Sexual Violence Victim Protocol: Clinical Cases

• The document outlines a protocol for comprehensive healthcare for victims of sexual violence, based on Resolution 459 of 2012 by the Ministry of Health and Social Protection of Colombia, which adopted the Comprehensive Care Protocol and Model for Victims of Sexual Violence

Clinical Cases

• Case 1: A 14-year-old presents with abdominal pain and tests positive for pregnancy and syphilis, reveals she is being abused by her stepfather

• Case 2: A 30-year-old reports waking up in an unfamiliar apartment after a night out, tests negative for HIV, hepatitis, STIs, and pregnancy.

• Case 3: A 13-year-old named Carolina is brought for consultation due to changes in behavior and reveals sexual abuse by her mother's boyfriend

• Case 4: A disoriented 29-year-old is found by police, remembers leaving work but not her whereabouts.

Actions to take

• Activate the "fucsia" code (related to sexual abuse protocol).
• Mandatory reporting is needed.
• Hospitalization may be necessary depending on the details discovered.
• HIV prophylaxis, levonorgestrel and STI prophylaxis can be required depending on details.
• Toxicological and physical exam with consent.
• File reports to competent entities with the victims wishes recorded.
• If the exposure it over 72 hours consult with infectology

Epidemiology of Violence

• Violence violates human dignity, integrity, freedom, equality, and autonomy.
• Violence, including sexual violence, is a violation of human, sexual, and reproductive human rights.
• Violence is a public health issue, affecting over a third of women globally.
• The Pan American Health Organization (PAHO) states 1 in 2 children between 2 and 17 experience some form of violence annually.
• Intrafamilial Violence: Intentional acts or omissions within family relationships that cause physical, psychological, patrimonial, or economic harm, disrespecting individual rights.
• Violence patterns involve toxic relationships, discussions, and a cycle of calm followed by physical or sexual violence.

Violence as a Public Health Issue

• Consequences: injuries, disabilities, physical/mental illnesses, mortality, social issues.
• WHO estimates: 30% women have experienced physical/sexual partner violence or sexual violence by others.
• An estimated one billion children aged 12-17 worldwide have experienced physical, sexual, emotional abuse, or neglect in the past year.
• Colombia Statistics for 2023: medico-legal assessments for violence inside the family, violence between ohter members of a family, violence against children, and violence agains adults.

Statistical Data on Sexual Violence

• From 2015 to 2023, the amount of medical-legal examinations performed on individuals range from 18,000 to 26,000 in Colombia.
• From 2015 to 2023, older children 10-14 account for the largest group affected by violence
• There was less data registered in the pandemic
• The most affected are girls between 10 and 14 years old

Violence Statistics in Colombia 2023

• Physical and psychological violence occur more in adult women, sexual violence occurs more towards younger girls.
• Progenitors such as step parents cause 78% of violence and the home is the location where most crimes take place

Factors that determine the abuse

• The care from medical and family personal can have an big impact in thd victim
• Types of abuse must be recorded.
• The personal resources to overcome the act
• Context in which the victimizations occur.

Consequences of Abuse

• Children and adolescents may experience poor academic performance, anxiety, psychological problems, depression, dissociation, emotional problems, despair, hostility, neuroendocrine dysfunction, obsessive-compulsive behaviors, paranoia, adolescent pregnancy, psychosis, PTSD, sexualized behavior, somatic problems, substance abuse, suicide attempts.
• Adults may manifest adaptation problems, anxiety, attachment disorders, eating disorders (women), bipolar disorder, violence victimization, coercive sexual relations, conversion disorder, depression, divorce, irritable bowel syndrome, marital conflict, maternal functioning problems, medical symptoms, panic disorder, paternity during teen pregnancy, pedophilia, pelvic pain, premenstrual discomfort, posttraumatic stress disorder, sex offense, sexual dysfunction, STIs including HIV, substance abuse, suicide attempt, or chronic urinary retention.

Exploration of varied clinical scenarios involving victims of sexual violence, emphasizing crucial reporting protocols rooted in Resolution 459 of 2012. The document highlights the importance of activating the appropriate healthcare protocols and mandatory reporting procedures to protect and assist victims effectively.