[Child sexual abuse and sexually transmitted infections in sub-saharan Africa]

Recently there has been increasing public concern regarding escalating child sexual abuse (CSA) in the sub-Saharan Africa. Medical consequences of child sexual abuse (CSA) include sexually transmitted infection (STI) and human immune virus (HIV) infection. The purpose of the study was to review literature on CSA and associated STI/HIV in the sub-Saharan Africa. The study covered the 23-year period from 1980 to 2003. The mean age of the child victims was 8 years. The incidence of penetrative sex in the studies ranged from 70 to 97%. Physical signs of CSA included genital or anal injuries, perineal trauma, and vesico-vaginal or recto-vaginal fistula. The incidence of STD varied according to whether the study was retrospective or prospective. Ten percent to 67% of children with STD had been sexually abused while 15 to 30% of sexual abuse incidents were associated with STD. The prevalence of HIV ranged from 3% in Togo to 37.5% in Cameroon. Most alleged child abusers were adult males known by the child, i.e., family members (30-60%), instructors or teachers, household personnel or neighbours. Some acts were motivated by traditional practices such as early, forced marriage and beliefs such as presumed benefits of sex with virgin children (cure for STI/HIV/STD, magic powers or wealth). This study shows that CSA is widespread throughout sub-Saharan Africa. Most problem involving CSA in sub-Saharan Afica have not been documented. Knowledge about the extent and special aspects of CSA in Africa can be useful for implementation of suitable management measures.