Post-exposure prophylaxis, STI testing and factors associated with follow-up attendance: a review of 4159 cases of acute post-sexual assault medical care.

BACKGROUND: Sexual assault (SA) is a prevalent issue with enduring consequences. Post-SA medical care mainly focuses on injuries, sexually transmitted infection (STI) prevention and detection, as well as preventing unwanted pregnancies. Swift access to post-SA medical care is vital with sexual assault treatment units (SATUs) streamlining this care. The primary aim of our study is to report on post-SA care provided at the national SATU network in Ireland with a secondary aim of analysing factors associated with follow-up attendance for STI testing. METHODS: This is a retrospective cohort study of all acute attendances (<7 days from incident) at the national SATU network between 1 January 2017 to 31 December 2022. RESULTS: A total of 4159 acute cases presented during the study period. Emergency contraception (EC) was administered to 53.8% (n=1899/3529) of cases, while postexposure prophylaxis (PEP) for chlamydia was given in 75.1% (n=3124/4159) and for HIV in 11.0% (n=304/3387). Hepatitis B vaccination was initiated in 53.7% (n=2233/4159) of cases. 1.4% (n=59/4159) of the attendees were referred to an emergency department for the treatment of injuries. Follow-up appointments were scheduled for 75.8% (3151/4159) of acute cases. 71.6% (n=2257/3151) attended follow-up.Certain factors were found to correlate with a higher likelihood of attending follow-up appointments: adolescents (p<0.0001), concern about drug-facilitated SA (DFSA) (p=0.01), no consumption of recreational drugs before the incident (p<0.0001), alcohol consumption prior to the incident (p=0.01), and not reporting the crime to the police (p<0.001). However, gender (p=0.06) and the presence of injury at time of primary attendance (p=0.97) were not predictive of likelihood of follow-up attendance. CONCLUSION: This study demonstrates that EC, chlamydia PEP, HIV PEP and hepatitis B vaccination were all administered at SATU. A small proportion of attenders required emergency injury care. Factors influencing attendance at follow-up include age, drug use, alcohol use and police involvement, highlighting the need for tailored patient-centred support.

A scoping review of nursing interventions to reduce PTSD in adolescents who have been sexually abused.

Incidences of sexual violence have increased over the past few years. The negative impacts of sexual violence on adolescents are social isolation, low self-esteem, and disrupting the developmental stages of adolescents, and can even cause the risk of suicide. Nurses as providers of comprehensive nursing care have a role in reviewing various aspects to reduce the impact of sexual violence on adolescents. The purpose of this study is to explore methods of nursing intervention for reducing the symptoms of post-traumatic stress disorder among adolescents who are victims of sexual violence. The design used in this study is scoping review. Article were searched from CINAHL, PubMed, and Scopus databases. The inclusion criteria for articles in this study were full text, randomized control trial or quasi-experimental research design, English language, samples is adolescents (10-19 years based on WHO) who are victims of sexual violence, and the publication period of the last 10 years (2013-2022). We found 12 articles which discussed about nursing interventions in reducing PTSD symptoms in adolescents who are victims of sexual violence. Range of the samples is 40-405 adolescents. Several articles from developed countries. There are three nursing intervention methods that can be carried out, namely improve skill interventions, relaxation interventions, and cognitive behavior therapy. Nurses act as educators, facilitators and counselors so that victims can recover from their traumatic experiences. Providing nursing interventions to adolescents who are victims of sexual violence needs to pay attention to all aspects that affect the physical and psychological condition of the victim.

The Influence of Race on Detected and Undetected Sexual Offense Histories: A Comparison of White and Black Men Committed as Sexually Violent Persons.

Understanding the difference between the proportion of sexual offenses that are officially detected versus the total number of sexual crimes that occur has been of interest to decision makers for some time. Previous studies have not considered possible racial differences. More aggressive responses by police and the criminal justice system as well as cultural differences in victim type/reporting rates may result in differences between detection rates of Black versus White men. In the current study (N = 190), we examined the difference between Black (n = 51) and White (n = 139) men committed to a forensic hospital as a Sexually Violent Person on factors that could impact the detected rate. Overall, we found that White men had significantly more total victims, undetected victims, undetected and detected child victims, total male victims, undetected male victims, undetected acquaintance victims, and total (detected and undetected) acquaintance victims than Black men. Black men had significantly more detected adult victims, but this difference did not remain when accounting for undetected victims. We explore reasons for these differences as well as provide recommendations for practice.

What About Language?: A Mixed Methods Examination of the Impact of Person-Centered Language on Students' Perceptions of Individuals Who Commit Sex Offenses.

Person-centered language is a well-known approach to reducing stigmatizing labels among marginalized groups. However, little research has explored person-centered language's impact in criminal justice classrooms. Utilizing a mixed-method research design, this study explores the impact of person-centered language on students' perceptions of persons convicted of sex offenses. The study used three sections of an online Sex Crimes course. The course sections were identical, except for the language used and awareness of person-centered language; the control group section did not utilize person-centered language, the second section utilized person-centered language, and the third section utilized person-centered language and was given an informational lecture on stigmatizing language. Quantitative data was collected from the Perceptions of Sex Offenders Scale at the beginning and end of the semester. Students' end-of-semester reflection papers served as the qualitative component. The findings suggest shifts in punitive attitudes toward sentencing and management for the group exposed to person-centered language and the informational lecture. These differences were not apparent for the other groups and subscales. While qualitative data provided a more in-depth understanding of students' perceptions, overall, exposure to person-centered language didn't seem to impact student perceptions. However, exposure alongside a lecture about person-centered language, seemingly had a more pronounced impact on students' perceptions, suggesting that transparency surrounding language and reducing stigma are important components of person-centered language. The findings have implications for using person-centered language for criminal justice pedagogical practices, as well as considerations beyond the classroom (e.g., program development and curricula).

Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study.

OBJECTIVE: To compare mortality from all causes, internal causes (eg, cancers, circulatory and respiratory system diseases), and external causes (eg, suicide, accidents, assault) among people who were sexually abused during childhood with mortality for the general population. DESIGN: Historical cohort study. SETTING, PARTICIPANTS: 2759 people (2201 women, 79.8%) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995, as recorded in Victorian Institute of Forensic Medicine records. MAIN OUTCOME MEASURES: Mortality rate, based on linked National Death Index data (1980-2020), by five-year age group; sex- and age-standardised mortality ratios; comparison of rates with age- and sex-adjusted rates for the general Victorian population (incident rate ratio [IRR]). RESULTS: We included 115 deaths of people under 50 years of age in our analysis (4.2% of people sexually abused as children; 79 women, 36 men); 56 deaths were attributed to external, 56 to internal causes (cause of death information missing in three cases). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population; age- and sex-standardised all-cause mortality ratios were highest for people aged 25-29 years (men: 16.5; 95% confidence interval [CI], 11.0-22.0; women: 19.2; 95% CI, 14.3-24.2). The age- and sex-adjusted mortality rate for people sexually abused as children was higher than in the general population for all-cause (IRR, 8.25; 95% CI, 5.92-11.5), internal cause (IRR, 5.92; 95% CI, 3.89-9.01), and external cause deaths (IRR, 12.6; 95% CI, 9.61-16.6); the differences in external cause mortality were greater for people who had experienced penetrative (IRR, 14.9; 95% CI, 10.9-20.5) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92; 95% CI, 5.35-14.9). CONCLUSIONS: Sexual abuse during childhood is associated with higher mortality rates into mid-adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life.

Analysis of reported cases of sexual violence in Espírito Santo, southeastern Brazil, 2011-2018.

BACKGROUND: sexual violence includes all sexual acts consummated or attempt to obtain them, unwanted sexual comments and actions that go against the other's sexuality through coercion, which can be done through the use of physical force, psychological pressure, extortion or threat, this phenomenon appears in all life cycles. Identified the frequency and characteristics of sexual violence against women in a state in the southeastern region of Brazil. from 2011 to 2018. METHOD: this is a cross-sectional epidemiological study that evaluated all cases of sexual violence reported in Espírito Santo, present in the Information System of Diseases and Notifications of the Ministry of Health from 2011 to 2018. The analysis was based on performed in Stata 14.1. RESULTS: the prevalence of notification of sexual violence was 13.2% (CI95%: 12.8-13.5). Most victims were women (PR: 3.38), aged between 0 and 9 years (PR: 19), with a higher prevalence in people without disabilities or disorders (PR: 1.18) and residents of urban/periurban area (PR: 1.15). Men were the most frequent aggressors (PR: 13.79), with the most prevalent cases being reported by people unknown to the victim (PR: 6.01). The occurrence was 78% more reported at home and committed by an aggressor (PR:1.19). Most cases were repeated (PR:1.13). CONCLUSIONS: the notification of sexual violence in Espírito Santo was high and evidenced the vulnerability of some groups, as well as the profile of the perpetrators. It is necessary to work on training professionals in the areas of health and education in relation to the identification of cases of sexual violence, mainly due to the significant involvement of children and adolescents.

Explaining Male Sex Offender Recidivism: Accounting for Differences in Correctional Supervision.

PURPOSE: Contrary to public opinion, empirical studies have consistently shown that persons convicted of a sexual offense (PCSO) are less likely to recidivate with a general offense. While researchers often point toward the surreptitiousness of sexual offending to explain low rates of recidivism, this paper tests a novel explanation: SOs recidivate at lower rates than persons convicted of a non-sexual offense (PCNSO) because they are more often revoked to prison before they are able to commit a new crime, perhaps owing to more restrictive post-release supervision guidelines. METHODS: Using a sample of 196,468 unique male releases, the difference in general and sexual recidivism between PCSO (n = 29,420) and PCNSO was assessed through survival analyses (Cox regression models). RESULTS: Results demonstrated that PCSO were significantly less likely to be reconvicted for a general crime, but more likely for a sex offense. They were also more likely to be reincarcerated due to a revocation without a new sentence. Accounting for revocations, the difference in reconviction risk lessens between the groups but does not disappear. CONCLUSIONS: This analysis provides evidence that differences in community supervision are contributing to the difference in recidivism rates between PCSO and PCNSO. Implications and future research are discussed.

Implementation of a Treatment Program for Individuals Imprisoned for Sex Offenses in Uruguay: Achievements, Problems and Challenges.

Treatment for individuals convicted of sex offenses has substantially improved in developed countries in recent decades, providing practitioners with an extensive literature to guide the implementation of effective programs to reduce sexual reoffending. Nevertheless, sexual offending rehabilitation is still in its infancy in Latin American countries such as Uruguay, so little is known about the transference and implementation of evidence-based programs. The current study examines the strengths, barriers, and challenges of implementing a sex offenses treatment program in Uruguay. The findings suggest some achievements of the program, but also several problems with implementation. Some problems are universal among different countries (e.g., scarce resources and facilities, insufficiently trained staff, and unexpected changes in the organization), but others were particularly relevant in the Uruguayan context (e.g., government policy alien to a rehabilitation approach, lack of appropriate prison facilities, lack of training for therapists from a cognitive-behavioral perspective). All these difficulties must be anticipated and solved for successful generalizability of rehabilitation programs to different correctional systems.

Predictors of Individual and Interpersonal Adjustment Among Non-offending Partners of Individuals With Histories of Sexual Offenses.

Recent research indicates that the consequences of sexual offenses extend beyond target victims, including to non-offending partners of individuals with sexual offense histories. However, little research has focused on non-offending partners' wellbeing and relationships with persons with sexual offense histories leading up to and following acts of sexual aggression. Non-offending partners may be secondary victims of their partners' offenses in managing psychological difficulties (e.g., guilt, shame), social stigma and isolation, fear for their safety, or difficulties in their romantic relationships resulting from their partners' sexual offenses, often with minimal supports. The current study examined key correlates of individual and interpersonal adjustment among 207 non-offending partners of individuals with histories of sexual offenses who were residing in Canada (n = 36) or the United States (n = 171). Findings indicate that positive changes due to the offense (i.e., improved finances), self-esteem, interpersonal adjustment, instrumental support, lower levels of acceptance, and humor positively predicted individual adjustment. Interpersonal adjustment was predicted by trust, intimacy, partner's stress communication, and problem-focused and emotion-focused common dyadic coping. Findings highlight the need for services for non-offending partners, including interventions that address self-esteem and practical difficulties resulting from the offense, and couples therapy to address trust issues, intimacy concerns, and shared coping with stressors related to the offense.

Analysis of factors related to behaviours to prevent sexual assault of teenage girls.

Objectives: To analyse the factors associated with the behaviour of teenage girls in terms of preventing a sexual assault. Method: The descriptive, cross-sectional, correlational study was conducted in April 2021 at a senior high school in Cibitung, Bekasi, Indonesia, after approval from the ethics review committee of the Faculty of Nursing, Universitas Airlangga. The sample comprised class X-XII students aged 15- 19 years. Data was collected using a questionnaire. Data was analysed with logistic regression test using SPSS 20. RESULTS: Of the 139 subjects, 52 (37.4%) were aged 16 years, 58 (41.7%) were in class XII. Significant relationship of behaviour to prevent sexual assault was found with knowledge (p=0.008), attitude (p=0.010) and peer interaction (p=0.007). CONCLUSIONS: Preventing sexual assault behaviour among girls was found to be related to knowledge, attitude and peer interaction.

Sexual Victimization of Children and Adolescents: A Qualitative Study with Brazilian Undergraduates on Disclosure, Detection, Outcomes, and Consequences.

This qualitative study aimed to discover whether experiences of sexual violence suffered by a sample of adolescents and young-adults at a Brazilian public health had been disclosed or detected, why or why not, and what happened after disclosure or detection. Seventy-one (8.3%) students were victims of sexual violence, and 52 (73.2%) were females. The researchers interviewed 22 participants to obtain an oral history of these abuse experiences. The 22 interviewees had experienced 29 episodes of violence. Acquaintances had perpetrated 26 of these attacks, and of these 26 only four (15.4%) occurrences were never disclosed. Twenty-two experiences were disclosed or detected, of which four (18.2%) were promptly revealed (days after the event), resulting in a discontinuation of the violence. Unfortunately, molestation continued without intervention in nine (41.0%) of the revealed situations, despite disclosure or detection. The authors find that children or adolescents disclosing their experiences of sexual violence cannot end the attacks. This study identifies an urgent need to educate society about how to respond appropriately to revelations of sexual violence. Children or adolescents must be oriented to disclose their abuse and seek help from as many people as necessary until they are heard, believed and the violence is ended.

The impact of sexual victimization on substance use disorder treatment completion: A systematic review and meta-analysis.

Background:A significant proportion of individuals seeking treatment for substance use disorders (SUDs) have experienced sexual victimization, which has been shown to disrupt the efficacy of SUD treatment services. Objective: To evaluate the relationship between lifetime sexual victimization and SUD treatment completion. Methods: Relevant literature was identified through a systematic, computerized search of nine electronic databases (May 2018) and reference harvesting, yielding 15 peer-reviewed articles published between 1992 and 2017. Two authors independently conducted title and abstract screens, full-text reviews, data abstraction, and methodological appraisals. Risk of bias was assessed using a modified mixed-methods appraisal tool. Only nine studies met criteria for the meta-analysis, which used a random-effects model. Results: Included studies yielded mixed results regarding the impact of sexual victimization on treatment completion. The meta-analysis yielded a non-significant trend of survivors of sexual victimization having slightly lower odds of completing treatment. Conclusions: Findings from this systematic review and meta-analysis did not support the impact of sexual victimization on treatment completion. Methodological limitations of the extant literature limit cross-study comparisons. Future studies should document program-related factors to improve the ability to understand relationships affecting treatment completion.

A perspective review of cannabis use and sexual offenses.

Substance abuse is an established risk factor for crime and violence, including sexual violence. Nevertheless, the link between cannabis use and sexual offenses remains poorly understood. Cannabis use has a broad effect on sexual functioning and can have both acute and lasting adverse effects on psychological functioning, which in turn can elevate the risk of sexual offending behavior. Yet there is a scarcity of studies that have examined the link between cannabis use and sexual offending. To help fill the gap, this perspective review investigates the link between substance use and crime with a particular emphasis on cannabis use and its effects on sexual and psychological functioning. It then explores how these mechanisms may contribute to sexual offenses and recidivism, with a final discussion on how cannabis use should be conceptualized as a risk factor for sexual violence.

A Systematic Review of Professionals' Views About Community Management Policies for Individuals Convicted of Sexual Offenses.

A contentious criminal justice policy issue in recent times has been community management policies for individuals convicted of sexual offenses. This systematic review attained professionals' views, areas of concern, and recommendations for community management policies. It went beyond the extant literature by exploring perceptions of heterogenous professional groups involved in the criminal justice system. Of the 25 studies, 12 were quantitative, nine qualitative, and four mixed methods, and included custodial and community correctional officers, probation officers, psychologists, police officers, prosecutors, lawmakers, and academics. Overall, professionals mostly supported the policies, but had less support for public registries and community notification. Four key issues associated with the policies were apparent: problems with actuarial risk assessment tools, difficulties accessing information with partner agencies, limited resources, and lack of education among the public. Within this, four recommendations were identified. These findings offer a valuable resource for researchers, along with government and policy professionals tasked with overseeing community management policies.

Retrospective Perceptions of Grooming in Same-Sex versus Opposite-Sex Child Sexual Abuse.

Research on child sexual abuse (CSA) has predominantly focused on opposite-sex (e.g., male adult-female child) adult-child pairs, neglecting same-sex (e.g., male adult-male child) adult-child pairs. Grooming behaviors are an early indicator of CSA and while it is important to recognize grooming to prevent abuse, research has shown that detecting these behaviors is a difficult task. Despite this difficulty, people retrospectively overestimate their ability to recognize abuse once it is clear that abuse has occurred. The current study investigated how outcome information (abuse did or did not occur) and the sex of the adult-child pair influenced perceptions of adult-child interactions. Participants evaluated vignettes depicting grooming and non-grooming behaviors in same-sex and opposite-sex adult-child conditions. Participants who were told CSA occurred provided higher likelihood ratings that abuse occurred than participants who were not given information about the abuse. There was some evidence that gender pairings influenced retrospective perceptions of these interactions.

Detecting Grooming Behaviors in Same-Sex versus Opposite-Sex Child Sexual Abuse.

Child sexual abuse (CSA) is a prevalent concern that often leads to severe, life-long consequences. Grooming is an early indicator of CSA, and it is imperative to be able to recognize these behaviors in adult-child relationships to prevent abuse from occurring. Research on CSA and grooming has primarily focused on opposite-sex (male adult and female child) abuse while little research has focused on same-sex (male adult and male child) abuse. The current study examined how the sex of the adult-child pair might impact the identification of grooming behaviors. Participants in this study were presented with a series of vignettes depicting grooming and non-grooming behaviors in either same-sex or opposite-sex adult-child pairs. Participants were more likely to label the behaviors presented as grooming when shown situations involving an opposite-sex adult-child pair as opposed to a same-sex adult-child pair.

Characteristics of Older Adult First-Time Sex Offenders: Insights From the Missouri Registry.

OBJECTIVE: To explore the characteristics of older adult first-time sex offenders (who offended for the first time at the age of 65 years or above). DESIGN: The authors retrieved and analyzed data from the publicly available Missouri sex offender registry database up to December 2018 and the Missouri public case management system website. PARTICIPANTS: Registered older (≥65 years) sex offenders in the state of Missouri, United States. MEASUREMENTS: Sociodemographic characteristics of the offender, offense type(s), offense, and conviction dates; age and sex of the victim(s); and case disposition information (whether the trial was waived or not and what were the sentences imposed). RESULTS: One hundred and ninety-four older adult sex offenders all males were identified, of which 172 were first-time offenders. The majority were white; the median age of offense was 68.6 years old. One hundred and thirty-nine (80.8%) first-time offenders were convicted strictly of non-pornography offenses, with prepubescent girls the predominant victim pool. The most prevalent charge in this subgroup was Child Molestation, First Degree (36.5%). Twenty-eight (16.3%) offenders were convicted strictly of pornography offenses, the most prevalent one being Possession of Child Pornography (96.6%). The recidivism rate among first-time offenders was close to 1%. CONCLUSION: A substantial proportion of older registered sex offenders are first-time sex offenders and most of them have underage victims. Although the offense and recidivism rates seem to be low, future longitudinal studies should focus on the predictors of sexual offending in the older population, in order to design targeted preventive measures, risk assessment, and treatment options.

Intimate Partner Sexual Violence Among Canadian University Students: Incidence, Context, and Perpetrators' Perceptions.

Men's sexual violence against women is pervasive and is commonly committed against young women by intimate partners. Limited research has examined occurrence rates of intimate partner sexual violence among university students separated by various tactics and sexual acts. Using surveys with convenience samples of 142 Canadian university women and 441 Canadian university men, we examined women's self-reported intimate partner sexual violence victimization and men's self-reported perpetration rates in their most recent heterosexual intimate relationship in the past year. We examined a detailed breakdown across different tactics (i.e., verbal coercion, intoxication, and threats of harm/physical force) and sexual acts (i.e., nonpenetrative sexual contact; oral, vaginal, and anal penetration). Thirty-three percent of women reported at least one victimization experience, and 16% of men reported at least one perpetration experience. The most common tactic reported was verbal coercion for both women's victimization and men's perpetration, and the most common sexual act reported was vaginal penetration for women's victimization and oral sex for men's perpetration. We also examined contextual features and perceptions of the effects of perpetrators' most memorable incidents. These most memorable incidents often occurred either in their own or their partner's home and involved alcohol consumption. Most men reported no significant effects of their sexual violence on their relationships and sometimes normalized their behavior. We briefly discuss the implications of our results for future research and interventions.

Indirect and Neuropsychological Indicators of Pedophilia.

The present study aimed to differentiate pedophilic child sex offenders (CSOs) from nonoffending controls (CTLs), as well as contact from noncontact CSOs. For this purpose, we investigated 21 contact CSOs, 20 noncontact CSOs (child pornography offenders), as well as 21 CTLs on neuropsychological test measures and indirect test measures of sexual interest. Multiple logistic regression models showed that three parameters of indirect tests and two neuropsychological test parameters allowed the differentiation of CSOs from CTLs with a maximum accuracy of 87%. The profile of contact and noncontact CSOs was remarkably similar and the optimal model for this group differentiation had a maximum accuracy of 66%, with slightly increased levels of risk-taking behavior and greater susceptibility for perceptual interference in contact CSOs than in noncontact CSOs. The findings suggest that standardized, objective methods can support the assessment of sexual offenders against children in forensic psychiatry and legal psychology.

Testing the Static-99R as a Global Screen for Risk of Sex Crime Recidivism in a Norwegian Routine Sample.

The Static-99R has been recommended for use as a first global screen for sorting out sex-convicted persons who are in need of further risk assessment. This study investigated the Static-99R's predictive validity based on a nonselected Norwegian sample (n = 858) of persons released from prison after having served a sex crime sentence. After a mean observation period of 2,183 days, 3.4% (n = 29) had recidivated to a new sex offense. A higher number of recidivists were found among those with higher Static-99R total scores. The predictive contribution from each of the ten Static-99R risk items was investigated using standard logistic regression, proportional hazard regression, and random forest classification algorithm. The overall results indicate that the Static-99R is relevant as a risk screen in a Norwegian context, providing similar results concerning predictive accuracy as previous studies.