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Child sexual abuse and links to HIV and orphanhood in urban Zimbabwe
  1. Isolde J Birdthistle1,2,
  2. Sian Floyd1,
  3. Stewart Mwanasa3,
  4. Auxillia Nyagadza2,
  5. Edmore Gwiza3,
  6. Judith R Glynn1
  1. 1Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Biomedical Research & Training Institute, Nicoz Diamond Building, Harare, Zimbabwe
  3. 3Family Support Trust Clinic, Child Rehab Unit, Harare Central Hospital, Southerton, Harare, Zimbabwe
  1. Correspondence to Dr Isolde J Birdthistle, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street 3rd Floor, London WC1E 7HT, UK; isolde.birdthistle{at}


Background Evidence of a link between sexual violence and HIV is growing; however, studies among children are scarce. The authors sought to characterise child sexual abuse in Harare, Zimbabwe, and explore its links with HIV and orphanhood.

Methods Records for new clients attending a child sexual abuse clinic from July 2004 to June 2005 were computerised and reviewed. Information on characteristics, medical examinations, laboratory tests and perpetrators were summarised. Orphan prevalence was compared with Demographic and Health Survey (DHS) 2005/2006 data for Harare, and a household-based survey in a neighbouring community.

Results Over 1 year, 1194 new clients (90% female) aged 7 weeks to 16 years were assessed, with 93% of boys and 59% of girls classified clinically as prepubertal. 94% of clients reported penetrative sexual abuse, occurring most often in the child's home. Most perpetrators were identified as relatives or neighbours by children under 12 years, and ‘boyfriends’ by adolescent girls. At presentation, 31/520 (6%) clients tested were HIV-positive. Where recorded, 39 (6%) clients presented within 3 days of abuse, and 36 were given postexposure prophylaxis for HIV (PEP). Among female clients, orphan prevalence was higher than in the DHS (OR=1.7; 1.4 to 2.2) and neighbouring community (OR=1.7; 0.7 to 4.3).

Conclusions High numbers of children in Harare experience penetrative sexual abuse, and most present too late for PEP. More immediate presentation of sexual abuse can help to prevent HIV and recurrent abuse, and assist in examination and prosecution. Orphanhood emerged as a possible risk factor for sexual abuse and an important area for further research.

  • Child sexual abuse
  • adolescents
  • HIV
  • orphans
  • Zimbabwe

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  • Funding IB was funded by a European Union Marie Curie Fellowship, and was funded by an ESRC-MRC Fellowship (PTA-037-27-0154). AN was funded by an Andrew W Mellon Foundation grant for Research on HIV/AIDS & Population Studies in Southern Africa.

  • Competing interests None.

  • Ethical approval Ethics approval was provided by the ethics committees at Harare Central Hospital and the London School of Hygiene & Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.