Sexual abuse of human immunodeficiency virus-positive children. Outcomes for perpetrators and evaluation of other household children
L. T. Gutman, K. K. St Claire, C. Weedy, M. Herman-Giddens and R. E. McKinney Jr
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710.
OBJECTIVE--To obtain the following data that pertain to programs for the
prevention of sexual abuse and sexual transmission of human
immunodeficiency virus (HIV) to children: (1) to determine the prevalence
of sexual abuse among siblings and other children cohabiting with sexually
abused HIV-positive children, and (2) to determine if programs designed to
restrain identified perpetrators from further acts of child sexual abuse
were instituted. DESIGN--Case series. SETTING--Households of previously
described sexually abused HIV-infected children. PATIENTS AND OTHER
PARTICIPANTS--Twenty-two siblings or other children who lived in the homes
of 14 previously described HIV-infected sexually abused children. Eight
perpetrators of the abuse were identified. MAIN OUTCOME MEASURES--Sexual
abuse of cohabiting children was confirmed with disclosure interviews,
witness by other persons, diagnosis of another sexually transmitted
disease, or an abnormal physical examination result that was highly
suggestive of sexual abuse. Telephone contact with the Department of Social
Services, county sheriff or police, and district attorney provided data
regarding reports, criminal indictments, trials, convictions, and
plea-bargain arrangements for the identified perpetrators. RESULTS--Eleven
(50%) of the 22 cohabiting children were confirmed to have been sexually
abused and four (18%) were suspected of having been sexually abused. Seven
(32%) of the cohabiting children could not be examined and it was not known
if they had been sexually abused. No assailant was tried for a criminal
offense, required to participate in offender therapy, or prohibited from
unsupervised visitation of children. CONCLUSION--Programs for the
prevention of sexual abuse and sexual transmission of HIV to children
require means of ensuring the safety of children exposed to perpetrators
and require adequate supervision of perpetrators and their adherence to
therapy.
