Wellbeing and illbeing in women exposed to physical and sexual violence during peripregnancy: a population-based longitudinal study.

Background: Physical and sexual violence against pregnant women have been associated with detrimental mental health outcomes for victims. Few studies have examined both positive (wellbeing) and negative (illbeing) mental health indicators in the same sample. Additionally, the literature assessing mental health based on different forms of violence is limited.Objective: To compare both wellbeing (life satisfaction) and illbeing (anxiety and depression) trajectories between non-victimized and victims of physical, sexual and both forms of violence that occurred during or shortly before pregnancy. Further, we analyse whether social support moderates these trajectories.Method: This longitudinal study is based on the Norwegian Mother, Father and Child Cohort, including the period from early pregnancy to toddlerhood (3 years). We compared wellbeing and illbeing trajectories of non-victims (n = 73,081), victims of physical abuse (n = 1076), sexual abuse (n = 683), and both forms of abuse (n = 107) using Growth Curve Modelling. Finally, social support was included as a moderator of wellbeing and illbeing trajectories.Results: Results indicated that victims scored systematically lower in wellbeing and higher in illbeing. Exposure to violence did not significantly change the wellbeing trajectory, pointing to similar developments in wellbeing among victims and non-victims for the considered period. On the other hand, different trajectories in illbeing occurred between victims and non-victims, as well as between victimized groups. Victims experienced greater change in illbeing scores, with a steeper decrease in illbeing compared to non-victims. Both victims and non-victims returned to respective baseline scores 3 years after birth. All women benefited from social support, but victims of physical abuse were particularly protected by social support.Conclusions: There is an alarming persistence of mental health problems in women exposed to violence during peripregnancy. Different forms of violence differentially impact women's mental health. Social support is beneficial among all pregnant women.

Victims of peripregnancy violence score systematic lower in wellbeing over time than non-victims. However, the wellbeing trajectories among victims and non-victims are similar.On the other hand, illbeing (anxiety and depression) trajectories differ for non-victims and victims of physical, sexual and both forms of violence. All women decreased their levels of illbeing from pregnancy to the first 6 months postpartum, but victims had a steeper decrease during this period compared to non-victims.All women benefited from social support, but victims of physical abuse were particularly protected by social support.

Caracterização epidemiológica de violência sexual no sudeste da região norte do brasil / Epidemiological characterization of sexual violence in southeast of northern Brazil / Caracterización epidemiológica de la violencia sexual en el sureste del norte de Brasil

Introdução: A violência sexual é qualquer ato físico, coercivo, de intimidação com potencial psicológico contra outra pessoa, ocorrendo, especialmente,no sexo feminino, em qualquer faixa etária.Objetivo: Apresentar uma caracterização epidemiológica dos casos de violência sexual referente ao número de casos, faixa etária e gênero entre período de 2014 a 2019 no município de Tucuruí-Pará.Métodos:Trata-se de um estudo de caráter descritivo, comparativo e retrospectivo de corte transversal. A coleta dos dados foi realizada através de notificações em protocolos dos órgãos do governo estadual e do governo municipal, na cidade de Tucuruí-Pará.Para análise dos dados, foram utilizados o teste Exato de Fisher e teste de Mann Whitney.Resultados:A instituição com maior número de notificações foi pelo instrumento Estadual, com 771 casos notificados durante o período de 2014 a 2019, (∆%=631%; p<0,001) em relação ao instrumento municipal, que apresentou o total de 140 casos notificados. Quanto a diferença de gênero, as mulheres são as mais atingidas por este tipo de violência em ambos os órgãos analisados, assim como, com respeito a faixa etária mais acometida, a infância, adolescência e adultos jovens são os que mais sofrem com o problema da violência sexual, de acordo com os dados de ambos os órgãos.Conclusão: O perfil da violência sexual no município de Tucuruí é predominante entre mulheres, da faixa etária que vai desde a infância até a fase adulta. Os dados utilizados das duas instituições durante o período de estudo apresentaram diferenças estatísticas, sendo o instrumento de notificações Estadual o órgão com maior número de notificações em todas as comparações realizadas (AU).

Introduction: Sexual violence is any physical, coercive act of intimidation with psychological potential against another person, occurring especially among females, in any age group.Objective: Present an epidemiological characterization of cases of sexual violence regarding the number of cases, age group and gender between 2014 and 2019 in the municipality of Tucuruí-Pará.Methods: This is a descriptive, comparative and retrospective cross-sectional study. Data collection was carried out through notifications in protocols of state and municipal government agencies, in the city of Tucuruí-Pará.For data analysis, Fisher's exact test and Mann Whitney test were used.Results: The institution with the highest number of notifications was by the State instrument, with 771 cases notified during the period 2014 to 2019, (∆%=631%; p<0.001) compared to the municipal instrument, which presented a total of 140 cases notified. As for the gender difference, women are the most affected by this type of violence in both bodies analyzed, as well as, with respect to the most affected age group, childhood, adolescence and young adults are the ones who suffer most from the problem of sexual violence, according to data from both bodies. Conclusion: The profile of sexual violence in the city of Tucuruíis predominant among women, in the age group that goes from childhood to adulthood. The data used from the two institutions during the study period showed statistical differences, with the State notification instrument being the body with the highest number of notifications in all comparisons performed (AU).

Introducción: La violencia sexual es cualquier acto físico y coercitivo de intimidación con potencial psicológico contra otra persona,que ocurre especialmente entre mujeres, en cualquier grupo de edad.Objetivo:Presentar una caracterización epidemiológica de los casos de violencia sexual en cuanto al número de casos, grupo etario y género entre 2014 y 2019 en el municipio de Tucuruí-Pará. Métodos:Se trata de un estudio transversal descriptivo, comparativo y retrospectivo. La recolección de datos se realizó a través de notificaciones en protocolos de organismos gubernamentales estatales y municipales, en la ciudad de Tucuruí-Pará. Parael análisis de los datos se utilizó la prueba exacta de Fisher y la prueba de Mann Whitney. Resultados:La institución con mayor número de notificaciones fue por el instrumento Estatal, con 771 casos notificados durante el período 2014 a 2019, (∆%=631%; p<0,001) frente al instrumento municipal, que presentó un total de 140 casos notificados. En cuanto a la diferencia de género, las mujeres son las más afectadas por este tipo de violencia en ambos cuerpos analizados, así como, respecto al grupo de edad más afectado, la infancia, la adolescencia y los adultos jóvenes son quienes más sufren el problema de la violencia sexual, según datos de ambos organismos. Conclusión:El perfil de violencia sexual en la ciudad de Tucuruí es predominante entre las mujeres, enel grupo etario que va desde la niñez hasta la edad adulta. Los datos utilizados de las dos instituciones durante el período de estudio mostraron diferencias estadísticas, siendo el instrumento de notificación del Estado el organismo con mayor número de notificaciones en todas las comparaciones realizadas (AU).

How do young men narrate the redemption story of a sexual assault perpetrator?

Background: Little is known about how young men who have committed sexual assault might acknowledge wrongdoing and eventually change and make amends. There are practical barriers to seeking the real redemption stories of perpetrators.Objective: To explore hypothetical pathways to young men's accountability-taking and amends (i.e. redemption) after perpetration of sexual assault.Method: In a pre-registered, qualitative story completion study, we presented heterosexual, cisgender college men (N = 54) with a date-based sexual assault story written by a fictional male perpetrator. Participants were prompted to complete the story so that the protagonist, who initially denies wrongdoing, eventually changes and becomes a violence prevention advocate.Results: A thematic analysis of the redemption stories revealed that this study's speculative task was a challenging one. Half of the stories did not provide an explanation for how the perpetrator was able to acknowledge wrongdoing. Overall, individualistic themes (e.g. he introspected) were more common than relational, community, or societal facilitators of redemption.Conclusions: Without infrastructure for accountability-taking and repair, or narrative exemplars to draw from in public life, it is difficult to envision redemption from violence. Rare gender-based, structurally attuned analyses of sexual violence in the stories point the way towards a more transformative vision of redemption.

In this qualitative story completion study, college men wrote the redemption story of a fictional sexual assault perpetrator.Men had difficulty explaining how the perpetrator would acknowledge wrongdoing.Redemption themes tended to be individualistic versus rooted in community.

Defining military sexual trauma: establishing parameters and perspectives.

Background: The term military sexual trauma [MST] is increasingly used to describe instances of sexual harassment/assault that occur between serving personnel during military service. However, in the absence of a clear universal definition, MST is an increasingly contested term, with confusion about its scope, application to differing jurisdictions and implications for responses and treatment.Objective: This editorial provides a universal definition of MST, decoupled from any national system or framework.Method: Drawing on existing international evidence about the nature and impact of MST.Results and Conclusion: We argue that MST terminology provides a unique framing which recognises the institutional nature of MST victimisation and situates the context, behaviours, and impact on a continuum of violence.

MST terminology provides understanding and acknowledgement of the nuances of sexual harassment/assault in the military institution.MST terminology should encompass a continuum of sexual violence.Drawing on existing military health research, the authors contend that MST should be considered as a distinctive traumatic stressor.

Developing and implementing survivor-centred approaches for college student-athletes: perspectives from athletic department, Title IX, and campus advocacy personnel.

ABSTRACTBackground: Sexual violence (SV) is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Yet, prior research shows that many university practices can be more harmful than helpful to SV survivors and necessitates a reimagination of how institutions support SV survivors. Survivor-centred approaches may be one way to effectively address SV for students, including student-athletes, across college campuses.Objective: This qualitative study explored campus personnel experiences with and perceptions of survivor-centred SV prevention and intervention policies and practices on college campuses and examined how these approaches serve SV survivors, including college student-athletes.Methods: As part of a larger study on campus SV and student-athletes across four institutions, semi-structured interviews with 22 representatives from athletic departments, campus advocacy, and Title IX were conducted. Guided by phenomenology, a thematic analysis approach was used to identify key patterns in survivor-centred SV prevention and intervention policies and practices. Participant demographic data were analysed descriptively.Results: Most participants identified as white (72.2%), heterosexual (63.6%), women (68.2%), and were an average of 41.8 years old (SD = 10.2). The majority were in positions associated with athletic departments (63.6%), and they had been in their role for an average of 5.6 years (SD = 6.6). Through thematic analysis, three main themes were identified: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Conclusions: The findings from this study highlight clear policy and practice recommendations for survivor-centred SV prevention and intervention on college campuses, such as accessible, applicable SV training and the implementation of survivor-centred approaches. Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions and within athletic departments.

Sexual violence is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Survivor-centred approaches may offer solutions to better serve survivors of sexual violence, including student-athletes.Through interviews with athletic department, Title IX, and campus advocacy personnel, three themes were identified related to developing and implementing survivor-centred approaches: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions, particularly for college student-athletes.

Violência sexual infantojuvenil no Brasil: um panorama de seus determinantes e da maneira como se relacionam / Child and adolescent sexual violence in Brazil: an overview of its determinants and the way they are related

Objetivo: cconstruir um panorama diagnóstico da violência sexual infantojuvenil assistida no sistema de saúde no Brasil. Métodos: estudo transversal, analítico, realizado com dados do Ministério da Saúde a respeito da violência sexual infantojuvenil no Brasil, no período de 2010 a 2021. Foram conduzidas análises de estatística descritiva e multivariadas, por meio das técnicas de Análise de Correspondências Múltiplas e de Clusterização Hierárquica. Resultados: observou-se grande importância associada à presença de vítimas do sexo feminino, solteiras, adolescentes, que têm práticas sexuais apenas com homens, em ambiente residencial, na ausência de ex-cônjuge, patrão, madrasta ou cuidador no momento da ocorrência. Notou-se também, importância associada aos casos de recorrências, à coocorrência de violência física e psicológica, bem como relacionada à participação de pais, namorados e conhecidos como violentadores. Além disso, identificou-se que as ocorrências em via pública parecem estar mais associadas a vítimas de baixa escolaridade. Conclusão: a violência sexual infantojuvenil no Brasil se estabelece, portanto, como um importante problema social, cultural, de segurança e saúde pública. Foi possível explorar os principais parâmetros associados às ocorrências no país, permitindo, assim, a possibilidade de sua aplicação em ferramentas e serviços de assistência.

Objective: build a diagnostic overview of child and adolescent sexual violence assisted in the health system in Brazil. Methods: a cross-sectional, analytical study carried out with data from the Ministry of Health regarding child and adolescent sexual violence in Brazil from 2010 to 2021. Descriptive and multivariate statistical analyses were conducted using Multiple Correspondence Analysis and Hierarchical Clustering. Results: there was great importance associated with the presence of female victims, singles, and teenagers who have sexual practices only with men in a residential environment, in the absence of a former spouse, boss, stepmother, or caregiver at the time of the occurrence. It was also noted the importance associated with cases of recurrence, the co-occurrence of physical and psychological violence, as well as related to the participation of parents, boyfriends, and acquaintances as perpetrators. Furthermore, it was identified that incidents on public roads seem to be more associated with victims with low education. Conclusion: child and adolescent sexual violence in Brazil is, therefore, established as an important social, cultural, safety, and public health problem. It was possible to explore the main parameters associated with occurrences in the country, thus allowing the possibility of its application in assistance tools and services.

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.

[Sexual violence and young people: "it is not something you are born with, but with what you learn"]. / Violencia sexual y jóvenes: «no es algo con lo que naces, sino con lo que aprendes¼.

OBJECTIVE: To analyse the perceptions and experiences of young people in Spain about sexual violence (SV), its possible causes, victims and perpetrators.. METHOD: Qualitative study based on semi-structured interviews with 22 young people between 18 and 24 years old. A qualitative content analysis was carried out. RESULTS: In the juvenile narratives, the lack of definition and accuracy about what SV is stands out, except for mentioning rape, lack of consent and use of force in sexual relations. The girls, self-perceived as the main victims, also break with these narratives by providing a broader vision and gender inequalities related. In general, the most prevailed idea is that VS is perpetrated by men against women in heterosexual relationships inside and outside the couple. Regarding explanations, references coexist to both contextual factors (linked to gender inequalities and the social construction of sexual relationships) and behavioural factors (which includes the viewing of pornography). Tentatively proposals for improvement related to sexual and affective education emerge. CONCLUSIONS: In the perceptions of the young people, ambiguity seems to coexist with explicit references to the different ways in which it manifests itself and the influence of gender inequalities. Sex and life experience appear to influence these narratives. It is necessary to promote a more critical perspective on the social construction of SV and intimate relationships in the young population.

Conductas autolíticas suicidas y no suicidas en víctimas de violencia sexual infantil / Suicidal and Non-Suicidal Self-Harm Behaviors in Victims of Sexual Violence Against Children

La violencia sexual hacia la infancia y las conductas autolesivas suicidas y no suicidas son dos problemáticas sociales y de salud que han incrementado. Las agresiones sexuales conllevan un impacto, afectando a la tendencia a realizar comportamientos autolíticos. Por ello, se pretendía estudiar la relación existente entre haber sido víctima de VSI y la probabilidad de realizar conductas autolesivas suicidas y no suicidas en adolescencia y adultez temprana. Para ello, se ha realizado una revisión sistemática, a través de las bases de datos Pubmed y PsicInfo de artículos publicados entre 2015 y 2022. Se ha hallado una relación significativa entre ambas problemáticas, observando que los intentos de suicidios de estas víctimas estaban relacionados intrínsecamente con sus experiencias de agresión. Así, se ha encontrado que variables como el género, la rumiación, la desregulación emocional, el apoyo social y las características de la agresión median la relación existente entre la violencia sexual infantil y las conductas autolíticas suicidas y no suicidas. Este tipo de investigaciones nos ayuda a establecer el foco de intervención en los casos de víctimas de agresión sexual infantil, pero debe también ayudar a dar visibilidad a la problemática e impulsar la intervención preventiva protegiendo la infancia. (AU)

Sexual violence against children and suicidal and non-suicidal self-injurious behaviors are two social and health problems that have increased. Sexual assaults have an impact, affecting the tendency to carry out autolytic behaviors. Therefore, it was intended to study the relationship between having been a victim of sexual violence in their childhood and the probability of engaging in suicidal and non-suicidal self-injurious behaviors in adolescence and early adulthood. For this, a systematic review has been carried out, through the Pubmed and PsycInfo databases of articles published between 2015 and 2022. A significant relationship has been found between both problems, observing that the suicide attempts of these victims were intrinsically related to their experiences of aggression. Thus, it has been found that variables such as gender, rumination, emotional dysregulation, social support, and characteristics of aggression mediate the relationship between sexual violence against children and suicidal and non-suicidal autolytic behaviors. This type of investigation helps us to establish the focus of intervention in the cases of victims of child sexual assault, but it should also help to give visibility to the problem and promote preventive intervention protecting children. (AU)

Conductas autolíticas suicidas y no suicidas en víctimas de violencia sexual infantil / Suicidal and Non-Suicidal Self-Harm Behaviors in Victims of Sexual Violence Against Children

La violencia sexual hacia la infancia y las conductas autolesivas suicidas y no suicidas son dos problemáticas sociales y de salud que han incrementado. Las agresiones sexuales conllevan un impacto, afectando a la tendencia a realizar comportamientos autolíticos. Por ello, se pretendía estudiar la relación existente entre haber sido víctima de VSI y la probabilidad de realizar conductas autolesivas suicidas y no suicidas en adolescencia y adultez temprana. Para ello, se ha realizado una revisión sistemática, a través de las bases de datos Pubmed y PsicInfo de artículos publicados entre 2015 y 2022. Se ha hallado una relación significativa entre ambas problemáticas, observando que los intentos de suicidios de estas víctimas estaban relacionados intrínsecamente con sus experiencias de agresión. Así, se ha encontrado que variables como el género, la rumiación, la desregulación emocional, el apoyo social y las características de la agresión median la relación existente entre la violencia sexual infantil y las conductas autolíticas suicidas y no suicidas. Este tipo de investigaciones nos ayuda a establecer el foco de intervención en los casos de víctimas de agresión sexual infantil, pero debe también ayudar a dar visibilidad a la problemática e impulsar la intervención preventiva protegiendo la infancia. (AU)

Sexual violence against children and suicidal and non-suicidal self-injurious behaviors are two social and health problems that have increased. Sexual assaults have an impact, affecting the tendency to carry out autolytic behaviors. Therefore, it was intended to study the relationship between having been a victim of sexual violence in their childhood and the probability of engaging in suicidal and non-suicidal self-injurious behaviors in adolescence and early adulthood. For this, a systematic review has been carried out, through the Pubmed and PsycInfo databases of articles published between 2015 and 2022. A significant relationship has been found between both problems, observing that the suicide attempts of these victims were intrinsically related to their experiences of aggression. Thus, it has been found that variables such as gender, rumination, emotional dysregulation, social support, and characteristics of aggression mediate the relationship between sexual violence against children and suicidal and non-suicidal autolytic behaviors. This type of investigation helps us to establish the focus of intervention in the cases of victims of child sexual assault, but it should also help to give visibility to the problem and promote preventive intervention protecting children. (AU)

[Addressing sexual violence in health services]. / La violencia sexual y su abordaje en el sistema de salud.

Sexual violence is a very underdetected public health problem, with important short and long-term consequences on physical, mental, social, sexual and reproductive health, which must be taken into account by health services. Health systems are part of the set of resources necessary for a comprehensive approach from the ecological model: prevention and promotion of healthy sexuality with equality, adequate and coordinated care in the event of sexual assault and subsequent support to prevent sequelae. All sexual violence has health consequences, even those that may seem less serious such as sexual harassment or sexual cyberviolence. We must know the needs of the victim and their possible emotional reactions. A risk assessment will be carried out, the victim will be referred to a hospital if necessary and comprehensive and integrated care will be provided. Care and follow-up must focus on the survivor and with professionals trained in trauma to understand the consequences of sexual violence, offer a safe and trusting environment and know how to reinforce their qualities and support.

Rethinking sexual violence labels: exploring the impact of 'victim' and 'survivor' discourse.

Background: Universities' responses to sexual violence have faced scrutiny for their lack of proactiveness and their failure to address campus socio-cultural norms that contribute to rape myth acceptance. The labels victim and survivor play a crucial role in shaping attitudes toward sexual violence, but there is limited research on how university students perceive these labels.Objective: This paper explores sexual violence labels and their role in perpetuating rape culture. Undergraduate university students' beliefs on using the label survivor instead of victim to describe someone who has experienced sexual violence were examined to consider how these labels create societal discourse on sexual violence.Method: The study draws on qualitative data collected from undergraduate students in Canada and the United States through open-response questions in an interactive textbook. Data were analysed and interpreted using a multi-method approach that combined principles of Critical Discourse Analysis and Feminist Poststructuralism. Direct quotes and word clouds from participants' responses are used as evidence and to visually display discourse.Results: Findings revealed that participants recognised the negative societal discourses associated with the label victim and supported using survivor to challenge perceptions of sexual violence. Despite this, participants expressed hesitancy to adopt the label survivor because of the potential negative implications, such as the label promoting the allocation of individual blame, increasing barriers to justice, and reducing the perceived severity of sexual violence.Conclusions: This study underscores the complexities of sexual violence labels, the influence of language in shaping societal perceptions, and the need for a more comprehensive and equitable approach to responding to sexual violence.

Dichotomy of Labels and Nuanced Perceptions: Sexual violence labels shape identity perceptions. Participants dichotomised the labels victim and survivor, associating one with negative attributes and the other with positive attributes. However, nuanced views of how people perceive and identify with these labels challenge distinct categories. Victims being negatively perceived, while survivors are admired for their resiliency highlights complexities in societal expectations that may not fully address the underlying determinants of sexual violence.Role of Language in Reproduction of Rape Culture: Poststructuralist theories emphasise the role of language in the production and maintenance of discourse. The study shows that victim discourse is steeped in rape myths. The historical discourse surrounding the label may contribute to the perpetuation of negative attitudes and behaviours toward victims of sexual violence. The emergence of the label survivor reflects a societal shift, but findings suggest this may lead to societal complacency towards sexual violence.Spectrum of Severity and Societal Empathy: Participants' understanding of sexual violence as a spectrum of severity may lead to unequal levels of empathy and support. This discourse creates positions of dominance and oppression, potentially marginalising certain groups who are disproportionately affected by sexual violence. The study highlights how severity discourse can influence institutional agendas and may result in political and institutional neglect of sexual violence.

Violencia sexual y jóvenes: «no es algo con lo que naces, sino con lo que aprendes» / Sexual violence and young people: “it is not something you are born with, but with what you learn”

Objetivo: Analizar las percepciones y experiencias de la población joven en España sobre la violencia sexual (VS), sus posibles causas, víctimas y perpetradores. Método: Estudio cualitativo basado en entrevistas semiestructuradas a 22 jóvenes de entre 18 y 24 años. Se llevó a cabo un análisis del contenido cualitativo. Resultados: En las narrativas juveniles destacan la indefinición y la inconcreción sobre lo que es la VS, excepto cuando mencionan la violación, la falta de consentimiento y el uso de la fuerza en las relaciones sexuales. Las chicas, interpeladas como principales víctimas, aportan una visión más amplia y vinculada a las desigualdades de género. En general, predomina la idea de que la VS es perpetrada por hombres contra mujeres en relaciones heterosexuales dentro y fuera de la pareja. En las explicaciones, conviven las referencias a factores tanto contextuales (ligados a las desigualdades de género y la construcción social de las relaciones sexuales) como conductuales (que incluyen el visionado de pornografía). También emergen algunas estrategias relacionadas con la educación sexual y afectiva. Conclusiones: En las percepciones de las personas jóvenes participantes en este estudio parecen convivir la ambigüedad con referencias explícitas a las diferentes formas en las que se manifiesta la VS y la influencia de las desigualdades de género. El sexo y la experiencia vital parecen influir en estas narrativas. Se requiere el fomento de una perspectiva más crítica sobre la construcción social de la VS y las relaciones íntimas en la población joven.(AU)

Objective: To analyse the perceptions and experiences of young people in Spain about sexual violence (SV), its possible causes, victims and perpetrators.Method: Qualitative study based on semi-structured interviews with 22 young people between 18 and 24 years old. A qualitative content analysis was carried out. Results: In the juvenile narratives, the lack of definition and accuracy about what SV is stands out, except for mentioning rape, lack of consent and use of force in sexual relations. The girls, self-perceived as the main victims, also break with these narratives by providing a broader vision and gender inequalities related. In general, the most prevailed idea is that VS is perpetrated by men against women in heterosexual relationships inside and outside the couple. Regarding explanations, references coexist to both contextual factors (linked to gender inequalities and the social construction of sexual relationships) and behavioural factors (which includes the viewing of pornography). Tentatively proposals for improvement related to sexual and affective education emerge. Conclusions: In the perceptions of the young people, ambiguity seems to coexist with explicit references to the different ways in which it manifests itself and the influence of gender inequalities. Sex and life experience appear to influence these narratives. It is necessary to promote a more critical perspective on the social construction of SV and intimate relationships in the young population.(AU)

O aborto legal em casos de gravidez decorrente de violência sexual: percepções e vivências de médicas e médicos obstetras / Legal abortion in cases of sexual violence pregnancy: perceptions and experiences of obstetricians / El aborto legal en casos de embarazo resultante de violencia sexual: percepciones y experiencias de médicas y médicos obstetras

Resumo: Este estudo objetivou analisar as percepções de obstetras e residentes de ginecologia-obstetrícia, atuantes numa maternidade escola federal, sobre o aborto legal em casos de gravidez decorrente de violência sexual, desvelando suas motivações, resistências e sentimentos, e identificando suas experiências com o tema. A primeira etapa correspondeu ao preenchimento de um questionário autoaplicável. Os critérios de seleção foram: obstetras vinculados ao centro obstétrico; diretor da divisão médica; e residentes do programa de ginecologia-obstetrícia da instituição. Obtiveram-se 36 questionários respondidos. A segunda etapa correspondeu à realização de uma entrevista, tendo sido utilizado o critério de amostragem por saturação e foram entrevistados seis médicos. As entrevistas foram analisadas pelo método de análise de conteúdo, na modalidade temática. Os questionários retrataram que todos os participantes já haviam prestado assistência a mulheres em situação de violência sexual e que a maioria já havia participado da realização de um aborto legal. As entrevistas evidenciaram os dilemas enfrentados pelos profissionais na assistência a esses casos e a escassez da formação profissional em relação à temática. A palavra da mulher foi tida ora como objeto de suspeição em relação à veracidade do estupro, ora como capaz de suscitar afetação das profissionais em suas escutas, o que possibilitou que essas se aproximassem das vítimas e ofertassem uma assistência mais humanizada. Os resultados apontaram para a importância da temática ser abordada nos campos da saúde e da formação para além do enfoque técnico-científico, visando produzir novas estratégias de cuidado.

Abstract: This study aimed to analyze the perceptions of obstetricians and gynecology-obstetrics residents at a federal school maternity hospital regarding legal abortion in cases of sexual violence pregnancy, understand their motivations, strengths, and feelings, and identify their experience with this topic. The first stage consisted of answering a self-administered questionnaire. The selection criteria were: obstetricians linked to the obstetric center, director of the medical division, and residents of the institution's obstetrics-gynecology program. In total, 36 questionnaires were answered and returned. The second stage corresponded to an interview using a saturation sampling criterion. Six physicians were interviewed. The interviews were evaluated using a thematic content analysis. The questionnaires showed that all participants had already provided care to women in situations of sexual violence and that most of them had already participated in a legal abortion procedure in these cases. The interviews highlighted the dilemmas faced by professionals in providing care to these women and the lack of professional training to handle these cases. The speeches of women were sometimes seen as an object of suspicion regarding the veracity of sexual violence, and sometimes as an object that caused professionals to feel emotionally affected while listening to them, allowing professionals to approach the victims and offer more humanized care. The results pointed to the importance of addressing this topic in the areas of health and providing training beyond the technical-scientific focus in order to support the development of new care strategies.

Resumen: El estudio tuvo como objetivo analizar las percepciones de obstetras y residentes de gineco-obstetricia de una maternidad escolar federal sobre el aborto legal en casos de embarazo resultante de violencia sexual, revelar sus motivaciones, resistencias y sentimientos, e identificar sus experiencias con el tema. La primera etapa consistió en completar un cuestionario autoadministrado. Los criterios de selección fueron los siguientes: obstetras vinculados al centro obstétrico; director de la división médica; y residentes del programa de gineco-obstetricia de la institución. Se obtuvieron 36 cuestionarios cumplimentados. La segunda etapa consistió en una entrevista, utilizando un criterio de muestreo por saturación. Se entrevistó a 6 médicos. Las entrevistas se analizaron mediante el método de análisis de contenido, en la modalidad temática. Los cuestionarios mostraron que todos los participantes ya habían brindado asistencia a mujeres en situación de violencia sexual y que la mayoría ya había participado en la realización de un aborto legal en estos casos. Las entrevistas pusieron de manifiesto los dilemas que enfrentan los profesionales en la asistencia a estos casos y la escasa formación profesional con relación al tema. La palabra de la mujer fue vista a veces como objeto de sospecha con respecto a la veracidad de la violación, y a veces como un objeto capaz de suscitar la afectación de las profesionales en sus escuchas, lo que les permitió acercarse a las víctimas y ofrecer una asistencia más humanizada. Los resultados señalaron la importancia de que la temática sea abordada en los campos de la salud y de la formación más allá del enfoque técnico-científico, con el objetivo de producir nuevas estrategias de cuidado.

Trend and spatial pattern of intimate partner rape notifications against women in Northeast Brazil (2013-2022) / Tendência e padrão espacial das notificações de estupro por parceiro íntimo contra mulheres no Nordeste do Brasil (2013-2022)

ABSTRACT Objective: To analyze the trend and spatial pattern of intimate partner rape reports against women in Northeast Brazil. Methods: Ecological time-series study and spatial analysis with secondary data from the Notifiable Diseases Information System between 2013 and 2022. Gross rape rates were calculated by type of intimate partner and by age group of the victim. Prais-Winsten regression was used to calculate the trend, and the global and local Moran indices were used for spatial analysis. Results: A total of 5,542 cases of intimate partner rape were reported. Spousal rates ranged from 0.34/100,000 women in 2013 to 0.51/100,000 in 2017, with greater increases between 2018 (1.04/100 thousand) and 2022 (1.28/100 thousand). There was an upward trend in the Northeast as a whole (APC=19.47; 95%CI 15.88-23.22) and in almost all states, except Paraíba and Sergipe. Cases perpetrated by boyfriends (APC=23.90; 95%CI 12.80-36.09) and among women aged 15 to 19 years (APC=22.63; 95%CI 4.18-44.35) showed the highest annual variation. A concentration of high rates was observed in several municipalities in the northwest of Ceará and southeast of Pernambuco. Conclusion: The trend in intimate partner rape rates against women increased in the Northeast, especially among younger women and by boyfriends, with a greater agglomeration of notifications in Ceará and Pernambuco.

RESUMO Objetivo: Analisar a tendência e o padrão espacial das notificações de estupro por parceiro íntimo contra mulheres no Nordeste do Brasil. Métodos: Estudo ecológico de série temporal e análise espacial com dados secundários do Sistema de Informação de Agravos de Notificação (SINAN) entre 2013 e 2022. Foram calculadas taxas brutas de estupro por tipo de parceiro íntimo e por faixa etária da vítima. Para o cálculo de tendência, utilizou-se a regressão de Prais-Winsten e, para a análise espacial, adotou-se o índice global e local de Moran. Resultados: Foram notificados 5.542 casos de estupro pelo parceiro íntimo. As taxas perpetradas pelo cônjuge variaram de 0,34/100 mil mulheres em 2013 para 0,51/100 mil em 2017, com maiores elevações entre 2018 (1,04/100 mil) e 2022 (1,28/100 mil). Houve tendência de aumento no Nordeste como um todo (VPA=19,47; IC95% 15,88-23,22) e em quase todos os estados, exceto Paraíba e Sergipe. Os casos perpetrados por namorados (VPA=23,90; IC95% 12,80-36,09) e entre mulheres de 15 a 19 anos (VPA=22,63; IC95% 4,18-44,35) exibiram maior variação anual. Observou-se concentração de altas taxas em diversos municípios no noroeste do Ceará e no sudeste de Pernambuco. Conclusão: A tendência das taxas de estupro contra mulheres perpetrado pelo parceiro íntimo aumentou no Nordeste, principalmente entre as mais jovens e por namorados, tendo maior aglomerado de notificações no Ceará e em Pernambuco.

Competências comuns para a prática interprofissional no cuidado às pessoas em situação de violência sexual / Common skills for the interprofessional practice in care for people in sexual violence

Resumo Introdução: A violência sexual é um grave problema na sociedade brasileira cujas repercussões no âmbito da saúde pública tornam imperativa a abordagem dessa questão no contexto da formação das suas profissões. Igualmente, a integralidade do cuidado destinado às pessoas em situação de violência sexual requer a atuação conjunta de diversas profissões, além da integração em rede e articulação de diferentes equipamentos sociais. Objetivo: Este estudo teve como objetivo reconhecer quais competências - entendidas como o conjunto de conhecimentos, habilidades e atitudes - são necessárias para o desenvolvimento do cuidado integral destinado às pessoas em situação de violência sexual, segundo os melhores padrões de qualidade e segurança para a saúde delas. Método: Realizou-se um estudo qualitativo de caráter exploratório e descritivo que envolveu a aplicação de um formulário prévio sobre os conhecimentos acerca das competências, seguido da dinâmica da construção da figura humana, que consiste na confecção de um boneco no qual os conhecimentos estariam representados pela cabeça, as habilidades pelos membros e as atitudes pelo corpo, na realização de uma oficina com 76 participantes de diferentes profissões. Adicionalmente, aplicou-se um questionário a 32 profissionais com reconhecida expertise na área de violência sexual e com experiência prática no atendimento às pessoas nessa situação. Foi empregada a análise temática categorial. Resultado: Identificaram-se desafios a serem superados nas três dimensões constituintes das competências, com nítida deficiência de conhecimentos para a atuação em rede visando à efetividade e à integralidade do cuidado. Reconheceram-se 15 competências comuns aos profissionais que lidam com a violência, e o produto final foi representado num infográfico de disposição radial com a organização dos conhecimentos, das habilidades e das atitudes identificados como necessários para o desenvolvimento de tais competências. Conclusão: Reconhecer competências comuns e identificar, separadamente, quais conhecimentos, habilidades e atitudes as constituem representa estratégias promotoras da abordagem transversal desses conteúdos na formação das profissões, sobretudo da saúde. A proposição de uma matriz de competências comuns para prática interprofissional no cuidado destinado às pessoas em situação de violência sexual pode orientar a qualificação desse cuidado e alicerçar a interprofissionalidade em cenários cruciais de atuação coletiva para o enfrentamento da flagrante injustiça social que a violência sexual significa.

Abstract Introduction: Sexual violence is a serious problem in Brazilian society whose repercussions on public health make it imperative to address this issue in the context of training in professions. Likewise, comprehensive care for people in situations of sexual violence requires the joint action of different professions, in addition to network integration and articulation of different social facilities. Objective: This study aimed to reflect which competencies - understood as the set of knowledge, skills and attitudes - are permitted for the development of comprehensive care for people in situations of sexual violence, according to the best standards of quality and health safety they. Method: A qualitative study of an exploratory and descriptive nature was carried out, which involved the application of a preliminary form on knowledge about skills, followed by the dynamics of the construction of the human figure, which consists of manufacturing a doll in which the knowledge would be represented by the head, by the skills of the members and by the attitudes of the body, in the creation of an office with 76 participants from different professions. Furthermore, a questionnaire was administered to 32 professionals with experience in the area of sexual violence and with practical experience in caring for people in this situation. Categorical thematic analysis was used. Result: Result: Challenges were identified to be overcome in the three dimensions that constitute competencies, with a clear lack of knowledge for working in a network aiming at the effectiveness and comprehensiveness of care. 15 competencies common to professionals who deal with violence were recognized, and the final product was represented in a radially arranged infographic with the organization of knowledge, skills and attitudes identified as necessary for the development of such competencies. Conclusion: Recognizing common competencies and identifying, separately, which knowledge, skills and attitudes constitute them represent strategies that promote a transversal approach to these contents in the training of professions, especially in health. Proposing a matrix of common competencies for interprofessional practice in care for people in situations of sexual violence can guide the qualification of this care and support interprofessionality in crucial scenarios of collective action to combat the blatant social injustice that sexual violence means.

Violência sexual contra mulheres e os processos de trabalho em unidades de saúde especializadas: avanços, desafios e resistências feministas / Sexual offenses against women and work processes in specialized health services: achievements, challenges and feminist resistance

Resumo Neste artigo, buscou-se refletir sobre a atenção ofertada às mulheres em situação de violência sexual (VS) em duas unidades de saúde especializadas (UE) do Sistema Único de Saúde (SUS). A partir da análise qualitativa de entrevistas com profissionais dessas UE e de observações participantes realizadas entre novembro/2021 e agosto/2022, notaram-se problemas como: dificuldades em abordar o tema da VS e do aborto; despreparo para acolher mulheres em situação de VS; e fragilidades na atuação em rede. Como avanços, destacam-se: a compreensão da VS como problema social e de saúde por profissionais das equipes multidisciplinares, que se configuram como referências positivas para organização do trabalho em torno da VS nas UE; a disponibilidade de insumos necessários; e a percepção da melhoria na humanização da atenção à VS, desde a implementação da coleta de vestígios no SUS. É evidente que, para além das questões técnicas, o atendimento à VS é permeado por questões socioculturais e de gênero que atravessam os processos de trabalho, afetando a organização e a forma como o cuidado será ofertado. Enfatiza-se a importância da resistência feminista dos profissionais das equipes multidisciplinares para realização do trabalho e a urgência da formação de profissionais sensíveis para tratar das violências de gênero.

Abstract This study aimed to reflect on the health care offered to women in situations of sexual violence (SV) in two specialized units (SU) in the Brazilian Unified Health System (SUS). Based on a qualitative analysis of interviews with professionals from these SUand participant observations, carried out from November/2021 to August/2022, this study observed problems such as difficulties in approaching subjects of SV and abortion; unpreparedness to welcome women in situations of SV, and network weaknesses. As advances, this research found that multidisciplinary team professionals understand of SV as a social and health problem, workers who serve as positive references for organizing work around SV in SU; the availability of the necessary supplies; and the perception of improvement in the humanization of SV care since the implementation of trace collection at SUS. In addition to technical issues, health care is evidently permeated by sociocultural and gender issues that affect work processes, affecting organizations and the way care is provided. The importance of feminist resistance by professionals in multidisciplinary teams is emphasized due to the urgent need to train sensitive professionals to deal with gender-based violence.

Violencia sexual contra la mujer: reporte de caso / Sexual violence against women. Case report

Introducción: La violencia sexual contra la mujer es un problema de grandes magnitudes, que no ha sido adecuadamente dimensionado, debido a la tendencia a no denunciar de las víctimas. Justificación: En Honduras el 24% de las mujeres reporto haber sufrido algún tipo de violencia sexual, en algún momento de su vida, por lo que la investigación en este campo es relevante. Resumen del caso: Femenina adulta que fue atacada sexualmente por un hombre desconocido que la intercepto en la vía pública; la denuncia y la investigación integrada culmino con la captura y condena del imputado. Conclusión: Este caso ilustra la importancia del trabajo integrado entre los entes de investigación, forenses y fiscalía para la gestión adecuada de la información que culmino en la detención y condena del sospechoso y justicia para la víctima...(AU)

Lifetime sexual violence among transgender women and travestis (TGW) in Brazil: Prevalence and associated factors / Violência sexual durante a vida em mulheres trans e travestis (MTT) no Brasil: Prevalência e fatores associados

ABSTRACT Objective To describe the prevalence, characteristics, and factors associated with sexual violence in transgender women and travestis (TGW) in Brazil. Methods This cross-sectional study was conducted in five Brazilian cities (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo) between 2019 and 2021. Participants were recruited using the respondent-driven sampling (RDS) technique. The outcome of interest is the self-reported experience of sexual violence throughout the respondents' lifetime. We evaluated the actions taken by victims of sexual violence and how they dealt with the experience. Logistic regression analysis was employed to examine the associations between sociodemographic and behavioral factors (such as race, income, drug use, sex work, and access to healthcare) and the outcome. Results A total of 1,317 TGW were interviewed. Among them, 53% (n=698) reported experiencing sexual violence. For 64.4% (n=419) of the respondents, sexual violence occurred on more than one occasion. The majority of TGW did not seek health services (93.2%, n=648), disclose the violence (93.9%, n=653), nor seek support from family or friends (86.5%, n=601). A higher prevalence of sexual violence was associated with homelessness (adjusted prevalence ratio — aPR=1.69, 95% confidence interval — 95%CI 1.01-2.84), a history of engaging in sex work (aPR=2.04, 95%CI 1.46-2.85), self-reporting regular, bad, or very bad emotional health (aPR=1.67, 95%CI 1.28-2.19), and experiencing difficulties accessing health services in the previous year (aPR=2.78, 95%CI 1.74-4.43). Conclusion The high prevalence of sexual violence, analyzed together with the actions of the victims, indicates a context of high vulnerability and low institutional support. In this scenario, violence can be exacerbated, resulting in severe health consequences.

RESUMO Objetivo Descrever a prevalência, características e fatores associados à violência sexual em mulheres trans e travestis (MTT) no Brasil. Métodos Estudo transversal conduzido em cinco cidades brasileiras (Campo Grande, Manaus, Porto Alegre, Salvador e São Paulo) entre 2019 e 2021. As participantes foram recrutadas usando a técnica respondent-driven sampling (RDS). O desfecho é a experiência de violência sexual ao longo da vida. As ações tomadas pelas vítimas e como elas lidaram com a experiência foram avaliadas. Análise de regressão logística foi empregada para examinar as associações entre fatores sociodemográficos e comportamentais (como raça, renda, trabalho sexual e acesso aos serviços de saúde) e o desfecho. Resultados Um total de 1.317 MTT foram entrevistadas. Entre elas, 53% (n=698) relataram violência sexual. Para 64,4% (n=419) destas, a violência sexual ocorreu em mais de uma ocasião. A maioria das MTT não procurou serviços de saúde (93,2%, n=648), não denunciou (93,9%, n=653) nem buscou apoio de familiares ou amigos (86,5%, n=601). A maior prevalência de violência sexual foi associada à falta de moradia (razão de prevalência ajustada — RPa=1,69, IC 95% 1,01-2,84), histórico de envolvimento em trabalho sexual (RPa=2,04, IC 95% 1,46-2,85), relato de saúde emocional regular, ruim ou muito ruim (RPa=1,67, IC 95% 1,28-2,19) e experiência de dificuldades de acesso aos serviços de saúde (RPa=2,78, IC 95% 1,74-4,43). Conclusão A alta prevalência de violência sexual, analisada em conjunto com as ações das vítimas, indica um contexto de alta vulnerabilidade e baixo suporte institucional. Nesse cenário, a violência pode ser exacerbada, resultando em graves consequências para a saúde.

Subjetividades de médicas y médicos en su encuentro con víctimas de violencia sexual en hospitales universitarios de Medellín, Antioquia, 2021-2022 / Subjectivities of female and male physicians in attending victims of sexual violence in university hospitals in Medellín, Antioquia 2021-2022

Resumen Objetivo: Comprender la expresión de las subjetividades de médicas(os) en su encuentro con víctimas de violencia sexual en urgencias hospitalarias. Metodología: Investigación cualitativa, diseño de caso colectivo, con enfoque etnográfico, con la elaboración de un diario de campo, dos itinerarios institucionales, dos entrevistas a coordinadoras, diez entrevistas en profundidad a médicas(os) y un encuentro reflexivo. Resultados: Se identificaron cuatro momentos en el recorrido de la víctima, y en ellos emergieron expresiones subjetivas que se agruparon en formas de reconocimiento y mecanismos. Se incorporaron el campo médico en el subcampo medicina moderna en sus habitus, sus prácticas clínicas vulneraron a las víctimas de violencia sexual. Por el contrario, si se apartaron de las lógicas que impuso el campo médico, sus prácticas se tradujeron en un cuidado comprensivo. Discusión: El no reconocimiento conduce a la imposibilidad del ejercicio de la ciudadanía de la salud; sus mecanismos parten de procesos de socialización desde sus constructos sociohistóricos que se ven reforzados por el modelo médico hegemónico y el campo médico generando tensión entre las lógicas prácticas de médicas(os) y las necesidades de las víctimas. Sin embargo, se observa una fractura de dicho modelo como una posibilidad de transformación hacia un cuidado comprensivo.

Abstract Objective: To understand how physician's subjectivity is expressed while attending to victims of sexual violence at emergencies. Methodology: Qualitative research, a collective case design with an ethnographic approach, via the elaboration of a field journal, two institutional itineraries, 12 in-depth interviews to leaders and doctors and one workshop. Results: There were four moments identified on victim's itinerary at emergencies services, in each moment emerged subjectivity's expressions, that could be organized on forms of subjectivity and their mechanisms within. If the physicians embodied the modern medicine, a subfield of medicine, into their habitus, their practices tend toward the revictimization of their patients. In the other hand, if doctors do not embody such practices and assume a critical posture about it, they tend toward a comprehensive care. Discussion: The non-recognition of such practices leads to the impossibility of exercising health citizenship, its mechanisms are a result of socialization processes from sociohistorical constructs that are reinforced by hegemonic medical model and the medical field., generating tension between practical logics of physicians and the needs of the victims. However, a fracture of this model is observed as a possibility of transformation toward comprehensive care.