Journal Article > CommentaryFull Text
BMJ. 2016 April 20; DOI:10.1136/bmj.i2037
Akol AD, Caluwaerts S, Weeks AD
BMJ. 2016 April 20; DOI:10.1136/bmj.i2037
Journal Article > ResearchFull Text
Public Health Action. 2013 June 21; Volume 3 (Issue 2); 109-12.; DOI:10.5588/pha.13.0012
Buard V, Van der Bergh R, Tayler-Smith K, Godia P, Sobry A, et al.
Public Health Action. 2013 June 21; Volume 3 (Issue 2); 109-12.; DOI:10.5588/pha.13.0012
SETTING
Médecins Sans Frontières Clinic for sexual gender-based violence (SGBV), Nairobi, Kenya.
OBJECTIVES
Among survivors of SGBV in 2011, to describe demographic characteristics and episodes of sexual violence, medical management, pregnancy and human immunodeficiency virus (HIV) related outcomes.
DESIGN
Retrospective review of clinical records and SGBV register.
RESULTS
Survivors attending the clinic increased from seven in 2007 to 866 in 2011. Of the 866 survivors included, 92% were female, 34% were children and 54% knew the aggressor; 73% of the assaults occurred inside a home and most commonly in the evening or at night. Post-exposure prophylaxis for HIV was given to 536 (94%), prophylaxis for sexually transmitted infections to 731 (96%) and emergency contraception to 358 (83%) eligible patients. Hepatitis B and tetanus toxoid vaccinations were given to 774 survivors, but respectively only 46% and 14% received a second injection. Eight (4.5%) of 174 women who underwent urine pregnancy testing were positive at 1 month. Of 851 survivors HIV-tested at baseline, 96 (11%) were HIV-positive. None of the 220 (29%) HIV-negative individuals who returned for repeat HIV testing after 3 months was positive.
CONCLUSION
Acceptable, good quality SGBV medical care can be provided in large cities of sub-Saharan Africa, although further work is needed to improve follow-up interventions.
Médecins Sans Frontières Clinic for sexual gender-based violence (SGBV), Nairobi, Kenya.
OBJECTIVES
Among survivors of SGBV in 2011, to describe demographic characteristics and episodes of sexual violence, medical management, pregnancy and human immunodeficiency virus (HIV) related outcomes.
DESIGN
Retrospective review of clinical records and SGBV register.
RESULTS
Survivors attending the clinic increased from seven in 2007 to 866 in 2011. Of the 866 survivors included, 92% were female, 34% were children and 54% knew the aggressor; 73% of the assaults occurred inside a home and most commonly in the evening or at night. Post-exposure prophylaxis for HIV was given to 536 (94%), prophylaxis for sexually transmitted infections to 731 (96%) and emergency contraception to 358 (83%) eligible patients. Hepatitis B and tetanus toxoid vaccinations were given to 774 survivors, but respectively only 46% and 14% received a second injection. Eight (4.5%) of 174 women who underwent urine pregnancy testing were positive at 1 month. Of 851 survivors HIV-tested at baseline, 96 (11%) were HIV-positive. None of the 220 (29%) HIV-negative individuals who returned for repeat HIV testing after 3 months was positive.
CONCLUSION
Acceptable, good quality SGBV medical care can be provided in large cities of sub-Saharan Africa, although further work is needed to improve follow-up interventions.
Journal Article > Meta-AnalysisAbstract
Sex Transm Infect. 2012 February 12; Volume 18 (Issue 5); DOI:10.3201/eid1801.110850
Chacko L, Ford NP, Sabaiti M, Siddiqui R
Sex Transm Infect. 2012 February 12; Volume 18 (Issue 5); DOI:10.3201/eid1801.110850
ObjectiveTo assess adherence to post-exposure prophylaxis (PEP) for the prevention of HIV infection in victims of sexual assault.MethodsThe authors carried out a systematic review, random effects meta-analysis and meta-regression of studies reporting adherence to PEP among victims of sexual violence. Seven electronic databases were searched. Our primary outcome was adherence; secondary outcomes included defaulting, refusal and side effects.Results2159 titles were screened, and 24 studies matching the inclusion criteria were taken through to analysis. The overall proportion of patients adhering to PEP (23 cohort studies, 2166 patients) was 40.3% (95% CI 32.5% to 48.1%), and the overall proportion of patients defaulting from care (18 cohorts, 1972 patients) was 41.2% (95% CI 31.1% to 51.4%). Adherence appeared to be higher in developing countries compared with developed countries.ConclusionsAdherence to PEP is poor in all settings. Interventions are needed to support adherence.
Conference Material > Abstract
Venables E, Seisun C, Malou EN, Gatkuoth MM, Chop Kuony C, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Sexual violence remains commonplace in conflict settings and has a devastating impact on the physical and mental health of survivors. We built on previous research by the ICRC, examining local norms and values surrounding violence, by focusing on how young men and their communities perceive sexual violence and its prevention. The ICRC seeks to protect and assist people affected by armed conflict and other situations of violence, and has been present in South Sudan since 1980 and CAR since 1983.
METHODS
We carried out a qualitative study, including 79 interviews and 16 focus group discussions. Participants included purposively selected young men and women (aged 15-33 years); community leaders (such as chiefs, cattle herders, traditional court members and health-care providers), and key informants with expertise in the field of sexual violence. Sites in South Sudan (Unity and Lakes States) and CAR (Bangui) were chosen because of the ICRC’s ongoing presence and the availability of referral services if required. Interviews and focus groups were conducted in French, English, Sango, Arabic, Nuer, and Dinka, transcribed and translated before being coded and thematically analysed using NVivo. Informed consent/assent was obtained from all participants.
ETHICS
This study was approved by the ICRC Ethics Review Board, the Comité Ethique et Scientifique of the University of Bangui, CAR, and by the Institutional Review Board of the Ministry of Health, South Sudan.
RESULTS
Findings from both countries linked male perpetration of sexual violence with prolonged conflict and insecurity; the presence of weapons; a weak justice system and impunity; revenge and punishment, and strong gendered norms and ideas around masculinity. Some men believed that women were to blame because of their behaviour or clothing. Participants saw the need to engage young men and their communities in prevention activities, but few were able to reflect upon their potential individual role in this. Strong community values and a sense of male responsibility were present in all study sites, and involving male leaders was believed to be essential for prevention activities. Interviewees in both countries suggested that providing information about HIV could be an entry point to talking about sexual violence with potential perpetrators.
CONCLUSION
Studies on sexual violence often understandably focus on survivors, and this is the first time the ICRC has conducted qualitative research of this kind with young men. Results, including discussions around local norms of masculinity, will contribute to and serve to strengthen existing sensitisation sessions and dialogue on the prevention of sexual violence. Strengthening existing partnerships with other actors is also essential. Whilst we found that participants were willing to discuss sexual violence, some may have been uncomfortable sharing their thoughts with the research team.
CONFLICTS OF INTEREST
None declared.
Sexual violence remains commonplace in conflict settings and has a devastating impact on the physical and mental health of survivors. We built on previous research by the ICRC, examining local norms and values surrounding violence, by focusing on how young men and their communities perceive sexual violence and its prevention. The ICRC seeks to protect and assist people affected by armed conflict and other situations of violence, and has been present in South Sudan since 1980 and CAR since 1983.
METHODS
We carried out a qualitative study, including 79 interviews and 16 focus group discussions. Participants included purposively selected young men and women (aged 15-33 years); community leaders (such as chiefs, cattle herders, traditional court members and health-care providers), and key informants with expertise in the field of sexual violence. Sites in South Sudan (Unity and Lakes States) and CAR (Bangui) were chosen because of the ICRC’s ongoing presence and the availability of referral services if required. Interviews and focus groups were conducted in French, English, Sango, Arabic, Nuer, and Dinka, transcribed and translated before being coded and thematically analysed using NVivo. Informed consent/assent was obtained from all participants.
ETHICS
This study was approved by the ICRC Ethics Review Board, the Comité Ethique et Scientifique of the University of Bangui, CAR, and by the Institutional Review Board of the Ministry of Health, South Sudan.
RESULTS
Findings from both countries linked male perpetration of sexual violence with prolonged conflict and insecurity; the presence of weapons; a weak justice system and impunity; revenge and punishment, and strong gendered norms and ideas around masculinity. Some men believed that women were to blame because of their behaviour or clothing. Participants saw the need to engage young men and their communities in prevention activities, but few were able to reflect upon their potential individual role in this. Strong community values and a sense of male responsibility were present in all study sites, and involving male leaders was believed to be essential for prevention activities. Interviewees in both countries suggested that providing information about HIV could be an entry point to talking about sexual violence with potential perpetrators.
CONCLUSION
Studies on sexual violence often understandably focus on survivors, and this is the first time the ICRC has conducted qualitative research of this kind with young men. Results, including discussions around local norms of masculinity, will contribute to and serve to strengthen existing sensitisation sessions and dialogue on the prevention of sexual violence. Strengthening existing partnerships with other actors is also essential. Whilst we found that participants were willing to discuss sexual violence, some may have been uncomfortable sharing their thoughts with the research team.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
Surgery. 2017 April 8; Volume 162 (Issue 2); 366-376.; DOI: 10.1016/j.surg.2017.03.001
Forrester JD, Forrester JA, Basimuoneye JP, Tahir MZ, Trelles M, et al.
Surgery. 2017 April 8; Volume 162 (Issue 2); 366-376.; DOI: 10.1016/j.surg.2017.03.001
BACKGROUND
Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity.
METHODS
We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones.
RESULTS
Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1-105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score (P = .003), degree of urgency (P = .02), mechanism (P < .0001), and a country's predominant religion (P = .006). Men were 1.7 times more likely to have an operative intervention in a predominantly Muslim country (P = .006).
CONCLUSION
Conflict is an unfortunate consequence of humanity in a world with limited resources. For most operative interventions performed in conflict zones, men were more commonly represented. Predominant religion was the greatest predictor of increased disparity between sexes, irrespective of the number of patients presenting as a result of traumatic injury. It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation.
Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity.
METHODS
We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones.
RESULTS
Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1-105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score (P = .003), degree of urgency (P = .02), mechanism (P < .0001), and a country's predominant religion (P = .006). Men were 1.7 times more likely to have an operative intervention in a predominantly Muslim country (P = .006).
CONCLUSION
Conflict is an unfortunate consequence of humanity in a world with limited resources. For most operative interventions performed in conflict zones, men were more commonly represented. Predominant religion was the greatest predictor of increased disparity between sexes, irrespective of the number of patients presenting as a result of traumatic injury. It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation.
Journal Article > ResearchFull Text
PLOS One. 2014 October 20; Volume 9 (Issue 10); e111096.; DOI:10.1371/journal.pone.0111096
Loko Roka J, Van der Bergh R, Au S, de Plecker E, Zachariah R, et al.
PLOS One. 2014 October 20; Volume 9 (Issue 10); e111096.; DOI:10.1371/journal.pone.0111096
BACKGROUND
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Conference Material > Slide Presentation
Venables E
MSF Scientific Days International 2021: Research. 2021 May 19
Conference Material > Video (talk)
Venables E
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > ResearchFull Text
PLOS One. 2022 December 30; Volume 17 (Issue 12); e0279692.; DOI:10.1371/journal.pone.0279692
Bossard C, Chihana ML, Nicholas S, Mauambeta D, Weinstein D, et al.
PLOS One. 2022 December 30; Volume 17 (Issue 12); e0279692.; DOI:10.1371/journal.pone.0279692
Female Sex Workers (FSWs) are a hard-to-reach and understudied population, especially those who begin selling sex at a young age. In one of the most economically disadvantaged regions in Malawi, a large population of women is engaged in sex work surrounding predominantly male work sites and transport routes. A cross-sectional study in February and April 2019 in Nsanje district used respondent driven sampling (RDS) to recruit women ≥13 years who had sexual intercourse (with someone other than their main partner) in exchange for money or goods in the last 30 days. A standardized questionnaire was filled in; HIV, syphilis, gonorrhea, and chlamydia tests were performed. CD4 count and viral load (VL) testing occurred for persons living with HIV (PLHIV). Among 363 study participants, one-quarter were adolescents 13–19 years (25.9%; n = 85). HIV prevalence was 52.6% [47.3–57.6] and increased with age: from 14.7% (13–19 years) to 87.9% (≥35 years). HIV status awareness was 95.2% [91.3–97.4], ART coverage was 98.8% [95.3–99.7], and VL suppression 83.2% [77.1–88.0], though adolescent FSWs were less likely to be virally suppressed than adults (62.8% vs. 84.4%). Overall syphilis prevalence was 29.7% [25.3–43.5], gonorrhea 9.5% [6.9–12.9], and chlamydia 12.5% [9.3–16.6]. 72.4% had at least one unwanted pregnancy, 17.9% had at least one abortion (40.1% of which were unsafe). Half of participants reported experiencing sexual violence (SV) (47.6% [42.5–52.7]) and more than one-tenth (14.2%) of all respondents experienced SV perpetrated by a police officer. Our findings show high levels of PLHIV-FSWs engaged in all stages of the HIV cascade of care. The prevalence of HIV, other STIs, unwanted pregnancy, unsafe abortion, and sexual violence remains extremely high. Peer-led approaches contributed to levels of ART coverage and HIV status awareness similar to those found in the general district population, despite the challenges and risks faced by FSWs.
Conference Material > Poster
Martinez Torre S, Carreño C, Sordo L, Llosa AE, Ousley J, et al.
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/88gr-bc57