**1.1 Definition of Child Sexual Abuse**

Child sexual abuse (CSA) is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violate the laws or social taboos of society (Faller 1988,Kempe 1978, Sedlak & Broadhurst 1996, Sgroi 1988).

CSA is evidenced by an activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person(Kempe 1978, Sgroi 1988). The sexual act can be divided into penetrative and non-penetrative and this may include but is not limited to the following;

Child sexual abuse includes:


Risk Factors in Sexually Abused

**1.4 Definition of a child** 

**1.5 Prevalence of Child Sexual Abuse in Zambia** 

(UTH).

been evaluated.

1998).

acquisition (Chomba et al 2006).

extent of the problem.

Children Reporting to the One Stop Centre at University Teaching Hospital in Zambia 115

CSA is not limited to the categories itemized above. It happens in any forum or society. It

There are multiple definitions of a child in the Zambian laws and these create disparities in interpretation. In the context of One Stop Centre (OSC) children are defined as those aged 16 years and below in keeping with the medical definition at the University Teaching Hospital

Zambia is a country in sub-Saharan Africa where the problem of CSA is compounded by HIV prevalence of 19.7 % in urban adults compared 10.3% in rural adults (p<0.00001)(ZHDS 2007). There are no studies on the prevalence of CSA in Zambia. The OSC was established

UTH houses the only medical school in the country and the schools of Registered Nurses and Midwifery. The paediatric department is the busiest deparment within the UTH catering mainly for management of the aqcutely ill. Most of the children before the establishment of the OSC were cared for at the department of obsterics and gynaecology. Though there is significant emphasis on prevention of mother to child HIV transmission in Zambia, HIV transmission through CSA had been a neglected issue. The contribution of CSA to the HIV pandemic remains unknown. However, the impact of HIV on children has

Children have been much affected by the HIV/AIDS epidemic in Zambia, where over 30,000 children are HIV positive (UNAIDS Report 2007). Perinatal transmission accounts for the majority of pediatric HIV infections where HIV prevalence is high. However, sexual exposure remains an important risk factor in children in the post-weaning period. While HIV transmission rates attributable to sexual abuse are unknown, pediatric victims of sexual abuse are at a higher risk of HIV transmission due to physical trauma and due to the fact that multiple exposures often occur prior to discovery of the abuse (Lindegren ML et al

In a pilot study conducted at the UTH in 2003, 99% of sexually abused children reporting to the gynecology ward were female, which also placed them at a higher risk for HIV

Although epidemiologic data for the prevalence of child sexual abuse (CSA) in Zambia is not available (Collings 2002), recent establishment of one stop centres will help in providing some information on factors associated with child sexual abuse thus help to unravel the

Literature from countries surrounding Zambia documents the existence of a CSA epidemic in the region. Prevalence studies rely on cross-sectional study design, most often surveying school children about their experiences of sexual abuse. In a review article of child sexual abuse in sub-Saharan Africa, Lalor et.al. report that between 3.2 and 7.1% of all respondents

specifically to offer post exposure HIV prophylaxis to children sexually abused.

Lusaka is the capital of Zambia with a population of close to 2 million (ZHDS 2007).

exists amongst the rich and the poor, the highly educated people and the illiterates.

#### **1.2 Other definition of sexual abuse**


#### **1.3 Risk factors in Child Sexual Abuse**

CSA has been in existence since time immemorial. CSA occurs in all societies as well as all social structures. It has been difficult to quantify the magnitude of CSA grobally including Zambia as most cases go unreported. There are a number of factors that make children vulnerable to sexual abuse. The key determinants are:

	- Zambia has one of the largest numbers of AIDS orphans in the world. This is estimated to be a total of 1,100,000 orphan of which two thirds of these orphans are AIDS orphans (Central Statistics Office – Lusaka)
	- Orphans are taken into foster home or orphanages where it is not uncommon to be sexually abused. Some may be taken in by relatives or find themselves in childheaded homes and are often forced to trade sex for money, food or abused by their caretakers

CSA is not limited to the categories itemized above. It happens in any forum or society. It exists amongst the rich and the poor, the highly educated people and the illiterates.

### **1.4 Definition of a child**

114 Sexual Abuse – Breaking the Silence

 RAPE happens when a person has sex that he or she did not agree to. It includes intercourse in the vagina, anus or mouth. Sometimes it happens when aone person

STATUTORY RAPE is sexual intercourse with a girl under the age set down by the law

 INCEST means the performance of any sexual act between persons who are forbidden by law to marry because they are family members. It applies not only to biological family members, but also to sexual acts between stepparents and stepchildren or

FELATIO is penal satisfaction by licking or sucking with the mouth and tongue (oral

 INDECENT ASSAULT is assault involving the sexual organs. It includes such actions as forced oral or anal sex, fondling, and attempted rape such actions as forced oral or anal

CSA has been in existence since time immemorial. CSA occurs in all societies as well as all social structures. It has been difficult to quantify the magnitude of CSA grobally including Zambia as most cases go unreported. There are a number of factors that make children

 Zambia has one of the largest numbers of AIDS orphans in the world. This is estimated to be a total of 1,100,000 orphan of which two thirds of these orphans are

 Orphans are taken into foster home or orphanages where it is not uncommon to be sexually abused. Some may be taken in by relatives or find themselves in childheaded homes and are often forced to trade sex for money, food or abused by their

Female sex - The most common cases of CSA in Zambia are that of a girl child by an

 Broken homes have been well documented in the United States as an important risk factor for child sexual victimization. In Zambia, loss of one parent has resulted in

Children whose parents suffer from mental illness or drug dependency have an

 War/ armed conflicts: Sexual abuse has been reported to be rampant communities engaged in wars and armed conflicts. Zambia is surrounded by neighbours who have had armed conflicts and resulting in setting up of these camps within the Zambian

Children who are mentally impaired are more likely to be sexually and the abuse not be

adult man or with a few between an adult woman with an under aged boy

HIV pandemic resulting in loss of parent has children into prostitution

forces another to have sex. Rape can happen to men and women.

(16 years for girls and 14 for boys in Zambia) with his/her consent.

**1.2 Other definition of sexual abuse** 

adopted children and their parents.

SODOMY is anal sexual intercourse

sex, fondling, and attempted rape.

**1.3 Risk factors in Child Sexual Abuse** 

caretakers

borders.

increase of repoted cases of CSA.

increased risk of being sexually abused.

detected until the child presents with pregnancy.

vulnerable to sexual abuse. The key determinants are:

Increased number of orphans has a big impact on the increase of CSA.

AIDS orphans (Central Statistics Office – Lusaka)

sex).

There are multiple definitions of a child in the Zambian laws and these create disparities in interpretation. In the context of One Stop Centre (OSC) children are defined as those aged 16 years and below in keeping with the medical definition at the University Teaching Hospital (UTH).
