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Title: Compliance with mandated emergency contraception in New Mexico emergency departments.
Author: Espey E; Ogburn T; Leeman L; Buchen E; Angeli E; Qualls C
Source: Journal of Women's Health. 2009 May;18(5):619-23.
Abstract: OBJECTIVE: New Mexico enacted a law in 2003 requiring that emergency departments (EDs) offer emergency contraception (EC) to survivors of sexual assault and that both doses be administered in the ED. This investigation sought to examine practices and knowledge of ED providers about EC in the setting of sexual assault. METHODS: We visited hospitals in New Mexico from July 2005 to December 2005 and administered an 18-item questionnaire to three providers-a physician, a nurse, and a clerk-in the ED. The questionnaire included items related to characteristics of the hospital, knowledge of providers about EC and the law, and ED practices relevant to EC for sexual assault survivors as well as for women who had consensual unprotected intercourse. RESULTS: Surveys were completed at 33 of 38 hospitals (87%). Overall, 52% of respondents reported that EC was routinely offered to sexual assault survivors, and 33% reported that both doses were administered in the ED. Forty-one percent of RNs, MDs, and clerks reported that EC was offered to sexual assault survivors who were minors regardless of age. Overall, 64% of respondents knew that EC may prevent pregnancy up to 72 hours after unprotected intercourse, and only 12% of respondents reported awareness of any requirements to offer EC to sexual assault survivors. Respondents reported that physicians in the ED more often routinely offered EC to sexual assault survivors (52%) than to women who requested it after consensual sex (20%). Thirty-three percent of respondents indicated parental consent was necessary for minors in the setting of sexual assault, although there is no requirement for parental notification in New Mexico. CONCLUSIONS: EDs in New Mexico are not universally complying with the law. Better dissemination of the law and education about EC could improve care of sexual assault survivors in New Mexico.
Language: English
Keywords:
NEW MEXICO | UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | WOMEN | EMERGENCY SERVICES | SEXUAL ABUSE | RAPE | HEALTH SERVICES | EMERGENCY CONTRACEPTION | HEALTH EDUCATION | NEEDS | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Delivery of Health Care | Health | Crime | Social Problems | Sociocultural Factors | Contraception | Family Planning | Education | Economic Factors
Document Number: 342561

Peer Reviewed

Title: Alcohol abuse, sexual risk behaviors, and sexually transmitted infections in women in Moshi urban district, northern Tanzania.
Author: Ghebremichael M; Paintsil E; Larsen U
Source: Sexually Transmitted Diseases. 2009 Feb;36(2):102-7.
Abstract: BACKGROUND: To assess the covariates of alcohol abuse and the association between alcohol abuse, high-risk sexual behaviors and sexually transmitted infections (STIs). METHODS: Two thousand and nineteen women aged 20 to 44 were randomly selected in a 2-stage sampling from the Moshi urban district of northern Tanzania. Participant's demographic and socio-economic characteristics, alcohol use, sexual behaviors, and STIs were assessed. Blood and urine samples were drawn for testing of human immunodeficiency virus, herpes simplex virus, syphilis, chlamydia, gonorrhea, trichomonas, and mycoplasma genitalium infections. RESULTS: Adjusted analyses showed that a history of physical (OR = 2.05; 95% CI: 1.06-3.98) and sexual violence (OR = 1.63; 95% CI: 1.05-2.51) was associated with alcohol abuse. Moreover, alcohol abuse was associated with number of sexual partners (OR = 1.66; 95% CI: 1.01-2.73). Women who abused alcohol were more likely to report STIs symptoms (OR = 1.61; 95% CI: 1.08-2.40). Women who had multiple sexual partners were more likely to have an STI (OR = 2.41; 95% CI: 1.46-4.00) compared to women with 1 sexual partner. There was no direct association between alcohol abuse and prevalence of STIs (OR = 0.86; 95% CI: 0.55-1.34). However, alcohol abuse was indirectly associated with STIs through its association with multiple sexual partners. CONCLUSIONS: The findings of alcohol abuse among physically and sexually violated women as well as the association between alcohol abuse and a history of symptoms of STIs and testing positive for STIs have significant public health implications. In sub-Saharan Africa, where women are disproportionately affected by the HIV epidemic screening for alcohol use should be part of comprehensive STIs and HIV prevention programs.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | KAP SURVEYS | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | URBAN POPULATION | MULTIPLE PARTNERS | SEXUALLY TRANSMITTED DISEASES | SEX BEHAVIOR | RISK BEHAVIOR | ALCOHOL USE AND ABUSE | PREVALENCE | RAPE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Sexual Partners | Behavior | Reproductive Tract Infections | Infections | Diseases | Measurement | Crime | Social Problems | Sociocultural Factors
Document Number: 330387

Title: ECP handbook: introducing and mainstreaming the provision of emergency contraceptive pills in developing countries.
Author: Hossain SM; Khan ME; Vernon R; Keesbury J; Askew I
Source: Washington, DC, Population Council, 2009. v, 25 p. (USAID Contract No. HRN A-00-98-00012-00William and Flora Hewlett Foundation Project No. 2007-1124)
Abstract: The intended audience for this handbook includes reproductive health (RH) program managers and government and NGO policy makers. It can be used in countries where ECPs are not currently available, as well as in contexts where the intention is to expand or mainstream access to existing ECP services. The handbook: Recognizes the different needs of diverse segments of the population, and places additional emphasis on targeting ECP services to "special groups," which include rape survivors and adolescents; Seeks to present an overall process that can be adapted to specific contexts and that is based on documented successful experiences in a range of contexts; Guides policymakers and program managers through the continuum of ECP programming: from needs assessments and operations research, to registration, to training, logistics, and ultimately mainstreaming through nationwide scaling-up. The handbook contains four sections: Introduction and Background describes the existing situation of ECP programmingaround the globe: Addressing the Needs of Specific Populations describes programming approaches designed for specific populations; Introducing and Mainstreaming ECPs describes five chronological steps for making ECP programming an integral component of a national RH program; The Bibliography lists useful resources for ECP programming.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | YOUTH | WOMEN | EMERGENCY CONTRACEPTION | RAPE | SIDE EFFECTS | CONTRACEPTIVE USE-EFFECTIVENESS | CONTRACEPTIVE AGENTS, PROGESTIN | PROGRAM ACCESSIBILITY | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Crime | Social Problems | Sociocultural Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraceptive Agents, Female | Contraceptive Agents | Program Evaluation | Programs | Organization and Administration
Document Number: 315212

Title: Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo.
Author: Hustache S; Moro MR; Roptin J; Souza R; Gansou GM
Source: International Journal of Mental Health Systems. 2009 Apr 1;3(7):1-10.
Abstract: Background: Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. Methods: Women who attended the M�decins Sans Fronti�res program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. Results: The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment). Conclusion: We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings.
Language: English
Keywords:
REPUBLIC OF THE CONGO | RESEARCH REPORT | EVALUATION | CLIENTS | WOMEN | WAR | RAPE | PSYCHOLOGICAL FACTORS | PSYCHOLOGICAL ABUSE | SCREENING | EMOTIONS | CARE AND SUPPORT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Political Factors | Sociocultural Factors | Crime | Social Problems | Behavior | Aggression | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 340204

Title: Emergency contraception services for adolescents: a National Survey of Children's Hospital Emergency Department Directors.
Author: Kavanaugh ML; Saladino RA; Gold MA
Source: Journal of Pediatric and Adolescent Gynecology. 2009 Apr;22(2):111-9.
Abstract: STUDY OBJECTIVE: To assess emergency contraception (EC) counseling and prescribing practices of children's hospital emergency department (ED) directors and the use of EC protocols in these settings. DESIGN: Cross-sectional study of children's hospital ED directors responding to a 15-minute 44-item semi-structured survey during telephone interviews. PARTICIPANTS: 50 of 96 eligible directors of children's hospital EDs in the United States. MAIN OUTCOME MEASURES: EC protocols, EC counseling processes, EC prescribing practices. RESULTS: Most (80%) ED directors reported always offering EC as part of sexual assault care; 66% were more likely to provide onsite EC in these situations. Only 52% identified the progestin-only regimen as the EC dispensed in their ED, and most (96%) limited provision to fewer than 120 hours after sex. Although 58% of ED directors reported ever prescribing ongoing contraception when providing EC, none had prescribed EC for future use. Written ED protocols for providing EC were more common for sexual assault care (76%) than for non-sexual assault care (14%). Directors who worked at hospitals with a sexual assault program were less likely to discuss all the recommended topics for EC counseling. CONCLUSIONS: The recommended standard of care for providing EC to adolescents in children's hospital EDs is not being met. Although risk of pregnancy following sexual assault and consensual unprotected sex is identical, discrepant practices emerged from this survey of pediatric ED directors. Increased education and policy initiatives within children's hospital EDs are needed to standardize EC services for adolescents in this setting.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | ADMINISTRATIVE PERSONNEL | HEALTH PERSONNEL | ADOLESCENTS, FEMALE | EMERGENCY CONTRACEPTION | HOSPITALS | EMERGENCY SERVICES | COUNSELING | PRESCRIPTIONS | RAPE | CONTRACEPTIVE AVAILABILITY | TIME FACTORS | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Organization and Administration | Delivery of Health Care | Health | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Health Facilities | Health Services | Clinic Activities | Program Activities | Programs | Distributional Activities | Crime | Social Problems | Sociocultural Factors | Population Dynamics
Document Number: 330952

Title: Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: the Refentse intervention study.
Author: Kim JC; Askew I; Muvhango L; Dwane N; Abramsky T; Jan S; Ntlemo E; Chege J; Watts C
Source: BMJ. 2009;338:b515.
Abstract: PROBLEM: Although international guidelines specify the central role of the health sector in providing comprehensive care, including HIV post-exposure prophylaxis (PEP), after sexual assault, in both industrialised and developing countries there are many challenges to providing timely and comprehensive services. DESIGN: A nurse driven model of post-rape care was integrated into existing hospital services; the before and after study design evaluated impacts on quality of care, reviewing 334 hospital charts and conducting interviews with 16 service providers and 109 patients. SETTING: 450 bed district hospital in rural South Africa. KEY MEASURES FOR IMPROVEMENT: Quality of care after rape (forensic history and examination, provision of emergency contraception, prophylaxis for sexually transmitted infections, referrals); provision of HIV counselling and testing and provision and completion of full 28 day course of PEP; and service utilisation (number of service providers seen on first visit and number of rape cases presenting to hospital per month). STRATEGIES FOR CHANGE: After completing baseline research, we introduced a five part intervention model, consisting of a sexual violence advisory committee, hospital rape management policy, training workshop for service providers, designated examining room, and community awareness campaigns. Effect of change Existing services were fragmented and of poor quality. After the intervention, there were considerable improvements in clinical history and examination, pregnancy testing, emergency contraception, prophylaxis for sexually transmitted infections; HIV counselling and testing, PEP, trauma counselling, and referrals. Completion of the 28 day course of PEP drugs increased from 20% to 58%. LESSONS LEARNT: It is possible to improve the quality of care after sexual assault, including HIV prophylaxis, within a rural South African hospital at modest cost, using existing staff. With additional training, nurses can become the primary providers of this care.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EVALUATION | INTERVIEWS | RURAL AREAS | CLIENTS | HEALTH FACILITIES | HEALTH SERVICES | HIV TESTING | COUNSELING | RAPE | EMERGENCY CONTRACEPTION | QUALITY OF HEALTH CARE | PSYCHOLOGICAL FACTORS | PROGRAM DESIGN | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Clinic Activities | Crime | Social Problems | Sociocultural Factors | Contraception | Family Planning | Health Services Evaluation | Program Evaluation | Behavior
Document Number: 330914

Title: Sexual violence against women and children in Chinese societies.
Author: Ko Ling Chan
Source: Trauma, Violence and Abuse. 2009 Jan;10(1):69-85.
Abstract: This article provides a comprehensive overview of the reported patterns of sexual violence against women and children in China. It reviews the prevalence of and risk factors for various types of sexual violence and discusses community knowledge and perceptions of these violent acts. It also critically examines three major problems of sexual violence research in China. First, the diversity of findings and study methods reported by surveys and criminal reports reflects the problems in obtaining accurate figures on the scope of the problem. Second, precautions must be taken in reading studies on Chinese culture-specific risk factors for domestic violence. Third, the study of culture-specific factors should not focus solely on cultural factors in a vacuum but rather, should examine traditional culture in the context of modern societies and consensus international standards of human rights. Recommendations for future research are also discussed.
Language: English
Keywords:
CHINA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | KAP SURVEYS | WOMEN IN DEVELOPMENT | CHILDREN | COMMUNITY | CHILD ABUSE | SEXUAL ABUSE | VIOLENCE AGAINST WOMEN | PREVALENCE | RISK FACTORS | RAPE | DOMESTIC VIOLENCE | KNOWLEDGE | PERCEPTION | Asia, Eastern | Asia | Developing Countries | Research Methodology | Surveys | Sampling Studies | Studies | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Crime | Social Problems | Sociocultural Factors | Measurement | Biology | Psychological Factors | Behavior
Document Number: 330270

10.

Peer Reviewed

Title: Disco funerals: a risk situation for HIV infection among youth in Kisumu, Kenya.
Author: Njue C; Voeten HA; Remes P
Source: AIDS. 2009 Feb 20;23(4):505-9.
Abstract: OBJECTIVE: We investigated the so-called 'disco funeral' phenomenon in Kisumu, Kenya, whereby community members including adolescents congregate at the home of the deceased for several days, accompanied by music and dancing. We explored whether disco funerals are a risk situation for HIV/sexually transmitted infection infection among youth. DESIGN:: Cross-sectional qualitative study. METHODS: We conducted 44 in-depth interviews with male and female adolescents aged 15-20 years in Kisumu municipality in Nyanza Province, Kenya. We also made observations during six disco funerals. RESULTS: Disco funerals were an important place for young people to hang out; they increased the opportunities to meet and engage in (risky) sexual activities. Many adolescents reported having casual sex on these occasions, sometimes with multiple partners, and mostly without condoms. Some girls were forced into sex, and there were several accounts of gang rape. Sex in exchange for money was reported frequently. Drugs and alcohol seemed to facilitate unprotected, multiple-partner, coerced, and transactional sex. CONCLUSION: In Kisumu, a town with a generalized HIV/AIDS epidemic, the high AIDS mortality leads to frequent disco funerals. Because many adolescents are having unprotected, transactional, or coerced sex at these occasions, disco funerals might contribute to the high HIV prevalence among youth, especially among adolescent girls. HIV interventions urgently need to include outreach actions to youth who hang out at disco funerals and link up with parents and funeral organizers to reduce risk situations.
Language: English
Keywords:
KENYA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | ADOLESCENTS | SEX WORKERS | MULTIPLE PARTNERS | DANCING | MUSIC | DEATH | SEX BEHAVIOR | RISK BEHAVIOR | RAPE | CONDOM USE | DRUG USE AND ABUSE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Sexual Partners | Culture | Sociocultural Factors | Mortality | Population Dynamics | Crime | Social Problems | Risk Reduction Behavior
Document Number: 341131

11.

Peer Reviewed

Title: Sexual violence and its health consequences for female children in Swaziland: a cluster survey study.
Author: Reza A; Breiding MJ; Gulaid J; Mercy JA; Blanton C; Mthethwa Z; Bamrah S; Dahlberg LL; Anderson M
Source: Lancet. 2009 Jun 6;373(9679):1966-72.
Abstract: BACKGROUND: Despite concern, few studies have been done about sexual violence against girls younger than 18 years of age in sub-Saharan Africa. We report the prevalence and circumstances of sexual violence in girls in Swaziland, and assess the negative health consequences. METHODS: We obtained data from a nationally representative sample of girls and women aged 13-24 years from selected households in Swaziland between May 15, 2007, and June 16, 2007, with a two-stage cluster design. The questionnaire examined demographics, type of sexual violence that took place before the respondent was 18 years of age, circumstances of the incident, and health-related conditions. Information was gathered from 1244 women and girls (response rate 96.3%), of whom 1242 provided retrospective responses to questions about sexual violence. We used regression models adjusted for relevant demographics to estimate the odds ratios for the associations between sexual violence and health-related conditions. FINDINGS: 33.2% (95% CI 29.9-36.7) of respondents reported an incident of sexual violence before they reached 18 years of age. The most common perpetrators of the first incident were men or boys from the respondent's neighbourhood (32.3% [28.8-36.1]) and boyfriends or husbands (26.2% [22.2-30.7]). The first incident most often took place in the respondent's own home (26.1% [21.6-31.2]). Sexual violence was associated with reported lifetime experience of sexually transmitted diseases (adjusted OR 3.69 [95% CI 1.78-7.66]), pregnancy complications or miscarriages (3.54 [1.47-8.55]), unwanted pregnancy (2.92 [1.87-4.55]), and self-report of feeling depressed (2.30 [1.70-3.11]). INTERPRETATION: Knowledge of the high prevalence of sexual violence against girls in Swaziland and its associated serious health-related conditions and behaviours should be used to develop effective prevention strategies. FUNDING: UNICEF.
Language: English
Keywords:
SWAZILAND | RESEARCH REPORT | SURVEYS | ADOLESCENTS, FEMALE | VIOLENCE AGAINST WOMEN | RAPE | SEXUAL ABUSE | SEXUAL HARASSMENT | PREVALENCE | DEPRESSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Sampling Studies | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Measurement | Mental Disorders | Diseases
Document Number: 341674

12.

Peer Reviewed

Title: The structure and outcomes of a HIV postexposure prophylaxis program in a high HIV prevalence setup in western Kenya.
Author: Siika AM; Nyandiko WM; Mwangi A; Waxman M; Sidle JE; Kimaiyo SN; Wools-Kaloustian K
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):47-53.
Abstract: BACKGROUND: In 2001, HIV postexposure prophylaxis (PEP) was initiated in western Kenya. METHODS: Design, implementation, and evolution of the PEP program are described. Patient data were analyzed for reasons, time to initiation, and PEP outcome. RESULTS: Occupational PEP was initiated first followed by nonoccupational PEP (nPEP). Antiretroviral regimens were based upon national PEP guidelines, affordability and availability, and prevailing HIV prevalence. Emerging side effects data and cost improvements influenced regimen changes. Between November 2001 and December 2006, 446 patients sought PEP. Occupational exposure: 91 patients: 51 males; 72 accepted HIV testing; 48 of 52 source patients were HIV infected; median exposure-PEP time 3 hours (range: 0.3-96 hours). Of 72 HIV-negative patients receiving PEP, 3 discontinued, 69 completed, and 23 performed post-PEP HIV RNA polymerase chain reaction (all negative). Eleven follow-up HIV enzyme-linked immunosorbent assay tests have all turned negative. Nonoccupational exposure: 355 patients; 285 females; 90 children; 300 accepted HIV testing; median exposure-nPEP time 19 hours (range: 1-672 hours). Of 296 HIV-negative patients on nPEP, 1 died, 15 discontinued, 104 are on record having completed PEP, and 129 returned for 6-week HIV RNA polymerase chain reaction (1 patient tested positive). Eighty-seven follow-up HIV enzyme-linked immunosorbent assay tests have all turned negative. CONCLUSIONS: It is feasible to provide PEP and nPEP in resource-constrained settings.
Language: English
Keywords:
KENYA | RESEARCH REPORT | RETROSPECTIVE STUDIES | HEALTH PERSONNEL | CLIENTS | ANTIRETROVIRAL THERAPY | HIV PREVENTION | ADMINISTRATION AND DOSAGE | TIME FACTORS | PROGRAM DESIGN | IMPLEMENTATION | NEEDLE PIERCING | RAPE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Delivery of Health Care | Health | Program Activities | Programs | Organization and Administration | HIV | HIV Infections | Viral Diseases | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Population Dynamics | Demographic Factors | Population | Risk Behavior | Behavior | Crime | Social Problems | Sociocultural Factors
Document Number: 342356

13.

14.

Peer Reviewed

Title: Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda.
Author: Zablotska IB; Gray RH; Koenig MA; Serwadda D; Nalugoda F; Kigozi G; Sewankambo N; Lutalo T; Mangen FW; Wawer M
Source: AIDS and Behavior. 2009 Apr;13(2):225-233.
Abstract: In a sample of 3,422 women aged 15�24 from Rakai, Uganda, the authors use adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI) to examine the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past, and HIV prevalence. During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06�1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25�2.56).
Language: English
Keywords:
UGANDA | RESEARCH REPORT | KAP SURVEYS | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | SEXUAL PARTNERS | YOUTH | WOMEN IN DEVELOPMENT | PERSONS LIVING WITH HIV/AIDS | ALCOHOL USE AND ABUSE | DOMESTIC VIOLENCE | VIOLENCE AGAINST WOMEN | HIV INFECTIONS | PREVALENCE | RAPE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Sex Behavior | Behavior | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Viral Diseases | Diseases | Crime | Social Problems | Sociocultural Factors | Measurement
Document Number: 340122

15.

Title: NGO report on violence against women in Burundi. Executive summary. CEDAW, January 2008.
Author: Action des Chretiens pour l'Abolition de la Torture [ACAT Burundi]; Organisation Mondiale Contre la Torture [OMCT]
Source: [Bujumbura], Burundi, ACAT Burundi, 2008. 7 p. http://www.omct.org/pdf/VAW/2008/CEDAW40th_Rep_alt_Burundi_fr.pdf (French full report)
Abstract: The aim of the report is to show the difficulties faced by thousands of women in Burundi due to the increase of violence against women. It is based on General Recommendation No19 of the Committee that affirms gender-based violence is a prohibited form of discrimination and recommends that States parties: take concrete and efficient measures to eradicate violence against women; ensure sufficient legal protection to all women against every form of gender based violence, including violence within the family, and the respect of their integrity and dignity; establish statistics on the scope, causes and consequences of violence against women and on the efficiency of measures intended to prevent and fight against this kind of violence. Unfortunately, the Government of Burundi has taken few measures to implement this recommendation. (excerpt)
Language: English
Keywords:
BURUNDI | CRITIQUE | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | POLICYMAKERS | POLICE | DOMESTIC VIOLENCE | VIOLENCE | RAPE | WOMEN'S HEALTH | LEGISLATION | PREVENTION AND CONTROL | LITIGATION | SOCIAL POLICY | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Economic Development | Economic Factors | Administrative Personnel | Organization and Administration | Corrections Officers | Government | Political Factors | Sociocultural Factors | Crime | Social Problems | Behavior | Health | Diseases | Policy
Document Number: 326332

16.

Title: Five years on. No justice for sexual violence in Darfur.
Author: Human Rights Watch
Source: New York, New York, Human Rights Watch, 2008 Apr. 44 p. (1-56432-302-1)
Abstract: Five years into the armed conflict in Sudan's Darfur region, women and girls living in displaced persons camps, towns, and rural areas remain extremely vulnerable to sexual violence. Sexual violence continues to occur throughout the region, both in the context of continuing attacks on civilians, and during periods of relative calm. Those responsible are usually men from the Sudanese security forces, militias, rebel groups, and former rebel groups, who target women and girls predominantly (but not exclusively) from Fur, Zaghawa, Masalit, Berti, Tunjur, and other non-Arab ethnicities. Survivors of sexual violence in Darfur have no meaningful access to redress. They fear the consequences of reporting their cases to the authorities and lack the resources needed to prosecute their attackers. Police are physically present only in principal towns and government outposts, and they lack the basic tools and political will for responding to sexual violence crimes and conducting investigations. Police frequently fail to register complaints or conduct proper investigations. While some police seem genuinely committed to service, many exhibit an antagonistic and dismissive attitude toward women and girls. These difficulties are exacerbated by the reluctance-and limited ability-of police to investigate crimes committed by soldiers or militia, who often gain effective immunity under laws that protect them from civilian prosecution. (excerpt)
Language: English
Keywords:
SUDAN | CRITIQUE | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | INTERNALLY DISPLACED PERSONS | POLICE | RAPE | REFUGEE CAMPS | FEAR | LITIGATION | JURISPRUDENCE | UN | INTERNATIONAL COOPERATION | Developing Countries | Africa, North | Africa | Economic Development | Economic Factors | Settlement and Resettlement | Migration | Population Dynamics | Demographic Factors | Population | Corrections Officers | Government | Political Factors | Sociocultural Factors | Crime | Social Problems | Residence Characteristics | Population Distribution | Geographic Factors | Emotions | Psychological Factors | Behavior | International Agencies | Organizations
Document Number: 326745

17.

Title: Triple jeopardy: Female adolescence, sexual violence, and HIV / AIDS.
Author: International Women's Health Coalition [IWHC]
Source: New York, New York, IWHC, 2008 Jun. 6 p. (On Health and Rights)
Abstract: Pervasive gender inequalities mean that girls especially face numerous violations to their sexual and reproductive health and rights, including sexual initiation before they are physically or emotionally ready. Girls who live in extreme poverty, among marginalized populations, without family support, or in situations of conflict and displacement are particularly vulnerable to coerced sexual encounters and abuse. (excerpt)
Language: English
Keywords:
GLOBAL | DEVELOPING COUNTRIES | TECHNICAL REPORT | ADOLESCENTS, FEMALE | VIOLENCE AGAINST WOMEN | RAPE | HIV | AIDS | RECOMMENDATIONS | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Domestic Violence | Crime | Social Problems | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases
Document Number: 327907

18.

19.

Title: Intercultural dialogue on violence against women. Final results of a Euro-Mediterranean project.
Author: Mediterranean Institute of Gender Studies; ANTIGONE - Information Centre on Racism, Ecology, Peace and Non Violence; Alliance for Arab Women; Association HEURA; ISIS International. Center for Women and Development
Source: Nicosia, Cyprus, Mediterranean Institute of Gender Studies, 2008. [99] p.
Abstract: This 101-page document summarises the final results of the 2007 project and study carried out by the Mediterranean Institute of Gender Studies (MIGS) to enhance the participation of women in intercultural dialogue about violence against women (VAW), as well as to develop strategies for overcoming discrimination and VAW in the Euro-Mediterranean (Euro-Med) region. MIGS, based in Cyprus, and 4 co-participating organisations from the region - Egypt (Alliance for Arab Women [AAW]), Greece (ANTIGONE - Information Centre on Racism, Ecology, Peace and Non Violence), Morocco (ISIS Center for Women and Development), and Spain (Association HEURA) - identified 25 women from diverse backgrounds to discuss VAW at a 2-day workshop. Funding for the collaboration came from the Anna Lindh Foundation for the Dialogue between Cultures. The document includes a synthesis of the reports on VAW from the 5 partner countries, information from the workshop and training sessions conducted in Cyprus, and the short-listed photographs from the project's photo competition and photo exhibition. It also summarises ways and means for further cooperation among the participants in the area of eliminating VAW, as well as ways of sharing and disseminating the results of the project activities to relevant stakeholders in the partner countries and in the Euro-Med region.
Language: English
Keywords:
GREECE | EGYPT | SPAIN | MOROCCO | SUMMARY REPORT | VIOLENCE AGAINST WOMEN | DOMESTIC VIOLENCE | LEGISLATION | HUMAN RIGHTS | RAPE | CAUSES OF DEATH | INEQUALITIES | GENDER ISSUES | WOMEN'S HEALTH | POVERTY | HIV INFECTIONS | Europe, Southern | Europe | Developed Countries | Developing Countries | Africa, North | Africa | Europe, Southwestern | Crime | Social Problems | Sociocultural Factors | Political Factors | Mortality | Population Dynamics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors | Health | Viral Diseases | Diseases
Document Number: 327909

20.

21.

Title: UNHCR handbook for the protection of women and girls.
Author: United Nations. Office of the United Nations High Commissioner for Refugees [UNHCR]. Division of International Protection Services
Source: Geneva, Switzerland, UNHCR, Division of International Protection Services, 2008 Jan. [410] p.
Abstract: The primary purpose of the Handbook is to help UNHCR staff fulfill their responsibilities to protect these women and girls more effectively. It is therefore intended for representatives, other managers, protection staff in the field and at headquarters, registration officers, eligibility officers, community services staff, field officers, and others. Protection partners will find it a useful source of information and guidance. The Handbook is intended to be used in situations of asylum, internal displacement, return, integration, and statelessness. It is equally applicable in urban and rural contexts. The objectives of the Handbook are to: improve understanding among UNHCR staff and partners of the challenges and barriers women and girls of concern confront in accessing and enjoying their rights during displacement, return, and (re)integration; ensure all UNHCR staff are familiar with the international legal standards forming the normative framework for our work to protect women and girls; ensure all UNHCR staff understand their responsibilities for the protection of women and girls; improve knowledge of how discrimination against women and girls can lead to statelessness and what initiatives can be taken to prevent and reduce cases of statelessness; provide guidance on ways of working and types of activities that can be carried out to fulfill our responsibilities; and refer staff to additional resources, guidelines, and tools that may be used to enhance the protection of women and girls. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | MANUAL | EVALUATION | WOMEN IN DEVELOPMENT | CHILD, FEMALE | REFUGEES | UNHCR | WOMEN'S EMPOWERMENT | WOMEN'S RIGHTS | RISK FACTORS | INTERVENTIONS | WAR | RAPE | WOMEN'S HEALTH | TREATIES | Economic Development | Economic Factors | Child | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Migrants | Migration | Population Dynamics | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Women's Status | Socioeconomic Factors | Human Rights | Biology | Programs | Organization and Administration | Crime | Social Problems | Health
Document Number: 325467

22.

Title: The epidemiology and the pathology of suspected rape homicide in South Africa.
Author: Abrahams N; Martin LJ; Jewkes R; Mathews S; Vetten L
Source: Forensic Science International. 2008;:[7] p.
Abstract: The objective was to describe the epidemiology and forensic management of suspected rape homicide in South Africa, with the aim of promoting the recognition of this form of violence against women amongst forensic pathologists during post-mortem examination. A retrospective national study in a proportionate random sample of 25 medico-legal laboratories was carried out to identify all homicides in 1999 of women over the age of 13 years. Data was collected from the mortuary file, autopsy report, police record and during interviews with police. A rape homicide was suspected in 16.3% (95% confidence intervals (CI): 10.6-22.3) of the female homicides which gave a rape homicide rate of 3.65/100,000 women over 13 years. Rape homicides were more likely to than other female homicides to be crimes where the perpetrator and victim were strangers, where the crime happened in public spaces and the victim older than the perpetrator. In addition to genital injuries, injuries associated with this crime included those of head and face, legs, neck and injuries caused by bites. Victims had larger numbers of injuries, and more often a mechanism of death due to strangulation asphyxiation, or blunt trauma, rather than gunshot. Rape homicide is an extreme form of violence against women and the prevalence in South Africa is higher than that of all female homicides in the United States. The particular pattern of injury found in these cases should be used to develop protocols for autopsies on murdered women to ensure that crucial evidence is not lost and the victims' and their families claim to justice is not compromised. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGY | WOMEN | RAPE | CAUSES OF DEATH | CRIME | HOMICIDE | VIOLENCE AGAINST WOMEN | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Public Health | Health | Demographic Factors | Population | Social Problems | Sociocultural Factors | Mortality | Population Dynamics | Domestic Violence
Document Number: 326730

24.

Title: Changes in genital injury patterns over time in women after consensual intercourse.
Author: Anderson SL; Parker BJ; Bourguignon CM
Source: Journal of Forensic and Legal Medicine. 2008 Jul;15(5):306-11.
Abstract: To date, there are no studies in the literature addressing whether or not microscopic genital injuries change over time or change in appearance during the 72 h time period following intercourse. In this study, women (n=35) had two evidentiary type pelvic examinations to document injuries after consensual intercourse. At Time 1 (within 48 h of consensual intercourse) a: larger total surface area of injury (p=0.02); larger surface area of injury to the posterior fourchette (p=0.02); larger surface area of abrasions (p=0.04); and larger surface area of redness (p=0.04) were found compared to Time 2 (24 h after Time 1). Since this research is exploratory, larger studies are needed to explore the differences in genital injuries based on the time of examination and in women after non-consensual intercourse.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN | RURAL POPULATION | PREVALENCE | GENITALIA, FEMALE | SEXUAL INTERCOURSE | ACCIDENTS AND INJURIES | TIME FACTORS | COLPOSCOPY | SEXUAL ABUSE | RAPE | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Population Characteristics | Measurement | Genitalia | Urogenital System | Physiology | Biology | Reproduction | Health | Population Dynamics | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Crime | Social Problems | Sociocultural Factors
Document Number: 328833

25.

Title: 13,915 reasons for equity in sexual offences legislation: A national school-based survey in South Africa.
Author: Andersson N; Foster AH
Source: International Journal for Equity in Health. 2008 Jul 29;7(20):[12] p.
Abstract: Prior to 2007, forced sex with male children in South Africa did not count as rape but as "indecent assault", a much less serious offence. This study sought to document prevalence of male sexual violence among school-going youth. A facilitated self-administered questionnaire in nine of the 11 official languages in a stratified (province/metro/urban/ rural) last stage random national sample. Teams visited 5162 classes in 1191 schools, in October and November 2002. A total of 269,705 learners aged 10-19 years in grades 6-11. Of these, 126,696 were male. Schoolchildren answered questions about exposure in the last year to insults, beating, unwanted touching and forced sex. They indicated the sex of the perpetrator, and whether this was a family member, a fellow schoolchild, a teacher or another adult. Respondents also gave the age when they first suffered forced sex and when they first had consensual sex. Some 9% (weighted value based on 13915/127097) of male respondents aged 11-19 years reported forced sex in the last year. Of those aged 18 years at the time of the survey, 44% (weighted value of 5385/11450) said they had been forced to have sex in their lives and 50% reported consensual sex. Perpetrators were most frequently an adult not from their own family, followed closely in frequency by other schoolchildren. Some 32% said the perpetrator was male, 41% said she was female and 27% said they had been forced to have sex by both male and female perpetrators. Male abuse of schoolboys was more common in rural areas while female perpetration was more an urban phenomenon. This study uncovers endemic sexual abuse of male children that was suspected but hitherto only poorly documented. Legal recognition of the criminality of rape of male children is a first step. The next steps include serious investment in supporting male victims of abuse, and in prevention of all childhood sexual abuse. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | QUESTIONNAIRES | CROSS SECTIONAL ANALYSIS | STUDENTS | YOUTH | CHILD, MALE | ADOLESCENTS, MALE | SEXUAL ABUSE | RAPE | VIOLENCE | CHILD ABUSE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Education | Age Factors | Population Characteristics | Demographic Factors | Population | Child | Adolescents | Crime | Social Problems | Sociocultural Factors | Behavior
Document Number: 327928

26.

Peer Reviewed

Title: Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa.
Author: Andersson N; Cockcroft A; Shea B
Source: AIDS. 2008 Dec;22 Suppl 4:S73-86.
Abstract: Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.
Language: English
Keywords:
AFRICA, SOUTHERN | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | DOMESTIC VIOLENCE | VIOLENCE AGAINST WOMEN | HIV PREVENTION | RAPE | SEXUAL ABUSE | PHYSICAL ABUSE | PSYCHOLOGICAL ABUSE | CHILD ABUSE | HIV TRANSMISSION | RISK BEHAVIOR | MALE ROLE | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Crime | Social Problems | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Violence | Behavior | Aggression | Social Behavior
Document Number: 330381

27.

Title: Linking sexual and reproductive health and HIV/AIDS. Gateways to integration: A case study from Haiti. Voluntary HIV counselling and testing: an entry point for comprehensive sexual and reproductive health services.
Author: Armstrong S
Source: Geneva, Switzerland, World Health Organization, 2008. 24 p. Also available in Spanish: http://149.120.32.2/upload/lib_pub_file/794_filename_ippf_linkages_haiti_sp.pdf and French: http://149.120.32.2/upload/lib_pub_file/828_filename_linking_sexual_rh_fr.pdf
Abstract: The process of linking sexual and reproductive health and HIV/AIDS needs to work in both directions: traditional sexual and reproductive health services need to integrate HIV/AIDS interventions, and programmes set up to address the AIDS epidemic need to integrate more general services for sexual and reproductive health. The case studies featured in this series have been chosen to demonstrate this two-way flow and to reflect the diversity of integration models. While these case studies focus primarily on service delivery components, structures, systems and policy issues are also important elements of successful integration.
Language: English
Keywords:
HAITI | RESEARCH REPORT | RECOMMENDATIONS | EVALUATION | PERSONS LIVING WITH HIV/AIDS | INTEGRATED PROGRAMS | REPRODUCTIVE HEALTH | HIV PREVENTION | VOLUNTARY COUNSELING AND TESTING | CONDOM USE | PROMOTION | FAMILY PLANNING PROGRAMS | REPRODUCTIVE RIGHTS | RAPE | Caribbean | Americas | Developing Countries | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Risk Reduction Behavior | Behavior | Marketing | Economic Factors | Family Planning | Human Rights | Political Factors | Sociocultural Factors | Crime | Social Problems
Document Number: 327836

28.

Title: Relationship of genital injuries and age in adolescent and young adult rape survivors.
Author: Baker RB; Sommers MS
Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2008 May-Jun;37(3):282-289.
Abstract: The objective was to examine the associations between age and genital injuries in adolescent and young adult women examined following rape. The design and setting was a retrospective review of 234 medical records from an emergency department sexual assault program. Women aged 14 to 29 years. Fifty percent of the sample was African American, 48% was White, and 2% was either Asian or an " other " race. Genital injury was described by injury prevalence, frequency, and anatomical locations of injuries. Overall genital injury prevalence was 62.8%. Younger age was not significantly associated with the presence or absence of genital injury. However, younger age was significantly associated with an increased number of genital injuries overall and to the thighs, labia minora, periurethral area, fossa navicularis, and vagina. These findings support the need for further research to determine if the current care provided to rape survivors is age appropriate. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | ADOLESCENTS, FEMALE | YOUTH | RAPE | ACCIDENTS AND INJURIES | GENITAL EFFECTS, FEMALE | PHYSICAL EXAMINATIONS AND DIAGNOSES | AGE FACTORS | PREVALENCE | Developed Countries | North America | Americas | Studies | Research Methodology | Adolescents | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Health | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Measurement
Document Number: 327179

29.
Peer Reviewed

Title: The child rape epidemic [letter]
Author: Booysen N; Brown C; Collison N; Diedericks R; Ginger F
Source: South African Medical Journal. 2008 Jul;98(7):490, 492; author reply 492.
Abstract: We wish to comment on the clinical review of 294 cases of child sexual abuse.1 A bias towards significant surgical injury may exist as the Department of Surgery at Red Cross Children's Hospital (RCH), which is a referral centre for managing child sexual abuse of all types, has the more severe cases referred. A case is made for examination under anaesthesia (EUA). Paediatric anaesthesia is highly specialised and best performed in centres of excellence; its unnecessary use should be avoided as it carries its own morbidity and mortality. Many clinicians, supported by protocols in other centres, hold that most children do not require EUA. Difficult cases or uncertainty and examiner inexperience are indications for referral and possible EUA. The use of EUA is perhaps contradictory to the authors' suggestion that it is '... perhaps time to encourage nursing staff to become qualified sexual assault nurse examiners to perform most of the examination'. (excerpt)
Language: English
Keywords:
SOUTH AFRICA | CRITIQUE | CHILD ABUSE | SEXUAL ABUSE | RAPE | STANDARDS | NEEDS | PERFORMANCE IMPROVEMENT | HEALTH SERVICES | REFERRAL AND CONSULTATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Crime | Social Problems | Sociocultural Factors | Research Methodology | Economic Factors | Management | Organization and Administration | Delivery of Health Care | Health | Program Activities | Programs
Document Number: 328505

30.

Title: Sexual violence among pregnant women in India.
Author: Chhabra S
Source: Journal of Obstetrics and Gynaecology Research. 2008 Apr;34(2):238-241.
Abstract: The aim was to discover the extent of sexual violence during pregnancy, its correlation to various variables and effects, and to consider future possibilities for creating awareness in health providers, health seekers and communities for prevention. Two thousand pregnant women were interviewed using a semi-structured, pre-designed, pre-tested questionnaire with some open-ended questions in the local language. Of 2000 women, 1959 (97.95%) reported that they had had sex with their partners during the current pregnancy. Of the 2000, 615 (30.7%) women had not wished to have sex during the pregnancy, but had been forced to do so. Women suffer with recurrent marital rape during pregnancy with considerable after effects. This sexual violence takes place irrespective of education or socioeconomic status. (author's)
Language: English