A study on sexual violence inflicted on individuals with intellectual developmental disorder.

BACKGROUND: Rates of violence and abuse perpetrated on people with intellectual and developmental disability (IDD) have been reported to be significantly higher than on individuals without disability. However, rates of sexual violence against people with IDD in some less industrialized countries, such as Sri Lanka, have not been previously reported. OBJECTIVES: To describe characteristics of victims and perpetrators as well as the types of abuse found during medicolegal examinations of patients with IDD. METHODOLOGY: This is a cross-sectional study that utilized a convenience sample of individuals with IDD who presented after abuse at three hospitals in Sri Lanka from 2011 to 2015. RESULTS: All subjects had mild or moderate IDD; 90.2% were females; 48.8% were between the ages of 11-20 years; and 47.56% lived with both parents. Most of the victims (48%) disclosed the abuse and 29% of the events were witnessed. The perpetrators were known to the victim 49% of the time, and 49% reported a single episode of abuse. Victims reported that the abuse had taken place in the victim's house 47% of the time. Vaginal intercourse and intercrural intercourse were the most common types of abuse, and 23% of patients were found to be pregnant. CONCLUSION: In this study that relied on victim report and medicolegal investigation, parties close to the victim usually perpetrated the sexual abuse. Therefore, it is important to have more than one level of support and care for individuals with IDD so there is more opportunity for reporting.

Definitions of antiretroviral treatment failure for measuring quality outcomes.

OBJECTIVES: Our aim was to compare three different definitions of treatment failure and discuss their use as quality outcome measures for a clinical service. METHODS: Data for treatment-naïve patients who attended the Melbourne Sexual Health Centre (MSHC) between 1 January 2000 and 31 December 2008 were analysed. Definition 1 was the strict Food and Drug Administration (FDA) definition of treatment failure as determined using the time to loss of virological response (TLOVR) algorithm. Definition 2 defined treatment failure as occurring in those whose viral load never fell to <400 HIV-1 RNA copies/mL or who developed two consecutive viral loads > or =400 copies/mL on any treatment (switching or stopping treatment with a viral load <400 copies/mL was permitted). Definition 3 was the same as definition 2 except that individuals were also deemed to have failed if they stopped treatment for 6 months or longer. RESULTS: There were 310 antiretroviral-naïve patients who started treatment in the study period. Of these, 156 [50.3%; 95% confidence interval (CI) 42.1-53.3%] experienced treatment failure under definition 1, 10 (3.2%; 95% CI 1.5-5.8%) experienced treatment failure under definition 2, and 16 (4.5%; 95% CI 2.5-7.4%) experienced treatment failure under definition 3 over the 108 months of follow-up. The probability of failing definition 1 was statistically different from the probability of failing definition 2 or 3 (P=0.01). CONCLUSION: There were significant differences in treatment failure for the three definitions. If definition 1 were used, the outcomes would be sufficiently common to enable clinics to be compared but would be less meaningful. If definition 2 or 3 were used, the events would be too rare to enable clinics to be compared, but it would be possible to set a benchmark level of success that clinics could aim to reach.

Legislation requiring monthly testing of sex workers with low rates of sexually transmitted infections restricts access to services for higher-risk individuals.

OBJECTIVES: In Victoria, Australia, legislation requires sex workers to undergo monthly testing for gonorrhoea, chlamydia and trichomonas, and 3-monthly for HIV and syphilis, despite extremely low rates of sexually transmitted infections (STI) in female sex workers (FSW). The aim of this study was to quantify the resources and opportunities lost from this screening. METHODS: Computerised medical records of patients attending the Melbourne Sexual Health Centre (MSHC) between October 2005 and October 2008 were reviewed. RESULTS: Consultations with FSW accounted for 15.1% of total consultation time (5722 of 37,670 h) and of these, 2896 h (7.7%) were used for monthly consultations involving testing for gonorrhoea, chlamydia and trichomonas, but no serology (termed swab-only testing). Only 133 (3.2%) of the 4208 cases of STI (defined as gonorrhoea, chlamydia, trichomonas, early syphilis, mycoplasma genitalium or HIV) that were detected at MSHC during the study period were among FSW who underwent swab-only testing. 1726 (41%) STI were detected among men who have sex with men (MSM). The STI detected per 100 h of consultation time was (fourfold) higher for MSM (19) than for FSW (4). If FSW were tested only every 3 months for gonorrhoea, chlamydia, trichomonas, syphilis and HIV the 2896 h spent on monthly swab-only testing would have been available for higher-risk clients CONCLUSION: The current legislation requiring monthly STI testing is compromising the access for higher-risk individuals to sexual health. Other countries contemplating mandatory testing need to consider the influence that the frequency of testing has on access to sexual health services for high-risk groups.