ADVOCATES FOR YOUTH

The Facts

Child Sexual Abuse II: A Risk Factor for HIV/STDs and Teen Pregnancy

Until the early 1970's child sexual abuse was thought to be rare, and centered among the poor. Experts now agree that child sexual abuse has always occurred and still exists in all socio-economic groups. Increased public awareness has led to greater reporting; from 1970 to 1990, child sexual abuse reports increased more than other categories of neglect or abuse.¹ Despite this gain, child sexual abuse still remains vastly under-reported.

Children and adolescents who have been sexually victimized are at increased risk for HIV infection, unplanned pregnancy and other negative outcomes. Unfortunately, the personal skills needed to prevent sexually-transmitted diseases and unintended pregnancy are exactly those eradicated by sexual abuse. People who work with youth must be aware of the possible connection; sexual abuse prevention must be a component of any program promoting adolescent reproductive and sexual health.

Child Sexual Abuse Is Serious and Wide-Spread.

• The American Medical Association defines child sexual abuse as "the engagement of a child in sexual activities for which the child is developmentally unprepared and cannot give informed consent."² Child sexual abuse is characterized by deception, force or coercion.³
• The National Resource Council estimates the percent of the U.S. population which has been sexually abused to range from a low of 20-24 percent to a high of 54-62 percent of the population; the higher estimate includes sexualized exposure without touching.¹ The largest retrospective study on the prevalence of child sexual abuse found 27 percent of women and 16 percent of men reported abuse.⁴
• Studies examining victimization of boys have recorded rates ranging from 3 to 31 percent of all men.¹ Male victimization is particularly hard to estimate due to beliefs that only girls can be abused; that sex between older women and boys is desirable; that male victimization of boys indicates lack of masculinity and/or acquiescence by the child.⁸
• Child sexual abuse often negatively effects long-term psychological and social well-being, although more than half of all sexual abuse survivors do not suffer the most extreme forms of psychiatric trauma.¹⁰
• Psychological and behavioral effects of child sexual abuse may include low self-esteem, depression, anxiety, fear, hostility, chronic tension, eating disorders, sexual dysfunction, self-destructive or suicidal behavior, post traumatic stress disorder, dissociation, multiple personality disorder, repeat victimization, running away, criminal behavior, academic problems, substance abuse and prostitution.^{1,3,8,17,19,23}
• Sexual abuse survivors are at higher risk for mental health and social functioning problems resulting from feelings of powerlessness, guilt, shame, stigmatization and low self-esteem.^8,9 Powerlessness damages coping skills and reduces ability to protect oneself from further abuse.⁸

Survivors Face Increased Risk for HIV/STD Infection and Unintended Pregnancy.

• Risk factors for STD infection include age of first intercourse, number of partners, use of safer sex practices and treatment services.¹⁸ Pregnant teens are often described as having low self efficacy and self esteem, as well as feelings of powerlessness and alienation.⁹ These risk factors overlap with those for child sexual abuse. Some teens intentionally become pregnant to escape abuse; pregnancy and STD infection may also caused by the offender, or be an indirect consequence of abuse.⁹
• Sexual abuse survivors are more likely to participate in activities that increase their risk for unintended pregnancy and infection with HIV and other STDs.^9,19,20 Youth who run away or are forced out of the home are especially vulnerable because of their participation in survival sex, prostitution and/or drug use.¹⁵
• Several studies indicate more than half of all sex workers are sexual abuse survivors.⁸ Sex workers are at great risk for pregnancy and STDs due to their high number of partners. One study found sexual abuse survivors were over four times more likely to have worked as prostitutes than their nonabused peers. Male sexual abuse survivors were eight times more likely to have worked as prostitutes.¹⁹
• A recent study asked pregnant teens if they had exchanged sex for drugs, shelter or money. Eighty-nine percent of those exchanging sex for one item on this list were sexual abuse survivors. Of those exchanging sex for two items, 93 percent were survivors. One hundred percent of the teens that had exchanged sex for drugs, shelter and money were survivors.⁹
• Sexual abuse survivors often begin voluntary sexual relationships earlier and have sex more often, increasing the risk for pregnancy.²¹ Compared to non-abused girls, sexual abuse survivors in one study began sexual intercourse a year earlier and were more likely to experience repeat pregnancies.⁹
• Compared to those without a sexual abuse history, sexual abuse survivors were twice as likely to have multiple sex partners and reported a 40 percent increased rate of having had sex with a stranger.¹⁹
• Studies of pregnant adolescents indicate a high rate of sexual victimization. Sexual abuse survivors are significantly more likely to become pregnant before age 18 than are their than non-abused peers.⁹ Other surveys of pregnant or parenting teens found half to two-thirds reported sexual abuse histories.^7,9,19
• Sexual abuse survivors frequently manage their emotional pain through alcohol and/or drug use.⁸ The use of alcohol and drugs inhibits safer sex practices and effective contraception. One study found sexual abuse survivors had a 70 percent rate of excessive tranquilizer and alcohol use compared to nonabused peers.¹⁹ Another found that abused teens and their partners were more than twice as likely to have used drugs or alcohol at the time of conception than non-abused teens.⁹
• HIV infection can occur from sexual abuse. A study of HIV-infected 3 to 17-year olds found one-seventh had been abused. Of this group, sexual abuse was the proven cause of infection in 29 percent.¹³ Half of the abused group had been assaulted by multiple perpetrators and 57 percent lived in homes with a transient adult population suggesting (but not confirming) sexual abuse as the transmission route.¹³
• Many more sexual abuse survivors contract HIV through risky behaviors. In a recent study of HIV-infected 12-20 year olds, 41 percent reported a sexual abuse history. Five percent were infected through blood transfusions and 3 percent were infected by the abuser. The rest acquired HIV from multiple sexual partners, intravenous drug use and prostitution subsequent to the abuse.²⁰
• Three overlapping groups with a high number of abuse survivors are at increased risk for HIV infection: runaways, homeless and emotionally disturbed adults.²² One study found male sexual abuse survivors had twice the HIV-infection rate of non-abused males and another found 65 percent of HIV-infected participants reported physical and/or sexual abuse histories.^19,22
• Pregnancy and STD prevention programs use skills-oriented approaches to sexual decision-making and contraceptive use. Unfortunately, abuse survivors who do not care if they live or die, and who believe they cannot affect what happens to them, have difficulty making choices and taking action to prevent negative sexual outcomes.⁹ Prevention programs must recognize that the skills needed to protect against HIV and unintended pregnancy are exactly those eradicated by sexual abuse.²²

References

1. National Research Council, Understanding Child Abuse and Neglect, Washington, DC: National Academy Press, 1993.
2. American Medical Association, Diagnostic and Treatment Guidelines on Child Sexual Abuse, Chicago: AMA, March, 1992.
3. Jon R. Conte, A Look At Child Sexual Abuse, National Committee for Prevention of Child Abuse, 1986.
4. The National Resource Center on Child Sexual Abuse, "Fact Sheet on Child Sexual Abuse," Hunstsville: NRCCSA, 1994.
5. Christine Courtois, Healing the Incest Wound: Adult Survivors in Therapy, WW Norton & Co, New York, 1988. 
6. The National Resource Center on Child Sexual Abuse, "The Incidence and Prevalence of Child Sexual Abuse," Hunstsville: NRCCSA, 1994.
7. "Sexual Abuse in Teens Common: What Is the Clinicians Role?" Contraceptive Technology Update, vol. 9, no. 11, November 1988.
8. David Finkelhor et al, A Sourcebook on Child Sexual Abuse, Newbury Park: Sage Publications, 1986.
9. Debra Boyer and David Fine. "Sexual Abuse as a Factor in Adolescent Pregnancy and Child Maltreatment." Family Planning Perspectives. vol. 24, no. 1, Jan 1992. 
10. David Finkelhor, Gerald Hotaling and Kerti Yllo, Stopping Family Violence: Research Priorities in the Coming Decade. Newbury Park: Sage Publications, 1988.
11. Laura Gonzalez, et al, "Children's Patterns of Disclosures and Recantations of Sexual and Ritualistic Abuse Allegations in Psychotherapy," Child Abuse and Neglect, vol. 17, No. 2, November 1993.
12. Dick Sobsey, "What We Know About Abuse and Disabilities," NRCCSA News, National Resource Center on Child Sexual Abuse, Nov/Dec 1992.
13. Laura Gutman et al, "Human Immunodeficiency Virus Transmission by Child Sexual Abuse," American Journal of Diseases of Children, vol. 145, Feb 1991.
14. M. Richardson, W. Meredith and D. Abbot, "Sex-Typed Role in Male Adolescent Sexual Abuse Survivors," Journal of Family Violence, vol. 8, no. 1, 1993.
15. Ritch Savin-Williams, "Verbal and Physical Abuse as Stressors in the Lives of Lesbian, Gay Male and Bisexual Youths: Associations with School Problems, Running Away, Substance Abuse, Prostitution and Suicide," Journal of Consulting and Clinical Psychology, vol. 62, no. 2, 1994.
16. "Massive Effects on Sex Life of Sex Abuse of Boys," Sexuality Today, vol. 8, no. 29, July 15, 1985.
17. Gregory Murray et al, "History of Childhood Sexual Abuse in Women with Depressive and Anxiety Disorders: A Comparative Study," Journal of Sex Education and Therapy, vol. 19, no. 1, 1993.
18. John Santelli, "Risk Factors for Adolescent Sexual Behavior, Fertility and STDs." Journal School Health, vol. 62, no. 7, Sept. 1992.
19. Sally Zierler et al, "Adult Survivors of Child Sexual Abuse and Subsequent Risk of HIV Infection," American Journal of Public Health, vol. 81, no. 5, May 1991.
20. Anthony Dekker et al, "The Incidence of Sexual Abuse in HIV Infected Adolescents and Young Adults." Journal of Adolescent Health Care. vol. 11, no. 3, May, 1990.
21. Denise Polit et al, "Child Sexual Abuse and Premarital Intercourse Among High-Risk Adolescents," Journal of Adolescent Health Care, vol. 11, no. 3, May 1990.
22. Christopher Allers et al, "HIV Vulnerability and the Adult Survivor of Child Sexual Abuse," Child Abuse and Neglect, vol. 17, no. 2, Nov. 1993.
23. Eva Deykin and Stephen Buka, "Suicidal Ideation and Attempts Among Chemically-Dependent Adolescents," American Journal of Public Health, vol. 84, no. 4, April, 1994.
24. Patrick Langan and Caroline Wolf Harlow, "Child Rape Victims, 1992," Crime Data Brief, U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 1994.

Compiled by Susan K. Flinn
January 1995 © Advocates for Youth

Click here to view the Publications Catalog and/or to order this publication.