization in a cohort of 493 male and 220 female junior Navy personnel who participated in a cross-sectional follow-up study on health-related behaviors. Survey data were obtained during 2000 about past-year prevalence of physical violence and sexual victimization. Chi-square tests of independence and multivariable logistic regression analyses were employed to estimate prevalence rates and to assess correlates of interpersonal violence. No gender differences were found for rates of violence victimization (16.4%) or sexual victimization (4.5%). Significant correlates of interpersonal violence victimization among males were depression and tobacco use; among females, significant correlates were depression and frequent heavy drinking. Findings suggest that large numbers of young enlisted adults serving in the military may be victims of interpersonal violence.

Influences of culture on Asian Americans' sexuality.

Asian Americans comprise a population group that is characterized by an enormous demographic, historical, and cultural heterogeneity, yet Asian Americans also share many Asian cultural characteristics such as the primacy of the family and the collective's goals over individual wishes, emphasis on propriety and social codes, the appropriation of sexuality only within the context of marriage, and sexual restraint and modesty. Although there are significant gaps in the scientific literature concerning Asian Americans sexuality, the existing data point to notable differences between Asian Americans and other ethnic groups on major aspects of sexual behavior. For example, relative to other U.S. ethnic group cohorts, Asian American adolescents and young adults tend to show more sexually conservative attitudes and behavior and initiate sexual intercourse at a later age. There are indications that as Asian Americans become more acculturated to the mainstream American culture, their attitudes and behavior become more consistent with the White American norm. Consistent with their more sexually conservative tendencies in normative sexual behavior, Asian American women also appear more reluctant to obtain sexual and reproductive care, which in turn places them at a greater risk for delay in treatment for breast and cervical cancer as well as other gynecological problems. Available data suggest that the prevalence rate of sexual abuse in Asian American communities appear lower than those of other groups, although it is not clear to what extent the low rates are due to cultural reluctance to report shameful experiences.

Survivors of sexual abuse: clinical, lifestyle and reproductive consequences.

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.