Child sexual abuse (CSA) is epidemic globally. In studies of adults in the United States and Canada, 20%-25% of women and 5%-15% of men have experienced sexual abuse. Zambia is a country in sub-Saharan Africa where the problem of CSA is compounded by HIV prevalences exceeding 25% in urban adults. Zambia's economic indicators are among the worst on the African continent and the numbers of orphans and street children are increasing. These children are particularly vulnerable to CSA. Though there is significant emphasis on prevention of mother to child HIV transmission in Zambia, HIV transmission through CSA remains a neglected issue. In neighboring Zimbabwe, 8% of CSA victims <=12 years of age have HIV. Most abused children in Zambia come to medical attention because of a sexually transmitted disease (STD). Beyond treatment of the STD, services are limited. Resources for follow-up and psychological counseling are lacking. In most cases, due to economic constraints, legal proceedings against the perpetrator are not instituted and the abuse continues. The Zambia-UAB HIV Research Project (ZUHRP) has an established NIH funded research infrastructure in Lusaka, the capital city of Zambia. This FIRCA proposes to expand the research agenda of NICHD ROI 40125-02 """"""""Family planning promotion in HIV infected Zambian couples"""""""" (7/01-6/06) through the addition of research on CSA. This research will be conducted in collaboration with district clinics and at the University Teaching Hospital (UTH) in Lusaka, with specialists in CSA, pediatrics, counseling, and HIV/STD. For the first time, the prevalence of CSA and predisposing circumstances will be systematically examined while we develop procedures that strengthen the medical and psychosocial management of sexually abused children. We will form partnerships with law enforcement and social service agencies in Zambia, including both governmental and non-governmental sectors. Over a three-year period, our goal is to obtain baseline data and establish a collaborative framework for future ROI funded studies of pediatric HIV reduction strategies through CSA prevention. Linkages with regional and international organizations will provide critical preparation for these efforts.
