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This article is a revision of a 1983 position paper of the Society for Adolescent Medicine with inclusion of the newest medical advances in research on adolescent sexuality; i.e., contraceptive compliance, promotion of behavior change, relationships of ethnicity and pregnancy, and male reproductive health. The issues for the 1990's will be sexually transmitted diseases' morbidity and mortality. Topics identified are sexual activity and adolescent pregnancy, care of the pregnant teen, sexually transmitted diseases, HIV infection, the male adolescent, sexual abuse in adolescents, gay and lesbian youth, interventions, reproductive health care of adolescents with disabilities and chronic illnesses, and training of primary care physicians. The HIV/AIDS epidemic has focused attention on the reproductive behavior of males. Sexual activity varies by racial/ethnic group. Interventions to delay sexual initiation needs to be examined, although condom use has increased among 17-19 year olds from 21% to 58% in metropolitan areas. However condom use is lowest among the group of men at highest risk of STDs: those who had ever used drugs, those who had ever had sex with a prostitute, and those that had 5 or more partners/year. Male beliefs about contraception have been infrequently examined. There are misconceptions about heterosexual transmission of HIV. Better screening is needed for STD detection. Fathers are more involved in prenatal care and postnatal intervention programs. 7% of children have been subjected to nonvoluntary sexual intercourse between the ages of 18-21. ; i.e., 12.7% of white women, 9% of black women, 1.9% of white males, and 6.1% of black males. Risk factors for white women were living apart form parents at 16 years, poverty, physical and emotional limitations, parental alcohol and smoking and drug use. Sexual assault was associated with hitchhiking and alcohol and drug use in 1 study cited. Physicians need to be sensitive to this issue and probe for information. The sexual needs of those unsure of orientation or who a re homosexual or lesbian are gradually becoming recognized. Among 12th graders. 1% of males and 1% of females viewed themselves as mostly or completely homosexual or lesbian, and 10% were unsure. Psychological and medical problems are encountered. Interventions needed are reproductive and STd information, multiple approaches in a variety of settings, adolescent clinics, and outreach.
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PMID:Society for Adolescent Medicine Position Paper on Reproductive Health Care for Adolescents. 183 15

During 1987-1989, 14 (14.6%) of the 96 children who tested positive for the human immunodeficiency virus (HIV) and were followed up by the Duke University (Durham, NC) pediatric acquired immunodeficiency syndrome team were confirmed to have been sexually abused. Every sexually abused child was evaluated for each of five modes of HIV transmission, and in nine children the pathway was identified. Four of the study children acquired HIV from child sexual abuse and in six, abuse was a possible source. Transmission by child sexual abuse was the most frequent of the proven modes of acquisition of HIV in this population. The other proven modes of acquisition were vertical transmission (n = 3) and HIV-contaminated blood transfusion (n = 2). Twelve males were identified (n = 8) or suspected (n = 4) of being perpetrators. Three knew themselves to have HIV at the time of an assault and eight were aware that the child had HIV at the time of an assault. There was no indication from any child that "safe sex" precautions had been observed. Children with HIV infection had multiple risk factors for abuse or neglect. The sociological descriptors of the lives of the 14 abused children showed multiple known risk factors for sexual abuse that also overlapped with known risk factors for or sequelae of the acquisition of HIV infection. These included drug abuse and alcoholism in the home, prostitution of a parent, lack of parenting, poverty, and chronic illness of the child. Prevention efforts should recognize that children as well as adults are at risk for sexually transmitted HIV infection.
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PMID:Human immunodeficiency virus transmission by child sexual abuse. 185 16

The diagnosis of suspected sexual abuse is nearly always based on a description of abuse provided by the child. The physician should invite a child to describe his or her sexual victimization in detail if such a "disclosure" interview has not already occurred, if the child seems ready to describe the abuse, and if a child protective services worker has not yet been notified of the suspected abuse. If an allegedly abused child has already been carefully interviewed, however, the physician should instead obtain information from the child's parents or other appropriate adults to determine how best to address the questions being raised. Nonspecific behavioral or somatic complaints unaccompanied by a specific description of sexual abuse should generate a differential diagnosis for further investigation. The goals of the physical examination of the sexually abused child are to identify abnormalities that warrant further diagnostic efforts or treatment, to obtain specimens to screen the patient for sexually transmitted infections, and to make observations and take specimens that may corroborate the patient's history of victimization. These goals should be met in the context of a standard, complete physical examination. The advisability of postcoital contraception should be discussed with every postmenarcheal victim seen within 72 hours after a rape. Because gonorrhea and chlamydial infections are the most prevalent STDs seen after sexual abuse and are often asymptomatic, universal screening for these infections is recommended. Parents of all abused children should be given an opportunity to make an informed choice about HIV screening. Because the risk of acquiring STDs is low, routine antibiotic prophylaxis is not recommended for sexually abused children. Physicians must report all cases of suspected sexual abuse to states' child protective services agencies. Failure to do so can incur legal penalties. Reporting sexual assaults of children to local law enforcement officials is strongly advised. The long-term impact of sexual abuse on children's psychological adjustment is unpredictable. In the short term, children's circumstances vary widely. Some show no evidence of psychological distress. Others have severe, pervasive difficulty. Office counseling by the empathetic and knowledgeable primary care physician, short-term crisis counseling, a more formal psychological evaluation, and longer-term psychotherapy may be recommended for individual children, depending on the nature and severity of each child's symptoms, his or her parents' preference, and the availability of services in the child's community.
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PMID:The medical evaluation of the sexually abused child. 219 18

This article focuses on the detection and management of sexual assault and sexually transmitted diseases (STDs) in adults and children. Sexual assault is a violent crime affecting both men and women and children of all ages. Sexual abuse can take many forms with rape being the most common form of sexual assault among adults. Among children, sexual assault ranges from fondling to oral and genital contact. Studies showed that the rates of gonorrhea and syphilis in adult victims range from 6% to 12% and from 0% to 3%, respectively. As to other STDs, the risk of acquiring Chlamydia trachomatis infection appears highest. Although the general prevalence of STDs among abused children remained low, studies indicated that gonococcal and chlamydial infections are frequent in this group. Moreover, post-assault infections with herpes simplex viruses, hepatitis B viruses, and HIV have been described in both adults and children. Due to the risk of STDs, prompt, sensitive, and competent care for assaulted victims is necessary which include an evaluation for STDs right after the assault and during follow-up. For adult victims, treatment should be given during the initial evaluation for any infections identified at that time. Treatment of abused children follows the same principles as treatment of adult victims but drug dosage is adjusted depending on body weight.
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PMID:Sexual assault and sexually transmitted diseases: detection and management in adults and children. 220 Oct 79

The incidence of human immunodeficiency virus (HIV) infection acquired by children through sexual abuse is presently unknown. A telephone survey of 63 practitioners of pediatric sexual abuse (PSA) assessment in the five U.S. regions with highest prevalence of HIV infection was conducted to determine the present status of guidelines for HIV antibody testing of PSA victims. No formal protocol was used by any of those surveyed, and a literature review found no existing guidelines for HIV antibody testing of PSA victims. A standard set of clinical situations was presented to practitioners to assess whether a consensus exists of indications for HIV antibody testing of abused children. Seven clinical profiles with 12 criteria were presented including HIV antibody status, AIDS/ARC clinical profile, and behavioral profile of the assailant; clinical profile of the victim; pre-assault victim behavioral profile compatible with high risk of HIV infection (exclusively adolescents); parent/guardian anxiety/psychosocial profile; and profile of the assaultive act with respect to potential transmissibility of HIV. We found an 85% or greater consensus for 6 testing criteria, and based upon these propose an interim set of HIV antibody testing guidelines for PSA victims. There was no consensus about five testing criteria, but their frequent citation merits further consideration. Clinical application of interim guidelines and design of prospective studies to quantitatively evaluate them are reviewed.
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PMID:Developing guidelines for HIV antibody testing among victims of pediatric sexual abuse. 209 45

An occupational therapist presented her 45-minute program called AIDS Education and Safe Sex 5 times to female mental patients in the locked ward of Cedarcrest Regional Hospital in Newington, Connecticut, to inform them about safe-sex practices and AIDS. She first administered a pretest then spoke briefly about AIDS and safe-sex practices. The lecture emphasized various important points such as no cure for AIDS exist, casual contact (e.g., kiss on the cheek, handshake) cannot transmit HIV, and effectiveness of using latex condoms. The occupational therapist spent much of her time addressing myths about AIDS and what safe-sex practices are. The patients discussed sexual abuse and dishonest partners. She administered a posttest which was the same as the pretest. Some sessions attracted more people than did other sessions. Test scores increased for every patient and for every session. They ranged from a 5% (68-73%) increase for the 3rd session to a 24% (67-91%) increase for the last session. She was not able to determine, however, whether the increased knowledge would translate into positive behavioral changes. Patients' psychiatric symptoms may have interfered with learning resulting in less than ideal improvements in knowledge. These symptoms were hypomanic behavior, restlessness, and distractibility. Perhaps other sessions with experiential techniques (e.g., putting condoms on dummies) would increase their understanding. This program helps fill the information gap not provided by the mass media which avoid mentioning safe-sex practices.
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PMID:Teaching safe sex practices to psychiatric patients. 231 19

The Centers for Disease Control reported that 109,167 cases of AIDS had been diagnosed since 1981 and that approximately 40,000 persons were living with AIDS at the time of this writing. These numbers, however, are the tip of an iceberg that consists of approximately 1.5 million Americans who are infected by the human immunodeficiency virus (HIV). As we described in earlier articles of this series, the HIV infection/AIDS epidemic has invaded the domain of the American family through heterosexual transmission, vertical transmission, drug abuse, and sexual abuse of children. Therefore, physicians for children are now facing the prospects of having to deal with this disease in their practices. If there is something unique about pediatrics and other specialties of the medical profession dealing with infants and children, it is that "prevention" of disease can be and has been used effectively. One only needs to remember the 1950s, when the poliomyelitis epidemic was causing the same, if not greater, concerns in the lives of the American families. The development and application of the "polio" vaccines has virtually eliminated the threat of poliomyelitis in our society. Similarly, the incidence of diphtheria, tetanus, and smallpox has decreased to the point that these diseases present practically no threat to the US population. Armed with these positive experiences, we need to examine what we can do today to curb the spread of the HIV infection/AIDS among infants and children, and by extension, among the general population of our country.
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PMID:Pediatric AIDS: prevention of HIV infection in infants and children. 240 77

The prognosis of 111 children and adolescents (from 2.5 months to 19.5 years of age) infected with human immunodeficiency virus (HIV) was assessed by survival analysis based on risk factors and clinical status. Risk factors included: maternal HIV infection 93; transfusion 12; both maternal HIV infection and transfusion 2; sexual abuse 1; and intravenous drug use and/or sexual activity 3. Children with perinatal infection survived from 2.5 months to 10.25 years (median, 1.87 years) and had inapparent infection from 6 weeks to 7.3 years (median, 0.75 years). Children who acquired HIV infection via transfusion had inapparent infection from 4 months to 5.7 years (median, 3.6 years). Actuarial survival following infection was not significantly different from maternally and transfusion-acquired infection; however, survival from infection was longer for children infected by transfusion beyond 2 years of age (mean, 7.5 years) than for children infected perinatally (mean, 5.6 years). The case-fatality ratio was 32%, with 25% of subjects succumbing within 1 year of developing an HIV-associated illness. Opportunistic infection was the most common acquired immunodeficiency syndrome-defining illness and the cause of death in 22 of the 35 children who died. Pneumocystis carinii and fungal pneumonias had the worst prognosis. Cryptosporidiosis and other opportunistic infections had a better prognosis. Because of difficulties in case finding, diagnosis of infection and variable survival of HIV-infected children, arge longitudinal studies and pooling of data among centers will be necessary to have an accurate understanding of the prognosis of individual clinical syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognosis of human immunodeficiency virus infection in children and adolescents. 271 74

The concept of empowerment is one which is often invoked in discussions over the nature of nursing practice in a range of health and welfare services. A short excursion through the Cumulative Index to Nursing and Allied Health Literature reveals that over the last 10 years 378 papers are identified which list empowerment as one of the topics discussed. In 1993, the number is 55. These papers cover a diverse range of health related issues: health promotion and HIV; breast feeding; mental health; management and leadership; change, training and education; feminism and women's issues; sexual abuse and violence; advocacy and working with immigrants; professionalism; and nursing theory. However, few of these papers discuss the relationship between empowerment and the notion of power itself. This gives rise to particular problems for nursing practice, for without a clear conceptualization of what is meant by power it is difficult to convincingly argue that one form of practice is more or less empowering than another. Alternatively, this dilemma may be stated in the following question: how do we work to empower others when we have no clear notion of what power is? This paper demonstrates that the concept of power demands a very specific consideration. In order to illustrate this it briefly identifies problems within two models of power which are drawn upon in nursing. It also demonstrates the way in which the work of Michel Foucault can be drawn upon to inform nursing in the analysis of the relationship between power and health.
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PMID:Nursing: empowerment and the problem of power. 760 94

This study explored whether homosexually active men who were sexually abused in childhood were more likely to engage in HIV-risk sexual behavior than men who were not sexually abused. Participants were 182 adult men of Puerto Rican ancestry living in New York City who had had sex with other men or with men and women. Quantitative and qualitative methods of exploration were used. Three groups were determined: (a) Abuse group (AB), formed by men who before age 13, had sex with a partner at least 4 years their senior and who felt hurt by the experience and/or were unwilling to participate in it; (b) Willing/not hurt group (W), consisting of men who had an older sexual partner before age 13 but did not feel hurt by the experience and were willing to participate; and (c) No-older-partner group (NOP). The results showed that men in the AB group were significantly more likely than men in the NOP group to engage in receptive anal sex and to do so without protection. Men in the W group were ranked between the other two groups in terms of their unsafe behavior. Age and education were cofactors both for receptive anal sex and for unprotected receptive anal sex. It is concluded that given the need to improve HIV prevention among Puerto Rican men who have sex with men, sexual abuse in childhood may constitute a marker to identify men at increased risk.
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PMID:Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men. 766 39


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