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Conference Summary
Infectious Diseases and Sexual
Coercion1
Consuelo M. Beck-Sague,*
Adrienne Wulfsohn,† Chris Beyrer,‡ Elizabeth Unger,* and Carolyn Black*
*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †PROAct,
Johannesburg, South Africa; and ‡Johns Hopkins University Bloomberg School
of Public Health, Baltimore, Maryland, USA
Suggested
citation for this article
South Africa:
Sexual Assault and STIs
South Africa's HIV prevalence (20.1%), particularly in Gauteng Province
(29.8%), is among the highest in the world. Incidence of rape, defined
as genital, anal, or oral penetration by a part of the assailant's body
or with an object, is high; most South African women have survived more
than one rape. From 1998 to 2002, a facility in Johannesburg offered antiretroviral
postexposure prophylaxis to sexual assault survivors seen within 72 hours
of assault. Of 858 examined, 65% were assaulted by multiple assailants;
14% and 22% were HIV-positive in the first and final years of the study
(1998 and 2002), respectively. Of 435 who received antiretroviral postexposure
prophylaxis, 173 returned for repeat HIV testing at 6 weeks; HIV infection
was diagnosed in 1 (0.2%) patient 8 months after the rape (1 month after
symptoms consistent with acute retroviral infection). This patient was
a mentally challenged 14-year-old who did not complete postexposure prophylaxis,
was HIV-negative at 6 weeks, and may have been subsequently exposed. Of
25 seronegative patients who sought treatment >72 hours after assault,
9 returned for follow-up examination; 1 (4%) seroconverted at 6 weeks.
This patient was a 16-year-old without other risk factors. The South African
government agreed to make HIV postexposure prophylaxis broadly available
in 2002 but has not yet done so.
Human Trafficking
Defined as transport of a person for work or services within or across
national borders through force, deception, or abuse of authority, trafficking
annually victimizes millions, trapping them in virtual slavery as commercial
sex workers or domestic or sweatshop workers. This traffic disproportionately
affects women. Source countries of trafficked women include Burma, Thailand,
Russia, Laos, China, and the Philippines; destination countries include
Thailand, China, Cambodia, India, Russia, Sweden, the United States, and
the European Union. Countries with domestic sex worker trafficking include
China, India, Thailand, Cambodia, and Burma. Health threats to trafficked
women include HIV, other STIs, severe mental health problems, and low
access to preventive healthcare. The HIV rate of trafficked Burmese commercial
sex workers is more than twice that of Thai commercial sex workers. Burma's
trafficking disproportionately affects persons of Shan ethnicity, who
have been made vulnerable by civil war, discrimination, and poverty. Effective
interventions include recognizing that trafficked women are crime victims
who deserve special consideration; avoiding trafficked women's repatriation;
trafficker prosecution; and partnerships between health, civil, and security
officials.
Child Sexual
Abuse
Child sexual abuse is common; 42% of U.S. adult women report sexual victimization
by an adult or older minor during childhood. STIs diagnostic for child
sexual abuse (e.g., Neisseria gonorrhoeae or Chlamydia trachomatis,
diagnosed by culture, which is less sensitive than nucleic acid amplification
testing) are uncommon. The relationship of genital human papillomavirus
infection, the most common STI, to child sexual abuse, remains unclear.
Genital swab and urine samples from minors evaluated for sexual abuse
were tested by using nucleic acid amplification for N. gonorrhoeae,
C. trachomatis, and human papillomavirus. Of 439 evaluated, 5.2%
had positive nucleic acid amplification test results (vs. 3.5% with positive
cultures) for N. gonorrhoeae or C. trachomatis; 13% (17%
of abused minors, but none of 16 children unlikely to have been abused)
had human papillomavirus detected by nucleic acid amplification tests.
Nucleic acid amplification tests increased the proportion of child sexual
abuse survivors with a diagnosis of N. gonorrhoeae or C. trachomatis
infection. Positive nucleic acid amplification tests for human papillomavirus
were strongly associated with child sexual abuse.
1The following comments were made in presentations
by the above authors at the International Conference on Women and Infectious
Disease.
Suggested citation
for this article:
Beck-Sague CM, Wulfsohn
A, Beyrer C, Unger E, Black C. Infectious diseases and sexual coercion
[conference summary]. Emerg Infect Dis [serial on the Internet]. 2004
Nov [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol10no11/04-0623_05.htm
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