1. How can one be sure that one does not have HIV infection?
This is easily determined. Every person knows what they have done or are currently doing. If the activity or situation is such that one might acquire HIV infection then the person should test for HIV now and three months after the last high risk activity. If both tests are negative then the person does not have an HIV infection.
2. How can I be sure that a person is not HIV positive? How can I be sure that my partner or spouse does not have HIV?
You can never be sure that a person is HIV negative. You cannot force another person to go for the test and tell you if it is positive. In any case, the test will be negative for three months and during that time you could get the infection from your partner.
Suppose that the person is really HIV negative. The test is negative on 1st March and on 1st June. The person gets married on 1st June (in some countries it is mandatory to test for HIV before marriage). After one month the person has extra marital sex (with a person who, unknown to both, has HIV infection) and gets an HIV infection. The infection can get transmitted to the spouse. Both will test negative till September. Thereafter the couple will test positive.
Instead of relying on tests to detect the infection (by which time it is too late anyhow), it is better to create a relationship of mutual trust. If you know a person for a long time, if you have developed a close and trusting relationship, then that person will confide in you. He or she may say that he or she had been involved in activities through which he or she might have got HIV infection. HIV tests done now and three months after the high risk activity will settle the issue. Since there is trust and love between the two of you, he or she may come back and tell you their test report. This depends entirely on trust.
3. What is the extent of HIV infection in India?
Currently about 0.3 percent of our general population (which includes people like you and me) is HIV positive. In some areas, up to five percent of pregnant women are HIV positive. This means that if you attend a marriage, and there are 500 people there, then up to 2 could be HIV positive – unknown to you and probably unknown to themselves.
4. Can one be cured of HIV infection?
No. We do not have a cure for HIV infection yet. Being a virus (the link between living and non living things) it has the capacity to survive in a dormant state for years. We have drugs that interfere with the multiplication of the virus, but we do not have drugs that can kill or eradicate the virus. So all we can do with drugs is disease control. We can keep the quantity of the virus in our body to a very low level but we cannot get it out of our body.
The HIV mutates very fast. It becomes resistant to the drug being administered pretty rapidly. So we have to use three different types of drugs simultaneously to keep the virus under control. It is like taking three different antibiotics at the same time.
5. I read in a magazine that there is a cure for HIV.
We often read about claims from people that they have found a cure for HIV or that there is a cure for HIV in alternative medicine. None of these claims have been scientifically validated.
6. Is there a vaccine against HIV?
There is no vaccine available against HIV. Though the disease is twenty years old, we have not yet come up with a successful vaccine because this virus, unlike polio and small pox viruses, mutates rapidly. By the time a vaccine is developed, the virus has changed its outer sheath and the vaccine cannot work. Some vaccines are at a trial stage in laboratories, but none are available for use.
7. Why aren’t all sex workers tested for HIV?
Sex workers run a high risk of getting HIV infection because of multiple sex partners. They can test themselves if they wish to. This often happens if they have been counseled about HIV and its effects on the body.
It is important to realize that the sex workers do not approach people in their homes asking for sex. People choose to go to the sex worker and offer them money or gifts to have sex with them. So why should the sex workers test themselves? Nobody is forcing people to have sex with the sex worker.
The government cannot force sex workers to get the test done. Even if the test is done today, what is the guarantee that he/she won’t get the infection tomorrow? Should the test be done daily? In any case, the window period gives a false negative report. What about the customer? Shouldn’t the customer test himself or herself?
8. Life is not worth living after getting HIV infection.
Being HIV positive can be very depressing. But we met a HIV positive person who was full of life. Here is her story (names have been changed to protect her identity):
A young girl called Rani, the daughter of a government employee, was married to Ramesh. Ramesh fell sick a few months after marriage. He was diagnosed to have AIDS which he had acquired from a premarital relationship. He died two months later. By then Rani had acquired the infection from her husband. Her in-laws blamed her for making Ramesh sick and drove her out of the house after Ramesh’s death. Rani returned to her parents’ house. They encouraged her to study further as she had only studied upto the 10th standard. She also underwent counseling to understand her condition and the various treatment options. Rani did a counseling course and went to work for an organisation. There she met a man who was also HIV positive. They fell in love and got married. Rani and her husband now have a child. She took all the precautions required to reduce the chances of HIV transmission to her baby during pregnancy and after birth. Her baby was tested at 18 months of age and found to be HIV negative. She feels happy and is content with what she is doing. Her family members are willing to look after her child if she and her husband succumb to AIDS.
Should Rani have committed suicide? Rani definitely does not think so.
With treatment, a HIV positive person can live a healthy useful life far beyond 2 – 10 years. With treatment, good nutrition and a positive outlook, people have been known to be living with HIV for over 15 years.
9. Can one live with a HIV positive person in the same house?
Yes, definitely. Unlike a common cold, HIV is not transmitted by casual contact with an infected person. You can live in the same house, eat together, eat food cooked by a HIV positive person, shake hands and play together, share the toilet and sleep in the same room without getting HIV from that person. Intimate (sexual) contact has to be avoided.
10. Can mosquitoes spread HIV ? Unlike Malaria, HIV does not have a life cycle in a mosquito, so mosquito bites do not cause HIV. Only close bodily contact, that allows mixing of body fluids that have a high viral load like semen, vaginal fluid or blood can cause HIV transmission from person to person.
11. How can HIV be destroyed ?
HIV is a very fragile virus and can be easily destroyed outside the human body. Boiling or hot water, soap, bleaching powder, alcohol or chlorhexidine can be used to destroy the virus.
12. Can HIV positive children attend normal schools?
Yes they can. Sharing a bench or playing together does not transmit infection. HIV positive children know about their status and they know that their blood can infect others. They are trained to report to a responsible adult if they get hurt and start bleeding. Moreover, HIV transmission will not occur if blood from an HIV positive person falls on intact skin.
13. How is HIV different from AIDS?
AIDS stands for Acquired Immuno Deficiency Syndrome. This is the last stage of HIV infection, when the infected person begins to fall sick and looks obviously ill.
People who are infected with HIV are called HIV positive. They look perfectly normal in appearance and health for about two to ten years after being infected. By this time, their immune system has been overpowered by the virus and they fall prey to a large number of infections and tumors. This stage is called AIDS. Now the person is visibly sick and, without treatment, usually dies within one year.
14. When can one suspect that one has AIDS?
HIV infection does not produce any symptoms. On reaching the stage of AIDS, the person begins to feel weak, has significant weight loss, has low grade fevers lasting for over a month, persistent loose motions, rashes, coughs and swollen lymph nodes. All of these symptoms are long standing (over months), persistent and do not respond to routine medication.
15. Where is HIV found in the body of an infected person?
HIV primarily infects the white blood cells. Besides blood it enters many other tissues and body fluids like semen, saliva and even sweat. However the amount of virus present and the infectivity of the virus differ from fluid to fluid as shown below.
Concentration of the virus Potency of virus Infectivity
Blood Very High High High
Semen Very High High High
Vaginal fluids Very High High High
Breast Milk High Medium Medium
Tears extremely Low Very Low Negligible
Saliva extremely Low Very Low Negligible
Sweat Not demonstrated Nil
Urine extremely Low Very Low Negligible
16. Can HIV be transmitted by open-mouth kissing?
Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, open-mouth kissing could allow HIV to pass from an infected person to a partner through cuts or sores in the mouth. Open-mouth kissing with an infected partner is not recommended.
17. Who is at risk of getting HIV infection?
1. A person who has had sex with many people is likely to come in contact with someone who is already infected with HIV.
2. A person who has only one sexual partner in his or her life, but the partner has had sex with other people.
3. A child born to an HIV positive mother.
4. A person who has had a blood transfusion of untested blood.
5. People sharing injection needles, tattoo needles and razors.
6. Medical and paramedical workers who come in contact with body fluids. Examples – doctors, nurses, lab technicians, sanitation staff.
18. How can I avoid HIV infection?
HIV infection can be reduced through safer sex practices, safe blood transfusions, and avoiding sharing needles and razors. Mother to child transmission can be reduced by testing all pregnant women for HIV and treating those positive with anti – HIV medication.
29. What are safer sex practices?
HIV transmission through sex can be avoided totally if a person never has sex. This is called abstinence. Since it is natural to want to have sex, the next best option is to have a single mutually faithful sexual partner. Two HIV negative people who have never had sex with anyone other than each other cannot get HIV by having sex with each other.
If a person has more than one sexual partner, there is an increased risk of getting HIV as any of the partners may be infected from their previous relationship. We cannot detect whether a person is HIV positive from their appearance. If one has multiple sex partners, the risk of HIV infection can be reduced (but not ruled out completely), by always using condoms during sex.
20. What is a condom? How does it reduce HIV transmission?
A condom is a contraceptive device made of latex which prevents direct contact between the penis and the vagina. The male condom is rolled onto the penis while the female condom is a plastic pouch which is inserted into the vagina. Condoms prevent direct contact between the body fluids of the two partners. The risk of HIV transmission falls. The condom may leak or burst or be incorrectly used allowing HIV transmission. Even as a contraceptive, the condom fails to prevent pregnancy in 10 to 15 percent of couples over a one year period.
Thursday, February 26, 2009
Commonly asked questions about child sexual abuse
Child sexual abuse (CSA) is very common both in India as well as worldwide. Adults can help in fighting this menace by learning about all aspects of CSA - how it happens, why it happens, why the child does not tell, what can be done if one finds out about it, how to support the child and what to do about the perpetrator.
Answers to some commonly asked questions about child sexual abuse (CSA).
Is Child sexual abuse common in India?
In 1993 -1994, Samvada, a Bangalore based NGO did a pioneering study in the history of CSA work in India by organizing a series of workshops for 348 girls (15 – 21 yrs old) from 11 schools and colleges in Karnataka.
They found that 47% of the respondents had been molested or had experienced sexual overtures, 15% when they were less than 10 yrs old. 15% had experienced serious sexual abuse, including rape. Of these 31% were less than 10 yrs old when abuse started.
The Ministry of Women and Child Development, Govt of India, Prayas and UNICEF, 2007 reported that out of 12,447 children (hailing from all strata of society), 53% reported sexual abuse. Out of 12,447 children, 21% reported severe sexual abuse.
Many reports (e.g.RAHI) prior to the recent report had indicated that child sexual abuse of girls was high in India. Now it appears that incidence of sexual abuse of boys is also on the rise. 52% of boys and 47% of girls have reported sexual abuse of one form or the other in this study. More boys than girls have reported severe form of sexual abuse.
Does this mean that 50% of our men (or women) are abusers?
No. This is because one abuser abuses many children. In a study in the USA, a convicted abuser had on average, abused 76 children. By exposing the abuser in the society, the abused child’s family can save many children from abuse. Hence it is very important to tell all the family members, friends and neighbours about this person. He/ she may be an influential person or a religious leader – but if he/she is a child abuser, he will not stop unless acted against. Though legal action is a way out, it may take a long time. Talking about this person among the family and neighborhood – “be careful with this person. I have heard that children are not safe with him/her” will keep children around him/her safe.
What is considered child sexual abuse?
Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a child or exploits a child for the purpose of sexual gratification.
Acts considered CSA may be:
Fondling – Touching genitals.
Violations of child’s privacy
Exposing children to adult sexuality
Behavior involving penetration.
Exploitation – giving or receiving money for using a child for sexual gratification.
An adult who engages in sexual activity with a child is performing a criminal and immoral act which can never be considered normal or socially acceptable behavior.
At what age does Child Sexual Abuse start?
One of the youngest victims of sexual abuse was a one and a half months old baby. However, in majority of cases, sexual abuse begins around 5 years of age, peaks at around 12 -14 years of age and then begins to decline (as per the Govt. report). It can, however, continue into adulthood.
Why do children keep quiet about CSA? How does CSA continue?
Children don’t talk about the abuse because they feel they won’t be believed, that they will be blamed for it or because they don’t want the family to break up. Often the abuser is a family member or is very close to the family. As the child has grown up loving and trusting that person, the person starts 'grooming' the child for sexual abuse by touching him/ her in an 'unsafe' way. The family remains unaware of this and the child feels confused.
If the family has brought up the child to think that anything to do with the reproductive tract is "dirty' or "shameful" the child will find it very difficult to report the grooming process. In the mean time the abuse continues and becomes more severe. The child now feels trapped and thinks 'I did not tell anyone when it first started. How can I tell now? Every one will blame me for not resisting or not telling earlier. Anyhow, I feel too ashamed to explain all this to my mother/ parent/ teacher. May be it will stop." The abuser, emboldened by the silence, goes ahead. He / she also uses bribes, threats, secrecy, promises, blackmail and emotional manipulation to keep the child from telling anyone.
A child’s brain is pitted not just against an adult brain of the abuser, but also against the silence and shame built around the current social perceptions of sexuality. The child can win only with the support of the family members, in a society that accepts and respects each individual's personhood and sexuality.
In some instances, the child informs the parents in a round about way or directly, and the child is either not fully understood or not believed or simply denied protection. CSA therefore continues.
If we don’t make a fuss about the abuse, won't the child forget it?
Children do not forget abuse. It remains with them and affects their behaviour and personality in many ways. In the present it can result in falling academic performance and a lack of interest in activities the child used to enjoy earlier
It may cause the child to become excessively sexualized in his or her behaviour, or it may cause the child to dislike themselves. The child may start keeping the body dirty and unattractive, wearing many clothes or baggy clothes to avoid attracting attention.
The adolescent may start behaving aggressively or become totally submissive. At times a very resilient child may appear to be ‘unaffected’. The psychological effects may however surface later in life.
Adult survivors of child sexual abuse may have difficulty in maintaining relationships, experience inability to trust close family and friends, develop harmful sexual behaviour or have marital problems.
Shouldn't we protest against only severe forms of CSA?
No. If we tolerate minor forms of abuse such as fondling, hugging, kissing children or exhibitionism then that becomes the norm. Let us have Zero tolerance for CSA.
Will 24 hour surveillance of the child prevent sexual abuse?
No. For one, it is not possible for a single adult to look after a child 24 hours a day. It is much better to empower the child. The child can be taught personal safety, personal space rules, and safe and unsafe touch, just as we teach our children about how to protect the body from heat, cold, fire and injury. Ask the child to come and tell you if anyone ever breaks the body rules.
Won't explaining about personal safety to the child unnecessarily frighten the child?
No. The child will not be frightened if we explain about personal safety as a choice and introduce the concept in a comfortable and non-threatening manner. We can tell the child that “you are the boss of your body. No one can touch you in a way you don’t like (this includes pinching and slapping and hitting etc)”.
Talk especially about the parts covered by the undergarments. How no one can touch them there except to keep them clean and healthy (mother, doctor). Talk about personal space – the space around our body that we consider to be our own. Talk about safe and unsafe touch. You may use a doll to explain to the child.
Children are told about strangers and robbers and kidnappers. Similarly tell them about their body rules and personal space. Do not frighten the child. Explain that most adults want to help and protect children. There are a few ‘bad’ people who want to hurt children. We need to protect ourselves from such people.
If society gets to know of the abuse, won't the child have more to lose than the abuser?
No. The silence of the abused and the people who know about it, is the main reason that sexual abuse continues. By exposing the abuser in a way which does not traumatise the child, helps the child to heal as well as stops other children from being abused. Every one wants to “Look Good” and have a “good” reputation. The criminal has his reputation to lose. The child is a victim, blameless and innocent and will heal faster from the trauma if he / she perceives that justice has been done.
Is Social ostracism of the abuser really a powerful option available to the family of the abused child?
Yes. Social ostracism often works better and faster than legal recourse. It also safeguards other children in the neighbourhood and in the extended family.
Do we have an obligation to protect not only our child, but other children in our community as well?
Yes. If our sister or neighbour knew that the person our child is associating with is an abuser, wouldn’t we expect her to warn us? Similarly should we not inform our relatives, friends and neighbours about an abuser we know of? We don’t need to prove his or her crime in a court of law. We believe our child. We wish to protect our nieces, nephews and the children in our community. We just need to let them know that they need to be aware and careful in the presence of a certain individual who has behaved in a reprehensible manner with a child. We can do this without exposing the identity of the child.
How can I detect a child victim of sexual abuse?
The majority of cases of CSA may go unrecognized unless we are aware and look for signs that may be suggestive of sexual abuse. How abused children can be detected through their behaviour is varied. The way the child presents can be demonstrated by the picture of an iceberg. What is obvious, or comes to the surface is only the tip of the problem.
The following is a pictorial representation of presentation of CSA, developed by Dr Shekhar Seshadri, Child Psychiatrist, NIMHANS, Bangalore, and a co-author of this workbook series. He is one of the first few psychiatrists in India to begin detailed work and research on child sexual abuse.
Obvious abuse:
1. Disclosure by the child
2. Detection (obvious) - pregnancy, child suffering from Sexually Transmitted infections , child having genital injuries
Suspicious of abuse:
_3. Sexualized behaviour, clear hints given by the child__
4. Clear symptoms like depression, post traumatic stress disorder
5. Sudden unexplained change in behaviour - school refusal, people avoidance_
6. Symptom patterns - sudden onset of bed wetting, aches, pains, general ill health
7. Children who do not report, hint or decompensate - because they are resilient,
have been threatened, manipulated etc.
Presentation of Child Sexual Abuse: By Dr Shekhar Seshadri, NIMHANS
When do I suspect child sexual abuse?
1. A change in the social behaviour of the child – a happy child becomes introverted, silent, refuses to participate in group activities. The child may become insecure and cling to a trusted adult, or become excessively fearful. Occasionally the child may become violent, easily enraged. The child tries to avoid coming in contact with a particular person.
2. A change in the personal grooming of the child – neglects personal appearance, deliberately tries to look unhygienic, shabby or unattractive. May begin to wear multiple layers of clothing, inappropriate for the weather.
3. Change in the academic performance, poor concentration, distracted, sleepy (since abuse may cause sleepless nights/ nightmares/ disturbed sleep), lack of interest.
4. Replaying the abuse with another child generally younger or same age as them. This is known as sexualized behaviour.
5. Change in eating habits: Child starts losing weight or may eat excessively, thus putting on weight.
How do children report sexual abuse? How can I encourage my child to report a disturbing incident?
A very small percentage of child victims of sexual abuse actually report it (12%). The reporting is often ambiguous because the young child may not have the vocabulary to explain what has happened or feels too shy to narrate the incident clearly.
You can encourage the child to disclose by accepting and understanding what the child is trying to convey. For example:
How can I probe the issue further if I have a doubt that my child is being abused?
Have a conversation with the child in private, in a casual setting.
1. Ask about the child’s feelings and emotional well being:
Do you feel happy; feel cheerful; feel jittery or restless; feel sad; feel like crying; feel afraid or scared; worry about things; feel, unhappy; feel nervous; feel bothered or upset?
2. Ask about how the child feels about him/herself:
How good or bad do you feel about:
yourself; your school work; your friendships; your body and your looks; the way others (peers and adults) treat you, the way others touch you?
3. You may ask leading questions about personal safety.
Has anyone ever embarrassed you and you did not talk about it with anyone?
Has anyone ever touched you in a way you didn’t like? Has any one – related or unrelated to you, known person or strangers, ever touched you in a way that made you feel uncomfortable / shy / yucky?
4. To make the child feel comfortable and reassured, state:
• I am asking you this because if this happens, you can always come and tell me
• Things that trouble you, need not be kept bottled up inside you.
• Yucky things are best let out.
• The person may tell you that it's all right, no need to tell any one, may try to bribe or even threaten you. But for your safety, it will be best to tell an adult you trust about it.
• You can tell me.
• When an adult or older person troubles (abuses) a child, it is never the child’s fault. The adult or older person is responsible for what they did.
How should I respond if a child confides about abuse?
The best way to respond to the child who has been abused:
• Tell the child you believe her / him.
• Praise the child’s courage in coming and telling you about it. Acknowledge the child’s feelings.
• Tell the child it was not her/ his fault. The adult was at fault. The adult is guilty of a crime – even if the child did not tell when the abuse first started, the child was not responsible for the abuse continuing.
• Tell the child that you would like to take the help of other adults (family members, institutions, staff members) to help the child, with the child’s permission.
• Do not make false promises like “I will send the abuser to jail. I will beat him /her up etc’
• Do not question or blame the child - “Why did you not shout for help?” “Why did you not tell me earlier?” “Why did you not fight?” Remember, it is a child and the abuser is a person known to the child – trusted and loved by the child.
• Do not ask the child to “Forgive” “forget” or “adjust”.
If you feel you are unable to support the child, you can always take the help of a competent, empathetic and trained counselor. In any case, you can always believe, accept and continue to care for the child. Taking the help of mental health professionals – Depending on an assessment of the child’s behaviour, symptoms and coping skills, mental health professionals need to be consulted. Severe symptoms, suspected or apparent self harm behaviour warrant a prompt consultation with a mental health professional with expertise in dealing with victims of child sexual abuse.
What possible strategies can be used to deal with the Abuser?
1. Counseling for the abuser, if repentant and willing
2. Community awareness – informing the abuser’s community about his / her actions. Community action
3. Para legal / quasi legal actions - a third person reporting abuse
4. Legal recourse
Certain basic principles need to be kept in mind while interacting with a child who has experienced sexual abuse:
1. Need for strict confidentiality
2. Best interests of the child.
3. Checks and balances in the reporting and decision making process. Do not hesitate to consult people who have experience in this field.
To sum up, I would like to quote Dr Shekhar Seshadri from his article on Good Practice in Child Sexual Abuse (CSA) Interventions (in AAINA,a mental health advocacy newletter July 2001):
"Child Sexual Abuse is a child issue, a sexuality issue, an abuse issue, a gender issue, a patriarchy issue and a power and domination issue. And good practice means one should be aware of all these dimensions and develop skills to intervene across these issues.
Author:
Dr Sangeeta Saksena, MD (OBG)
Enfold Proactive Health Trust
Facilitator: Life skills, Human Sexuality and Personal Safety programs for school and college students, parents and teachers.
Co author of “On Track” a workbook series on Life skills and Personal safety for school children
Answers to some commonly asked questions about child sexual abuse (CSA).
Is Child sexual abuse common in India?
In 1993 -1994, Samvada, a Bangalore based NGO did a pioneering study in the history of CSA work in India by organizing a series of workshops for 348 girls (15 – 21 yrs old) from 11 schools and colleges in Karnataka.
They found that 47% of the respondents had been molested or had experienced sexual overtures, 15% when they were less than 10 yrs old. 15% had experienced serious sexual abuse, including rape. Of these 31% were less than 10 yrs old when abuse started.
The Ministry of Women and Child Development, Govt of India, Prayas and UNICEF, 2007 reported that out of 12,447 children (hailing from all strata of society), 53% reported sexual abuse. Out of 12,447 children, 21% reported severe sexual abuse.
Many reports (e.g.RAHI) prior to the recent report had indicated that child sexual abuse of girls was high in India. Now it appears that incidence of sexual abuse of boys is also on the rise. 52% of boys and 47% of girls have reported sexual abuse of one form or the other in this study. More boys than girls have reported severe form of sexual abuse.
Does this mean that 50% of our men (or women) are abusers?
No. This is because one abuser abuses many children. In a study in the USA, a convicted abuser had on average, abused 76 children. By exposing the abuser in the society, the abused child’s family can save many children from abuse. Hence it is very important to tell all the family members, friends and neighbours about this person. He/ she may be an influential person or a religious leader – but if he/she is a child abuser, he will not stop unless acted against. Though legal action is a way out, it may take a long time. Talking about this person among the family and neighborhood – “be careful with this person. I have heard that children are not safe with him/her” will keep children around him/her safe.
What is considered child sexual abuse?
Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a child or exploits a child for the purpose of sexual gratification.
Acts considered CSA may be:
Fondling – Touching genitals.
Violations of child’s privacy
Exposing children to adult sexuality
Behavior involving penetration.
Exploitation – giving or receiving money for using a child for sexual gratification.
An adult who engages in sexual activity with a child is performing a criminal and immoral act which can never be considered normal or socially acceptable behavior.
At what age does Child Sexual Abuse start?
One of the youngest victims of sexual abuse was a one and a half months old baby. However, in majority of cases, sexual abuse begins around 5 years of age, peaks at around 12 -14 years of age and then begins to decline (as per the Govt. report). It can, however, continue into adulthood.
Why do children keep quiet about CSA? How does CSA continue?
Children don’t talk about the abuse because they feel they won’t be believed, that they will be blamed for it or because they don’t want the family to break up. Often the abuser is a family member or is very close to the family. As the child has grown up loving and trusting that person, the person starts 'grooming' the child for sexual abuse by touching him/ her in an 'unsafe' way. The family remains unaware of this and the child feels confused.
If the family has brought up the child to think that anything to do with the reproductive tract is "dirty' or "shameful" the child will find it very difficult to report the grooming process. In the mean time the abuse continues and becomes more severe. The child now feels trapped and thinks 'I did not tell anyone when it first started. How can I tell now? Every one will blame me for not resisting or not telling earlier. Anyhow, I feel too ashamed to explain all this to my mother/ parent/ teacher. May be it will stop." The abuser, emboldened by the silence, goes ahead. He / she also uses bribes, threats, secrecy, promises, blackmail and emotional manipulation to keep the child from telling anyone.
A child’s brain is pitted not just against an adult brain of the abuser, but also against the silence and shame built around the current social perceptions of sexuality. The child can win only with the support of the family members, in a society that accepts and respects each individual's personhood and sexuality.
In some instances, the child informs the parents in a round about way or directly, and the child is either not fully understood or not believed or simply denied protection. CSA therefore continues.
If we don’t make a fuss about the abuse, won't the child forget it?
Children do not forget abuse. It remains with them and affects their behaviour and personality in many ways. In the present it can result in falling academic performance and a lack of interest in activities the child used to enjoy earlier
It may cause the child to become excessively sexualized in his or her behaviour, or it may cause the child to dislike themselves. The child may start keeping the body dirty and unattractive, wearing many clothes or baggy clothes to avoid attracting attention.
The adolescent may start behaving aggressively or become totally submissive. At times a very resilient child may appear to be ‘unaffected’. The psychological effects may however surface later in life.
Adult survivors of child sexual abuse may have difficulty in maintaining relationships, experience inability to trust close family and friends, develop harmful sexual behaviour or have marital problems.
Shouldn't we protest against only severe forms of CSA?
No. If we tolerate minor forms of abuse such as fondling, hugging, kissing children or exhibitionism then that becomes the norm. Let us have Zero tolerance for CSA.
Will 24 hour surveillance of the child prevent sexual abuse?
No. For one, it is not possible for a single adult to look after a child 24 hours a day. It is much better to empower the child. The child can be taught personal safety, personal space rules, and safe and unsafe touch, just as we teach our children about how to protect the body from heat, cold, fire and injury. Ask the child to come and tell you if anyone ever breaks the body rules.
Won't explaining about personal safety to the child unnecessarily frighten the child?
No. The child will not be frightened if we explain about personal safety as a choice and introduce the concept in a comfortable and non-threatening manner. We can tell the child that “you are the boss of your body. No one can touch you in a way you don’t like (this includes pinching and slapping and hitting etc)”.
Talk especially about the parts covered by the undergarments. How no one can touch them there except to keep them clean and healthy (mother, doctor). Talk about personal space – the space around our body that we consider to be our own. Talk about safe and unsafe touch. You may use a doll to explain to the child.
Children are told about strangers and robbers and kidnappers. Similarly tell them about their body rules and personal space. Do not frighten the child. Explain that most adults want to help and protect children. There are a few ‘bad’ people who want to hurt children. We need to protect ourselves from such people.
If society gets to know of the abuse, won't the child have more to lose than the abuser?
No. The silence of the abused and the people who know about it, is the main reason that sexual abuse continues. By exposing the abuser in a way which does not traumatise the child, helps the child to heal as well as stops other children from being abused. Every one wants to “Look Good” and have a “good” reputation. The criminal has his reputation to lose. The child is a victim, blameless and innocent and will heal faster from the trauma if he / she perceives that justice has been done.
Is Social ostracism of the abuser really a powerful option available to the family of the abused child?
Yes. Social ostracism often works better and faster than legal recourse. It also safeguards other children in the neighbourhood and in the extended family.
Do we have an obligation to protect not only our child, but other children in our community as well?
Yes. If our sister or neighbour knew that the person our child is associating with is an abuser, wouldn’t we expect her to warn us? Similarly should we not inform our relatives, friends and neighbours about an abuser we know of? We don’t need to prove his or her crime in a court of law. We believe our child. We wish to protect our nieces, nephews and the children in our community. We just need to let them know that they need to be aware and careful in the presence of a certain individual who has behaved in a reprehensible manner with a child. We can do this without exposing the identity of the child.
How can I detect a child victim of sexual abuse?
The majority of cases of CSA may go unrecognized unless we are aware and look for signs that may be suggestive of sexual abuse. How abused children can be detected through their behaviour is varied. The way the child presents can be demonstrated by the picture of an iceberg. What is obvious, or comes to the surface is only the tip of the problem.
The following is a pictorial representation of presentation of CSA, developed by Dr Shekhar Seshadri, Child Psychiatrist, NIMHANS, Bangalore, and a co-author of this workbook series. He is one of the first few psychiatrists in India to begin detailed work and research on child sexual abuse.
Obvious abuse:
1. Disclosure by the child
2. Detection (obvious) - pregnancy, child suffering from Sexually Transmitted infections , child having genital injuries
Suspicious of abuse:
_3. Sexualized behaviour, clear hints given by the child__
4. Clear symptoms like depression, post traumatic stress disorder
5. Sudden unexplained change in behaviour - school refusal, people avoidance_
6. Symptom patterns - sudden onset of bed wetting, aches, pains, general ill health
7. Children who do not report, hint or decompensate - because they are resilient,
have been threatened, manipulated etc.
Presentation of Child Sexual Abuse: By Dr Shekhar Seshadri, NIMHANS
When do I suspect child sexual abuse?
1. A change in the social behaviour of the child – a happy child becomes introverted, silent, refuses to participate in group activities. The child may become insecure and cling to a trusted adult, or become excessively fearful. Occasionally the child may become violent, easily enraged. The child tries to avoid coming in contact with a particular person.
2. A change in the personal grooming of the child – neglects personal appearance, deliberately tries to look unhygienic, shabby or unattractive. May begin to wear multiple layers of clothing, inappropriate for the weather.
3. Change in the academic performance, poor concentration, distracted, sleepy (since abuse may cause sleepless nights/ nightmares/ disturbed sleep), lack of interest.
4. Replaying the abuse with another child generally younger or same age as them. This is known as sexualized behaviour.
5. Change in eating habits: Child starts losing weight or may eat excessively, thus putting on weight.
How do children report sexual abuse? How can I encourage my child to report a disturbing incident?
A very small percentage of child victims of sexual abuse actually report it (12%). The reporting is often ambiguous because the young child may not have the vocabulary to explain what has happened or feels too shy to narrate the incident clearly.
You can encourage the child to disclose by accepting and understanding what the child is trying to convey. For example:
How can I probe the issue further if I have a doubt that my child is being abused?
Have a conversation with the child in private, in a casual setting.
1. Ask about the child’s feelings and emotional well being:
Do you feel happy; feel cheerful; feel jittery or restless; feel sad; feel like crying; feel afraid or scared; worry about things; feel, unhappy; feel nervous; feel bothered or upset?
2. Ask about how the child feels about him/herself:
How good or bad do you feel about:
yourself; your school work; your friendships; your body and your looks; the way others (peers and adults) treat you, the way others touch you?
3. You may ask leading questions about personal safety.
Has anyone ever embarrassed you and you did not talk about it with anyone?
Has anyone ever touched you in a way you didn’t like? Has any one – related or unrelated to you, known person or strangers, ever touched you in a way that made you feel uncomfortable / shy / yucky?
4. To make the child feel comfortable and reassured, state:
• I am asking you this because if this happens, you can always come and tell me
• Things that trouble you, need not be kept bottled up inside you.
• Yucky things are best let out.
• The person may tell you that it's all right, no need to tell any one, may try to bribe or even threaten you. But for your safety, it will be best to tell an adult you trust about it.
• You can tell me.
• When an adult or older person troubles (abuses) a child, it is never the child’s fault. The adult or older person is responsible for what they did.
How should I respond if a child confides about abuse?
The best way to respond to the child who has been abused:
• Tell the child you believe her / him.
• Praise the child’s courage in coming and telling you about it. Acknowledge the child’s feelings.
• Tell the child it was not her/ his fault. The adult was at fault. The adult is guilty of a crime – even if the child did not tell when the abuse first started, the child was not responsible for the abuse continuing.
• Tell the child that you would like to take the help of other adults (family members, institutions, staff members) to help the child, with the child’s permission.
• Do not make false promises like “I will send the abuser to jail. I will beat him /her up etc’
• Do not question or blame the child - “Why did you not shout for help?” “Why did you not tell me earlier?” “Why did you not fight?” Remember, it is a child and the abuser is a person known to the child – trusted and loved by the child.
• Do not ask the child to “Forgive” “forget” or “adjust”.
If you feel you are unable to support the child, you can always take the help of a competent, empathetic and trained counselor. In any case, you can always believe, accept and continue to care for the child. Taking the help of mental health professionals – Depending on an assessment of the child’s behaviour, symptoms and coping skills, mental health professionals need to be consulted. Severe symptoms, suspected or apparent self harm behaviour warrant a prompt consultation with a mental health professional with expertise in dealing with victims of child sexual abuse.
What possible strategies can be used to deal with the Abuser?
1. Counseling for the abuser, if repentant and willing
2. Community awareness – informing the abuser’s community about his / her actions. Community action
3. Para legal / quasi legal actions - a third person reporting abuse
4. Legal recourse
Certain basic principles need to be kept in mind while interacting with a child who has experienced sexual abuse:
1. Need for strict confidentiality
2. Best interests of the child.
3. Checks and balances in the reporting and decision making process. Do not hesitate to consult people who have experience in this field.
To sum up, I would like to quote Dr Shekhar Seshadri from his article on Good Practice in Child Sexual Abuse (CSA) Interventions (in AAINA,a mental health advocacy newletter July 2001):
"Child Sexual Abuse is a child issue, a sexuality issue, an abuse issue, a gender issue, a patriarchy issue and a power and domination issue. And good practice means one should be aware of all these dimensions and develop skills to intervene across these issues.
Author:
Dr Sangeeta Saksena, MD (OBG)
Enfold Proactive Health Trust
Facilitator: Life skills, Human Sexuality and Personal Safety programs for school and college students, parents and teachers.
Co author of “On Track” a workbook series on Life skills and Personal safety for school children
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