Survivors' Concerns During the COVID-19 Pandemic: Qualitative Insights From the National Sexual Assault Online Hotline.

With the onset of the COVID-19 pandemic and the implementation of stay-at-home orders in March 2020, experts warned of the possible threat of increased interpersonal violence among individuals isolated with abusers. Researchers have sought to understand how the pandemic impacted victims primarily through the analysis of administrative data sources, such as hospital and police records. However, the preponderance of this data shows a decrease in formal help-seeking among victims during the pandemic, speaking to an impaired access to services but limiting our understanding of other ways in which the pandemic has affected survivors. To overcome these limitations, we examined data collected about users of the National Sexual Assault Online Hotline (NSAOH). Information was collected through staff based on retrospective recall following one-on-one chat sessions with 470 victims of sexual violence who contacted the NSAOH in the first six months of the pandemic and discussed COVID-19-related concerns. We qualitatively examined open-ended descriptions of COVID-19-related concerns and identified the four most common: (1) mental health concerns, (2) creation or exacerbation of an unsafe living situation, (3) not being able to access services, and (4) not having access to a mandatory reporter or trusted adult. These findings demonstrate the myriad ways in which the pandemic affected the lives of victims of sexual violence and can inform practices for services and practitioners to best meet the needs of survivors moving forward. Specifically, these findings highlight the need for more accessible mental health services and funding for sexual assault service providers, as well as the importance of safety planning, particularly in times of crisis.

Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary.

BACKGROUND: Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. METHODS AND FINDINGS: In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. CONCLUSIONS: Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. TRIAL REGISTRATION: Protocol Registry: PROSPERO CRD42017055549.

Reactions to the disclosure of intrafamilial childhood sexual abuse: Findings from the National Sexual Assault Online Hotline.

INTRODUCTION: For child sexual abuse (CSA) victims, disclosure can be helpful or harmful depending on how recipients respond. Despite a growing body of literature examining reactions to disclosure, little is known about the experiences of current CSA victims, particularly those abused by family. OBJECTIVE: We aimed to describe and explore the initial disclosure experiences of intrafamilial CSA victims, and whether reactions varied based on the type of disclosure recipient. PARTICIPANTS AND SETTING: This study utilized anonymous, archival data from the US-based National Sexual Assault Online Hotline (NSAOH), and focused on a sample of 224 intrafamilial CSA victims who had previously disclosed to one type of recipient. METHODS: NSAOH staff summarized children's disclosure experiences via an open-ended survey field. Data were independently coded using the Social Reactions Questionnaire. RESULTS: Nearly three-fourths (73%) of children described receiving a negative reaction to disclosure. Negative reactions included distracting or dismissing the victim (33%), not believing the victim (29%), or retaliating or responding violently following disclosure (10%). Children most frequently disclosed abuse to non-offending family (66%), friends (17%), and formal support providers (12%). Relative to friends and intimate partners, victims were more likely to discuss negative reactions from family (49% v 87%, respectively, Cramer's V = 0.33, p < 0.001). CONCLUSIONS: Disclosing to non-offending family may be unproductive and potentially harmful for some children. This study has implications for disclosure-related planning protocols on anonymous hotlines. Findings underscore the importance of educating the public, and parents in particular, about how to respond to CSA disclosures.

"I cannot change what happened to me, but I can learn to change how I feel": A case study from ImpACT, an intervention for women with a history of sexual trauma who are living with HIV in Cape Town, South Africa.

Sexual trauma is highly prevalent among women living with HIV in South Africa, and there is a great need for psychotherapeutic interventions to address these concerns. Improving AIDS Care After Trauma (ImpACT) is a manualized intervention, based on stress and coping theories, that builds skills for coping with sexual trauma and HIV to promote long-term HIV care engagement. Using qualitative case study methodology, we report the case of Xoliswa, a 34-year-old woman with a complex history of sexual trauma and alcohol use who was diagnosed with HIV 1 year prior to enrollment in ImpACT. The interventionist, a lay counselor, worked with Xoliswa in a primary care clinic to address her concerns by exploring personal values, managing barriers to HIV care, and teaching active coping. Xoliswa's drinking reduced, symptoms of trauma and depression improved, and she maintained strong HIV care engagement. The interventionist experienced stress and emotional challenges in delivering ImpACT to Xoliswa and other highly traumatized women, and the interventionist's skill development and support received through training and supervision are briefly discussed. The case demonstrates the feasibility of ImpACT in a resource-limited setting and highlights themes and barriers in therapy, which can inform future interventions for women living with HIV. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Activity of clarithromycin alone and in combination in a murine model of Mycobacterium kansasii infection.

Activities of clarithromycin alone and in combination with rifampicin, gatifloxacin or linezolid were evaluated against Mycobacterium kansasii in a murine infection model. Clarithromycin was the most active single agent. Rifampicin and gatifloxacin had similar activities, but were less active than clarithromycin. Clarithromycin in combination with rifampicin was the most active combination therapy.