OBJECTIVES Understand the barriers faced by male survivors of sexual violence Describe how male survivors may react to a sexual assault Gain knowledge and skills to provide first line support and medical care to male survivors of sexual violence or rape ID: 1048642
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1. 9. CARING FOR MALE SURVIVORS OF SEXUAL VIOLENCE
2. OBJECTIVES Understand the barriers faced by male survivors of sexual violence Describe how male survivors may react to a sexual assault. Gain knowledge and skills to provide first line support and medical care to male survivors of sexual violence or rape
3. Sexual violence towards men and boys is not about sexual desire, but is ABOUT DOMINANCE, POWER AND CONTROL Sexual violence towards men and boys is often done to make the survivor feel SHAME, HUMILIATED, DISEMPOWERED, emasculatedUNDERSTANDING SEXUAL VIOLENCE AGAINST MEN AND BOYS
4. SV occurs to people in vulnerable situations - including men and boys. Those at INCREASED RISK:Children or adolescents – in child labour, schools, foster homes or unaccompanied or separated in refugee campsBeing or perceived to be GBTWith a mental or physical disabilityBeing in DETENTION or the MILITARYIMMIGRANTS, A REFUGEE, DISPLACED OR UNDOCUMENTEDBeing in a CONFLICT OR NATURAL DISASTERSV IN MEN AND BOYS
5. TYPES OF SV AGAINST MEN AND BOYS
6. Rape, sexual violence, sexual tortureInflicting damage to the genitals to interfere with future sexual pleasure or to prevent future reproductionBeing forced to take part in sexual acts, often degrading or humiliating ones TYPES SV AGAINST MEN AND BOYS
7. SCOPE OF SV AGAINST MEN AND BOYS IN CONFLICTIN THE DRC, 24% of men in conflict-affected areas reported SV—an estimated 760,000 men.IN LIBERIA, 33% of former male combatants and 7.4% of male non-combatants reported SVIN 3 SUB-SAHARAN AFRICAN COUNTRIES, 2 to 7% of boys aged 15 to 19 had ever experienced sexual violence
8. ACTIVITY - MYTHS ABOUT SEXUAL VIOLENCE AGAINST MEN AND BOYS
9. THE IMPACT OF SV AGAINST MEN AND BOYS
10. Male survivors may be affected PHYSICALLY, PSYCHOLOGICALLY AND SOCIALLY.
11. Pain, injury, scarring and pain of the genitals (including testicles), PERINEUM OR RECTUM, ANAL SPHINCTOR OR INTRABDOMINAL INJURY, LOWER BACK PROBLEMSInfertility and sexual dysfunctionUrinary and bowel incontinence, rectal fissuresSTIS OR HIV GENITAL INFECTIONS OR ABSCESSES PHYSICAL CONSEQUENCES OF SV AGAINST MEN AND BOYS
12. Overwhelming SHAME, HUMILIATION, ANGER, IRRITABILITY, FEAR AND POWERLESSNESS, LOW SELF-ESTEEM, Depression; aggression; compulsive sexual behavior; ANXIETY, DEPRESSION, PHOBIAS; alcohol or drug abuse; self-harm; and suicide attempts.Somatic complaints - problems urinating or defecating, sleeplessness, sexual dysfunctionPSYCHOLOGICAL CONSEQUENCES OF SV AGAINST MEN AND BOYS
13. Challenged their perception of their MASCULINITY, SEXUALITY AND REPRODUCTIVE CAPACITYFeelings of weakness, guilt, shame related to social norms around masculinity, power, dominance and discrimination against sexual minorities and womenPSYCHOLOGICAL CONSEQUENCES OF SV AGAINST MEN AND BOYS
14. Social withdrawal or isolation, marital and family problems,Not being believed, blame, stigmatization, marginalisation from community and public life, isolation Fear of being rejected, excluded from, or harmed by their community Fear of criminalizationSOCIAL CONSEQUENCES OF SV AGAINST MEN AND BOYS
15. BARRIERS TO SERVICE ACCESSIBILITY AND PROVISION
16. ACTIVITY - BARRIERS TO CARE FOR MALE SURVIVORS
17. Lack of knowledgeLack of accessible servicesTraditional masculine normsFeelings of shame and fear of stigma, discrimination and not being believedLegal environment that criminalizes menBARRIERS TO SERVICE ACCESSIBILITY AND PROVISION
18. SPECIAL CONSIDERATIONS FOR HEALTH CARE AND PSYCHOSOCIAL SUPPORT FOR MALE SURVIVORS
19. LIVES FOR MEN AND BOYS•LISTEN• L•INQUIRE ABOUT NEEDS•I•VALIDATE• V
20. Reassure survivors about normal physiological reactions, erection and orgasm – they are normal reflexes they could not controlSV cannot change a person’s sexual orientation You are not “less of a man.” You are not aloneYou deserve supportVALIDATE MALE SURVIVORS OF SEXUAL VIOLENCE
21. VIDEO - WELCOME
22. DISCUSSA 20-year-old male arrives at the clinic one day after being gang raped by enemy soldiers. He complains of general body aches, anal soreness and mild bleeding with bowel movements. His exam reveals multiple anal cuts with significant tenderness. The patient appears increasingly anxious and reluctantly tells you that he thinks he experienced an erection during the assault. He expresses shame and feelings of disgust with himself. WHAT ARE THE APPROPRIATE MESSAGES THAT YOU SHOULD COMMUNICATE TO HIM? A. Explain that, in such circumstances, erections are a reflex that he could not control. B. Reassure him that he is not alone, and that it is common for survivors to experience guilt and shame. C. Advise him to keep the incident a secret from everyone. D. Both A and B.
23. A 20-year-old male arrives at the clinic one day after being gang raped by enemy soldiers. He complains of general body aches, anal soreness and mild bleeding with bowel movements. His exam reveals multiple anal cuts with significant tenderness. The patient appears increasingly anxious and reluctantly tells you that he thinks he experienced an erection during the assault. He expresses shame and feelings of disgust with himself. WHAT ARE THE APPROPRIATE MESSAGES THAT YOU SHOULD COMMUNICATE TO HIM? D. Both A and B. Explain that, in such circumstances, erections are a reflex that he could not control. Reassure him that he is not alone, and that it is common for survivors to experience guilt and shame. DISCUSS
24. Ask about medical historyAsk about the incident – type of violence, location on their body, if there was penetration, type of penetration (anal or oral), penetrating object (penis, object)Ask about signs, symptoms – pain, discomfort, injuriesHISTORY TAKING AND EXAMINATION FOR MEN
25. VIDEO - HISTORY
26. Assure the survivor that he is in control, he can ask questions, stop the examination at any time and decline any part of the examination. Explain the examination step by stepAsk often if he has any questions and if you can proceed. If he says “no”, then stop the examination at that point. Systematically conduct the examination from head to toe.GENERAL EXAM
27. VIDEO - GENERAL EXAM
28. GENITAL EXAMINATION OF MEN ASSESSWHAT TO LOOK FORScrotum Testicles Penis, frenulum, foreskinPeri-urethral tissueUrethral Meatus AnusBruising, tears, lacerations, bleeding, hematoma, swellingPain, swelling or torsion of testis Anal tearsBlood in urinePenile and urethral traumaRectal examination of rectum and prostate (if indicated)Signs of trauma and infection
29. VIDEO - GENITAL EXAM
30. DOCUMENTATION
31. DOCUMENTATION
32. Treatment of physical injuries Offer HIV Post-exposure prophylaxis (PEP) WITHIN 72 HOURS and follow-up HIV testingPresumptive treatment for STIs (chlamydia, gonorrhoea and syphilis)Offer Tetanus and hepatitis B prophylaxis MEDICAL CARE FOR MEN
33. VIDEO - MEDICAL CARE AND TREATMENT
34. DISCUSSA 20-year-old male arrives at the clinic one day after being gang raped by enemy soldiers. He complains of general body aches, anal soreness and mild bleeding with bowel movements. His exam reveals multiple anal cuts with significant tenderness. WHAT IS THE BEST RESPONSE TO THE PATIENT’S QUESTION REGARDING HIS RISK OF BECOMING INFECTED WITH HIV AS THE RESULT OF THE ASSAULT?A. Reassure him saying, “Don’t worry. You will be fine. ” B. Inform him he is at potential risk for HIV given the nature of the assault.C. Explain to him that his risk of infection may be lowered with PEP.D. Both B and C.
35. A 20-year-old male arrives at the clinic one day after being gang raped by enemy soldiers. He complains of general body aches, anal soreness and mild bleeding with bowel movements. His exam reveals multiple anal cuts with significant tenderness. WHAT IS THE BEST RESPONSE TO THE PATIENT’S QUESTION REGARDING HIS RISK OF BECOMING INFECTED WITH HIV AS THE RESULT OF THE ASSAULT?D. Both B and C. Inform him he is at potential risk for HIV given the nature of the assault. Explain to him that his risk of infection may be lowered with PEP.DISCUSS
36. DISCUSSJoshua is a 23 year old man. He is arresting at anti-government protest and taken to the government prison. The prison guards beat him with metal pipes, force him to be naked and 2 of them anally rape him in front of other prisoners. He is released from prison and comes to your clinic 7 days after the incident.WHAT MEDICAL CARE WILL YOU PROVIDE JOSHUA?A. Assessment and treatment of injuriesB. Offer HIV testingC. Offer HIV PEPD. Offer STI prophylaxisE. Offer vaccination for TetanusF. Offer vaccination for Hepatitis BG. All of the above
37. DISCUSSJoshua is a 23 year old man. He is arresting at anti-government protest and taken to the government prison. The prison guards beat him with metal pipes, force him to be naked and 2 of them anally rape him in front of other prisoners. He is released from prison and comes to your clinic 7 days after the incident.WHAT MEDICAL CARE WILL YOU PROVIDE JOSHUA?A. ASSESSMENT AND TREATMENT OF INJURIESB. OFFER HIV TESTINGC. OFFER HIV PEPD. OFFER STI PROPHYLAXISE. OFFER VACCINATION FOR TETANUSF. OFFER VACCINATION FOR HEPATITIS B
38. ACTIVITY - CASE STUDY
39. LIV(ES) FOR MEN AND BOYSE•Support•Including social support, mental health and psychosocial support, peer support groups, legal, justice, education, employmentS•ENHANCE SAFETY•
40. VIDEO - VALIDATE, ENHANCE SAFETY AND CONNECT WITH SUPPORT
41. KEY MESSAGESMale survivors of sexual violence face similar and unique consequences to other survivors of sexual violenceMale survivors should receive support and empathetic care, including:Listening, inquiring about needs, validatingMedical care – prevention of HIV, STIs, tetanus, hepatitis B and treatment of wounds and injuriesEnhancing safety and connecting with support