Transgressive women don't deserve protection: Young men's narratives of sexual violence against women in rural Papua New Guinea

Sexual violence against women and girls is commonplace in Papua New Guinea (PNG). While the experiences of women are rightly given central place in institutional responses to sexual violence, the men who perpetrate violence are often overlooked, an oversight that undermines the effectiveness of prevention efforts. 

This paper draws on interviews conducted with young men as part of a qualitative longitudinal study of masculinity and male sexuality in a rural highland area of PNG. It explores one aspect of male sexuality: men's narratives of sexual violence. Most striking from the data is that the collective enactment of sexual violence against women and girls is reported as an everyday and accepted practice amongst young men. However, not all women and girls were described as equally at risk, with those who transgress gender roles and roles inscribed and reinforced by patriarchal structures, at greater risk. 

To address this situation, efforts to reduce sexual violence against women and girls require an increased focus on male-centred intervention to critically engage with the forms of patriarchal authority that give license to sexual violence. Understanding the perceptions and experiences of men as perpetrators of sexual violence is a critical first step in the process of changing normative perceptions of gender, a task crucial to reducing sexual violence in countries such as PNG.

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By:  Kelly-Hanku A1,2, Aeno H1, Wilson L3, Eves R4, Mek A1, Nake Trumb R1, Whittaker M5, Fitzgerald L5, Kaldor JM1, Vallely A2.

• 1 Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.
• 2 Kirby Institute, UNSW Australia , Sydney , Australia.
• 3 School of Political Science and International Studies , University of Queensland , St Lucia , Australia.
• 4 State, Society and Governance in Melanesia Program , Australian National University , Canberra , Australia.
• 5 School of Public Health , University of Queensland , Herston , Australia.
• Cult Health Sex. 2016 Jun 2:1-14. 

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Risk Factors for Sexual Offending in Men Working with Children: A Community-Based Survey

Identifying risk factors for sexual abuse in men who work with children and who have already abused a child could lead to more appropriate screening and prevention strategies and is thus of major scientific and societal relevance. 

A total of 8649 German men from the community were assessed in an extensive anonymous and confidential online survey. Of those, 37 (0.4 %) could be classified as child sexual abusers working with children, 90 (1.0 %) as child sexual abusers not working with children, and 816 (9.4 %) as men who work with children and who have not abused a child. 

We assessed the impact of working with children as an individual risk factor for self-reported child sexual abuse and compared personal factors, pedophilic sexual fantasies, deviant sexual behaviors, antisocial behaviors, and hypersexuality among the three groups. Most interestingly, working with children was significantly associated with a self-reported sexual offense against children; however, it explained only three percent of its variance. 

Child sexual abusers working with children admitted more antisocial and more sexually deviant behaviors than child sexual abusers not working with children and than men working with children who have not abused a child. 

Our findings support some of the suggestions made by other researchers concerning factors that could be considered in applicants for child- or youth-serving institutions. However, it has to be pointed out that the scientific basis still seems premature.

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By:  Turner D1, Hoyer J2, Schmidt AF3, Klein V4, Briken P4.

• 1Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. turner.daniel@gmx.de.
• 2Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
• 3Institute for Health and Behaviour, Health Promotion and Aggression Prevention, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
• 4Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
• Arch Sex Behav. 2016 May 16.

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Prevalence of strangulation in survivors of sexual assault & domestic violence

Via:  http://goo.gl/s3TbEr

Correlates of Sexual Violence among Men Who Have Sex with Men in Tijuana, Mexico

Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. 

The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. 

The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. 

The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.

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By:  Semple SJ1, Stockman JK2, Goodman-Meza D3, Pitpitan EV2, Strathdee SA2, Chavarin CV1, Rangel G4, Torres K5, Patterson TL6.

• 1Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
• 2Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
• 3Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
• 4US-Mexico Border Health Commission, Tijuana, Mexico.
• 5Agencia Familiar Binacional, A.C., Tijuana, Mexico.
• 6Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA. tpatterson@ucsd.edu. 
• Arch Sex Behav. 2016 May 13. 

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Participating in a Culture of Consent May Be Associated with Lower Rape-Supportive Beliefs

With the recent national focus on rates of sexual violence, many interventions have been proposed, including those that focus on affirmative consent (e.g., "Yes Means Yes" campaign). 

The goal of the present study was to test whether individuals within a subculture with long-standing norms of affirmative consent-the bondage and discipline/dominance and submission/sadism and masochism (BDSM) community-report lower rape-supportive attitudes compared to individuals not from within this subculture. BDSM practitioner participants, adult participants from Amazon's Mechanical Turk (MTurk), and college student participants completed measures of hostile sexism, benevolent sexism, rape myth acceptance, victim blaming, expectation of sexual aggression, and acceptance of sexual aggression. 

BDSM practitioners reported significantly lower levels of benevolent sexism, rape myth acceptance, and victim blaming than did college undergraduates and adult MTurk workers. BDSM practitioners did not differ significantly from college undergraduates or adult MTurk workers on measures of hostile sexism, expectations of sexual aggression, or acceptance of sexual aggression. Limitations and implications are discussed.

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By:  Klement KR1, Sagarin BJ1, Lee EM1.

• 1 Department of Psychology , Northern Illinois University. 
• J Sex Res. 2016 Apr 27:1-5. 

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Differential Risk for Homelessness among US Male and Female Veterans with a Positive Screen for Military Sexual Trauma

IMPORTANCE:

Military sexual trauma (MST) is associated with adverse physical and mental health outcomes following military separation. Recent research suggests that MST may be a determinant in several factors associated with post deployment homelessness.

OBJECTIVE:

To evaluate MST as an independent risk factor for homelessness and to determine whether risk varies by sex.

DESIGN, SETTING, AND PARTICIPANTS:

A retrospective cohort study of US veterans who used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 was conducted using administrative data from the Department of Defense and VHA. Included in the study were 601 892 US veterans deployed in Iraq or Afghanistan who separated from the military between fiscal years 2001 and 2011 and subsequently used VHA services.

EXPOSURE:

Positive response to screen for MST administered in VHA facilities.

MAIN OUTCOMES AND MEASURES:

Administrative evidence of homelessness within 30 days, 1 year, and 5 years following the first VHA encounter after last deployment.

RESULTS:

The mean (SD) age of the 601 892 participants was 38.9 (9.4) years, 527 874 (87.7%) were male, 310 854 (51.6%) were white, and 382 361 (63.5%) were enlisted in the Army. Among veterans with a positive screen for MST, rates of homelessness were 1.6% within 30 days, 4.4% within 1 year, and 9.6% within 5 years, more than double the rates of veterans with a negative MST screen (0.7%, 1.8%, and 4.3%, respectively). A positive screen for MST was significantly and independently associated with postdeployment homelessness. In regression models adjusted for demographic and military service characteristics, odds of experiencing homelessness were higher among those who screened positive for MST compared with those who screened negative (30-day: adjusted odds ratio [AOR], 1.89; 95% CI, 1.58-2.24; 1-year: AOR, 2.27; 95% CI, 2.04-2.53; and 5-year: AOR, 2.63; 95% CI, 2.36-2.93). Military sexual trauma screen status remained independently associated with homelessness after adjusting for co-occurring mental health and substance abuse diagnoses in follow-up regression models (30-day: AOR, 1.62; 95% CI, 1.36-1.93; 1-year: AOR, 1.49; 95% CI, 1.33-1.66; and 5-year: AOR, 1.39; 95% CI, 1.24-1.55). In the fully adjusted models, the interaction between MST status and sex was significant in the 30-day and 1-year cohorts (30-day: AOR, 1.54; 95% CI, 1.18-2.02; and 1-year: AOR, 1.46; 95% CI, 1.23-1.74), denoting higher risk for homelessness among males with a positive screen for MST.

CONCLUSIONS AND RELEVANCE:

A positive screen for MST was independently associated with postdeployment homelessness, with male veterans at greater risk than female veterans. These results underscore the importance of the MST screen as a clinically important marker of reintegration outcomes among veterans. These findings demonstrate significant long-term negative effects and inform our understanding of the public health implications of sexual abuse and harassment.

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By:  Brignone E1, Gundlapalli AV2, Blais RK1, Carter ME2, Suo Y2, Samore MH2, Kimerling R3, Fargo JD1.

• 1Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah 2Department of Psychology, Utah State University, Logan.
• 2Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah3Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City4Department of Biomedical Informatics, Univer.
• 3National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California6Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California.
• JAMA Psychiatry. 2016 Apr 20. doi: 10.1001/jamapsychiatry.2016.0101. 

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Trajectory Analysis of the Campus Serial Rapist Assumption

IMPORTANCE:

Rape on college campuses has been addressed recently by a presidential proclamation, federal legislation, advocacy groups, and popular media. Many initiatives assume that most college men who perpetrate rape are serial rapists. The scientific foundation for this perspective is surprisingly limited.

OBJECTIVE:

To determine whether a group of serial rapists exists by identifying cohesive groups of young men, indicated by their trajectories of rape likelihood across high school and college.

DESIGN, SETTING, AND PARTICIPANTS:

Latent class growth analysis of the 2 largest longitudinal data sets of adolescent sexual violence on college campuses using 2 distinct groups of male college students. The first group was used for derivation modeling (n = 847; data collected from August 1990 through April 1995) and the second for validation modeling (n = 795; data collected from March 2008 through May 2011). Final data analyses were conducted from February 16, 2015, through February 20, 2015.

MAIN OUTCOMES AND MEASURES:

Rape perpetration assessed using the Sexual Experiences Survey.

RESULTS:

Across samples, 178 of 1642 participants (10.8%) reported having perpetrated at least 1 rape from 14 years of age through the end of college. A 3-trajectory model best fit both the derivation and validation data sets. Trajectories reflected low or time-limited (92.6% of participants), decreasing (5.3%), and increasing (2.1%) rape patterns. No consistently high trajectory was found. Most men who perpetrated a rape before college were classified in the decreasing trajectory. During college, the increasing trajectory included 14 men (15.2%) who reported having perpetrated a rape, the decreasing trajectory included 30 men (32.6%), and the low or time-limited included 48 men (52.2%). No participant in the low or time-limited trajectory reported perpetrating a rape during more than 1 period. Most men (67 [72.8%]) who committed college rape only perpetrated rape during 1 academic year.

CONCLUSIONS AND RELEVANCE:

Although a small group of men perpetrated rape across multiple college years, they constituted a significant minority of those who committed college rape and did not compose the group at highest risk of perpetrating rape when entering college. Exclusive emphasis on serial predation to guide risk identification, judicial response, and rape-prevention programs is misguided. To deter college rape, prevention should be initiated before, and continue during, college. Child and adolescent health care professionals are well positioned to intervene during the early teenage years by informing parents about the early onset of nonconsensual sexual behavior.

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By:  Swartout KM¹, Koss MP², White JW³, Thompson MP⁴, Abbey A⁵, Bellis AL¹.

¹Department of Psychology, Georgia State University, Atlanta.

²Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson.

³Department of Psychology, University of North Carolina at Greensboro, Greensboro.

⁴Institute on Family and Neighborhood Life, Clemson University, Clemson, South Carolina.

⁵Department of Psychology, Wayne State University, Detroit, Michigan.

JAMA Pediatr. 2015 Dec;169(12):1148-54. doi: 10.1001/jamapediatrics.2015.0707.

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Fantasy-Driven versus Contact-Driven Users of Child Sexual Exploitation Material: Offender Classification and Implications for Their Risk Assessment

Since the advent of the Internet, convictions for the possession, display, trading, and distribution of child sexual exploitation material (CSEM) have risen steadily, but little is known about their appropriate assessment and treatment, especially concerning their risk of reoffending. It has been suggested that a conceptual distinction of fantasy- versus contact-driven CSEM users might be of merit. 

Sixty-eight offenders recruited from sex offender treatment providers were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the findings showed differences in the psychological profiles between CSEM users and contact child sex offenders. Numerical and spatial methods of data analysis were used to identify subgroups of CSEM users; these confirmed the twofold distinction of fantasy- versus contact-driven offending. 

The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors; potentially differentiating distinct offender subgroups with different risks and needs. 

The current study informed the development of an empirical model of CSEM users that could aid in the assessment of risk of reoffending and cross-over to contact sex offending.

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By:  Merdian HL1, Moghaddam N2, Boer DP3, Wilson N4, Thakker J3, Curtis C3, Dawson D2.

• 1University of Lincoln, UK hmerdian@lincoln.ac.uk.
• 2University of Lincoln, UK.
• 3The University of Waikato, Hamilton, New Zealand.
• 4Department of Corrections, Hamilton, New Zealand. 
• Sex Abuse. 2016 Apr 6. pii: 1079063216641109.

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The impact of violence on sex risk and drug use behaviors among women engaged in sex work in Phnom Penh, Cambodia

HIGHLIGHTS

• Almost half the women engaged in sex work reported violence in the past 12 months.
• Prior physical violence exposure associated with subsequent sexual risk taking.
• Physical violence was associated with amphetamine type stimulant (ATS) use.
• Sexual violence was associated lower levels of condom use with non-paying partners.

BACKGROUND:

Violence, substance use, and HIV disproportionately impact female entertainment and sex workers (FESW), but causal pathways remain unclear.

METHODS:

We examined data from an observational cohort of FESW age 15-29 in Phnom Penh, Cambodia for associations between violence exposure and sexual risk and drug use. Validated measures of physical and sexual violence were assessed at baseline. Self-reported outcomes measured quarterly over the next 12-months included past month sexual partners, consistent condom use by partner type, sex while high, and amphetamine type stimulant (ATS) use. Biomarkers measured quarterly included prostate specific antigen (PSA) and urine toxicology. Generalized estimating equations were fit adjusting for age, education, marital status and sex work venue.

RESULTS:

Of 220 women, 48% reported physical or sexual violence in the preceding 12-months. Physical violence was associated with increased number of sex partners (adjusted incidence rate ratio [aIRR] 1.33; 95% CI: 1.04-1.71), greater odds of sex while high (adjusted odds ratio [aOR] 2.42; 95% CI: 1.10-5.33), increased days of ATS use (aIRR 2.74; 95% CI: 1.29-5.84) and increased odds of an ATS+ urine screen (aOR 2.80, 95%CI: 1.38-5.66). Sexual violence predicted decreased odds of consistent condom use with non-paying partners (aOR 0.24; 95% CI: 0.10-0.59) and greater odds of a PSA+ vaginal swab (aOR 1.83; 95% CI: 1.13-2.93).

CONCLUSIONS:

Physical and sexual violence are prevalent among Cambodian FESW and associated with subsequent sexual risk and drug use behaviors. Clinical research examining interventions targeting structural and interpersonal factors impacting violence is needed to optimize HIV/AIDS prevention among FESW.

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By:  Draughon Moret JE1, Carrico AW2, Evans JL3, Stein ES4, Couture MC5, Maher L6, Page K7; Young Women’s Health Study Collaborative.

• 1The Betty Irene Moore School of Nursing at UC Davis, 4610 X Street, #4202 Sacramento, CA 95817, United States. Electronic address: jdmoret@ucdavis.edu.
• 2University of California San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143, United States. Electronic address: adam.carrico@ucsf.edu.
• 3UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States. Electronic address: jennifer.evans@ucsf.edu.
• 4UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States. Electronic address: ellen.stein@ucsf.edu.
• 5University of San Francisco, School of Nursing and Health Professions, Department of Population Sciences, 2130 Fulton St., San Francisco, CA 94117, United States. Electronic address: mcouture@usfca.edu.
• 6The Kirby Institute for Infection and Immunity, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: lmaher@kirby.unsw.edu.au.
• 7Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States. Electronic address: pagek@salud.unm.edu.
• Drug Alcohol Depend. 2016 Apr 1;161:171-7. doi: 10.1016/j.drugalcdep.2016.01.028. Epub 2016 Feb 6. 

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Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study

PURPOSE:

There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.

METHODS:

Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population.

RESULTS:

In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups.

CONCLUSION:

This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

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By:  Brown GR1,2, Jones KT3.

• 1 Psychiatry Service, Mountain Home Veterans Affairs Medical Center , Johnson City, Tennessee.
• 2 Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University , Johnson City, Tennessee.
• 3 Office of Health Equity , Veterans Health Administration, Washington, District of Columbia.
• LGBT Health. 2016 Apr;3(2):122-31. doi: 10.1089/lgbt.2015.0058. Epub 2015 Dec 16. 

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Retrospective Analysis of Reproductive Health Indicators in the United Nations High Commissioner for Refugees Post-Emergency Camps 2007–2013

Background

The United Nations Refugee Agency’s Health Information System issues analytical reports on the current camp conditions and trends for priority reproductive health issues. The goal was to assess the status of reproductive health by analyzing seven indicators and comparing them to standards and host country estimates.

Methods

Data on seven indicators were extracted from the database during a seven-year period (2007 through 2013). A standardized country inclusion criterion was created based on the year of country implementation and the percentage of missing reports per camp and year. The unit of analysis was monthly camp reports by year within a country. To account for the lack of independence of monthly camp reports, the variance was computed using Taylor Series Linearization methods in SAS.

Results

Ten of the 23 eligible countries met the inclusion criterion. The mean camp maternal and neonatal mortality rates, except for two country years, were lower than the host country estimates for all countries and years. There was a significant increase in the percent of births attended by a skilled birth attendant (p < 0.0001), and 8 of 10 countries did not meet the standard of 100 % for all reporting years. The percent of births performed by Caesarian section (p < 0.001), were below the recommended minimum standard for nearly half of the countries every year. There was a significant increase in the percent of women screened for syphilis across years (p < 0.0001) and the percent of women who received post HIV exposure prophylaxis (p < 0.0001) and 10 % reached the standard for all reporting years, respectively.

Conclusion

Comprehensive, consistent and comparable statistics on reproductive health provides an opportunity to assess progress towards indicator standards. Despite some improvements over time, this analysis confirms that most countries did not meet standards and that there were differences in reproductive health indicators between countries and across years. Consequently, the HIS periodic monitoring of key reproductive health indicators at the camp level should continue. Data should be used to improve intervention strategies.

Below:  Proportion of women screened for syphilis annually by country. UNCHR target is 100 percent

Below:  Rate of condom distribution* in the population by year. *Figure depicts percentage (monthly rate*100)

Below:  Proportion of rape survivors who received post-exposure prophylaxis (PEP) within 72 h of an incident occurring. UNHCR target is 100 percent

Full article at:  http://goo.gl/iwPEIk

By:  Jennifer Whitmill, Curtis Blanton, Sathyanarayanan Doraiswamy, Nadine Cornier, Marian Schilperood, Paul Spiegel, andBarbara Tomczyk

Rollins School of Public Health Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, GA 30322 USA

Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 USA

Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 USA

United Nations High Commissioner for Refugees, Case Postale 2500 CH-1211, Genève 2, Dépôt Switzerland

Rollins School of Public Health Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, GA 30322 USA

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