title: Child sexual abuse and links to HIV and orphanhood in urban Zimbabwe.
abstract: BACKGROUND
  Evidence of a link between sexual violence and HIV is growing; however, studies among children are scarce. The authors sought to characterise child sexual abuse in Harare, Zimbabwe, and explore its links with HIV and orphanhood.
  
  
  METHODS
  Records for new clients attending a child sexual abuse clinic from July 2004 to June 2005 were computerised and reviewed. Information on characteristics, medical examinations, laboratory tests and perpetrators were summarised. Orphan prevalence was compared with Demographic and Health Survey (DHS) 2005/2006 data for Harare, and a household-based survey in a neighbouring community.
  
  
  RESULTS
  Over 1 year, 1194 new clients (90% female) aged 7 weeks to 16 years were assessed, with 93% of boys and 59% of girls classified clinically as prepubertal. 94% of clients reported penetrative sexual abuse, occurring most often in the child's home. Most perpetrators were identified as relatives or neighbours by children under 12 years, and 'boyfriends' by adolescent girls. At presentation, 31/520 (6%) clients tested were HIV-positive. Where recorded, 39 (6%) clients presented within 3 days of abuse, and 36 were given postexposure prophylaxis for HIV (PEP). Among female clients, orphan prevalence was higher than in the DHS (OR=1.7; 1.4 to 2.2) and neighbouring community (OR=1.7; 0.7 to 4.3).
  
  
  CONCLUSIONS
  High numbers of children in Harare experience penetrative sexual abuse, and most present too late for PEP. More immediate presentation of sexual abuse can help to prevent HIV and recurrent abuse, and assist in examination and prosecution. Orphanhood emerged as a possible risk factor for sexual abuse and an important area for further research.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK. isolde.birdthistle@lshtm.ac.uk
authors.forename: Isolde J
authors.initials: IJ
authors.lastname: Birdthistle
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Stewart
authors.initials: S
authors.lastname: Mwanasa
authors.forename: Auxillia
authors.initials: A
authors.lastname: Nyagadza
authors.forename: Edmore
authors.initials: E
authors.lastname: Gwiza
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002650:Child Abuse, Sexual / Q000517:prevention & control / Q000706:statistics & numerical data*; D054540:Child, Orphaned / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D014505:Urban Population; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D015030:Zimbabwe / Q000453:epidemiology