1. The myth of child rape as a cure for HIV/AIDS in Transkei: a case report

South Africa has one of the highest cases of HIV/AIDS infection in Africa, and Transkei, a former black homeland, now a part of the Eastern Cape Province, is one locality with a large number of HIV/AIDS sufferers. The unemployment level is very high and crime, including child rape, is very common. This report presents the case of a victim of rape, a nine-year old female child who was brought to the Umtata General Hospital, a victim of the mistaken belief that sex with a virgin will cure an HIV-infected person or AIDS sufferer of his illness. The alleged rapist was an HIV-positive uncle of the child. The myth of the 'HIV/AIDS virgin cure' is prevalent in the community. The history, physical examination and laboratory investigations of this case are given. A conclusion is drawn and preventive methods are suggested.     

Human immunodeficiency virus/acquired immunodeficiency syndrome knowledge and risk factors in Ethiopian military personnel

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related knowledge and behaviors were assessed in face-to-face structured interviews with 314 Ethiopian military personnel. A significant finding of this research was the association between HIV/AIDS knowledge and risky sexual behavior. That is, military personnel who had inaccurate knowledge about HIV/AIDS transmission and prevention were 3.4 times as likely to engage in combined sexual risk behaviors compared with personnel with accurate knowledge, after controlling for age, military rank, and marital status (odds ratio, 3.4; 95% confidence interval, 1.86-6.22). This finding highlights the potential value of educational programs in slowing the spread of HIV/AIDS in sub-Saharan Africa.     

HIV/AIDS and debt crises: threat to human survival in sub-Saharan Africa

Whether originating from the African primates in the Central African forest, or from polio vaccine trials by some western scientists, there is no doubt that HIV/AIDS poses the greatest single challenge to the marginalized poor of Africa, where it has found a malnourished, vulnerable, defenceless host. Collective response is necessary by physicians and health professionals who must be at the forefront of restoring hope and a dignified quality of life. In sub-Saharan Africa, HIV/AIDS is not a security threat but a painful slow death which forces victims into exhausting their lifetime savings on expensive medicines and massive hospital bills. It leaves helpless orphans to struggle for survival in countries where government subsidy on education and healthcare has been long withdrawn so as to channel the meagre state resources into debt servicing. A combination of the HIV/AIDS pandemic and Third World debt is subjecting millions of children to the worst form of violence. This article reviews the situation in sub-Saharan Africa, with special reference to Kenya and South Africa as examples of countries devastated by the HIV/AIDS pandemic. Changes elsewhere are noted and the global response is critically examined.     

HIV/AIDS, psychiatric disorder and sexual assault in Transkei: a case report

HIV infection and psychiatric disorders have a complex relationship. HIV infection could lead to psychiatric disorders, and psychiatric patients are more vulnerable to HIV infection. HIV is not only an illness which is associated with stigmatization and discrimination, but also has several risks attached including physical and sexual abuse. There is a scarcity of literature on HIV, mental illness and sexual assault although they are a common trio. The author describes an HIV-positive woman with a psychiatric disorder. She suffered from AIDS and periodic psychotic epidsodes. On a day when she had such an episode she became a rape victim. The history, and physical and genital examination has been described. The need for further research in the area of HIV/AIDS and mental health has been discussed. Preventive strategies have been recommended for HIV-infected individuals in poor health resource settings.     

HIV/AIDS and Debt Crises: Threat to human survival in Sub‐Saharan Africa*

Whether originating from the African primates in the Central African forest, or from polio vaccine trials by some western scientists, there is no doubt that HIV/AIDS poses the greatest single challenge to the marginalized poor of Africa, where it has found a malnourished, vulnerable, defenceless host. Collective response is necessary by physicians and health professionals who must be at the forefront of restoring hope and a dignified quality of life. In sub‐Saharan Africa, HIV/AIDS is not a security threat but a painful slow death which forces victims into exhausting their lifetime savings on expensive medicines and massive hospital bills. It leaves helpless orphans to struggle for survival in countries where government subsidy on education and healthcare has been long withdrawn so as to channel the meagre state resources into debt servicing. A combination of the HIV/AIDS pandemic and Third World debt is subjecting millions of children to the worst form of violence. This article reviews the situation in sub‐Saharan Africa, with special reference to Kenya and South Africa as examples of countries devastated by the HIV/AIDS pandemic. Changes elsewhere are noted and the global response is critically examined.     

AIDS: some medico-legal aspects

The increase in HIV infection in South Africa poses serious problems not only to medical services in this country, but also to its legal system. Some of the more immediate medico-legal problems surrounding AIDS are discussed: Informed consent to the testing for HIV antibodies, the maintenance of confidentiality and the question of whether health care workers may refuse to treat AIDS patients.     

Prevalence of HIV risk factors for individuals examined in clinical forensic medicine

Objective: to identify the prevalence of high-risk factors for infection with Human Immunodeficiency Virus (HIV) in individuals examined in clinical forensic medical practice and to determine opinions and attitudes about HIV in this patient group. Design: Anonymised questionnaire completed by consecutive individuals seen in clinical forensic medical practice. Setting: Police stations in London attended by Group IV forensic medical examiners. Subjects: 518 individuals examined in police stations (including prisoners and suspects, those detained in police custody, police officers and victims of crime). Results: 164 (31.7%) individuals did not respond to the questionnaire because of: 1) refusal (12.6%) 2) inability because of drugs and/or alcohol (11.4%) 3) mental illness/disorder (4.2%) or 4) language difficulties (3.5%). 28.4% of the respondents were in at least one of the 'high-risk' categories for HIV infection. 26.5% were intravenous drug misusers; 15% were prostitutes; 9.8% (or their sexual partners) had lived in Central or East Africa since 1977; 5.9% were male homosexuals and 0.5% were haemophiliacs. 5.1% were infected with HIV or had Acquired Immunodeficiency Syndrome (AIDS). Only 28.8% of individuals always used condoms in short-term sexual relationships. 44.4% of respondents believed that everyone should be tested for HIV. Conclusion: Over one-quarter of the respondents were in higher-risk groups for infection with HIV. Almost one-third could or would not respond. It is concluded that it is not possible to identify by questionnaire, individuals at higher risk of HIV infection in forensic medical practice. This reinforces the necessity of observing good clinical practice to reduce contamination risks in this work environment. It is clear that education about risks for HIV infection is still much needed.     

Islam and "female circumcision": the dispute over FGM in the Egyptian press,September 1994

In September 1994, during the United Nations Population Conference in Cairo, CNN broadcast a report about the custom of clitoridectomy in Egypt. The televised report included footage of such a ceremony performed on a ten-year-old Egyptian girl in Cairo a few days earlier. This broadcast revived the public polemics on clitoridectomy in Egypt. Secular newspapers such as al-Wafd and al-Ahali opposed this practice while religious circles used the al-Sha'b newspaper to justify it. The religious argument is based on Islamic tradition although the origin of the practice is admittedly pre-Islamic. This position maintains that the type of clitoridectomy performed involves minimal excision, but in practice it is much more radical. There are voices from within the lslamic camp, mainly those of women, that call for the abolition of this practice, basing this demand on the fact that this act is a minor rather than major principle of Islamic Law. Although the secular educated classes in Egypt tend to avoid this practice, they are a minority. The public argument continues in a low key while in reality thousands of young girls daily undergo this traumatic experience which maims them in body and in soul. Unless there is a sustained public outcry against it, this mutilation is destined to remain part of the Egyptian reality for a long time. This paper discusses the positions of the two sides to the dispute, concentrating mainly on the opinions of the Islamic faction which upholds the continuation of genital mutilation. These opinions are expressed by male Islamic elders while opposing arguments are presented by women who decry this practice.     

A retrospective observational study of genital findings in adult women presenting to a New Zealand Adult Sexual Abuse Assessment and Treatment Service following an allegation of recent sexual assault

ObjectiveThe aim of this study was to report on the prevalence of genital findings documented in women attending a forensic examination following an allegation of recent sexual assault. A secondary aim was to investigate for any associations between genital findings and variables related to population demographics and clinical factors.Study designA retrospective review of clinical records was undertaken for 593 women, aged between 17 and 45 years of age, who underwent a forensic examination within 72 h following an alleged sexual assault at the Pohutukawa clinic, adult Sexual Abuse Assessment and Treatment Service (SAATS) in Auckland, New Zealand over a four-year period. Statistical analysis to examine for any associations between any documented genital findings and subject variables was performed.ResultsThe key finding was that 66.4% (394/593) of the women had a normal genital examination. Of the 182 women with genital findings the presence of skin disruption and/or bruising was noted in 21.1% (125/593) and non-specific findings in 9.6% (57/593). 17 women were not included as the genital examination was incomplete. For 9.5% (56/593) of women the presence of abnormal genital skin was documented. From the adjusted odds ratios obtained by multivariate analysis there was a statistically significant association between the presence of genital findings and abnormal skin condition (OR 3.13, p = 0.0004).ConclusionThe study demonstrated that the majority of women seen within 72 h of an alleged sexual assault had a normal genital examination. Given the strength of the association between the presence of genital findings and skin condition, we recommend that documentation of the genital skin condition should become a routine part of a forensic examination following sexual assault. This is particularly important if genital findings are present, in order to present the full complexity of clinical examination findings to the court and provide an expert opinion regarding the limitations of attributing causation.     

Macroscopically detected female genital injury after consensual and non-consensual vaginal penetration: A prospective comparison study

ObjectiveThe aim of this study was to compare the prevalence, type and pattern of macroscopically detected female genital injury after consensual and non-consensual vaginal penetration to further an understanding of the forensic significance of genital injury in women reporting sexual assault. A secondary aim was to identify any effect of a range of possible variables upon the likelihood of genital injury resulting from vaginal penetrative sexual intercourse.Study designTwo groups of reproductive age women (aged 18–45 years) were prospectively recruited within 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presence of bruises, abrasions and lacerations at twelve external and internal genital sites. Forty one women who presented for forensic examination after reporting a sexual assault to police were recruited to the non-consensual group and 81 women who presented for routine cervical screening or with sexual health concerns to a primary health care service to the consensual group. Each group was examined by a different group of doctors, all of whom were experienced in both forensic genital examination and gynaecological examination of healthy and diseased sexually active women. Data collection and examination protocols were the same for both groups.ResultsThe key finding was a statistically significant difference in genital injury prevalence between women who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensual group (22/41) and 9.9% of the consensual group (8/81) were found to have at least one genital injury [OR 10.57, CI (4.07, 27.42), p < 0.00001]. Penetration with finger/s and possible pre-existing genital ‘infection’ were found to be significantly associated with the presence of injury in the univariate analysis after adjusting for consent. Logistic regression demonstrated that women penetrated without consent were 19.5 times more likely to sustain at least one genital injury, than those penetrated consensually [OR 19.53, CI (6.03, 63.24)] and that a penetration scenario that included finger/s was 4.2 times more likely to result in at least one genital injury than penetration without finger involvement [OR 4.25, CI (1.42, 12.78)], when controlling for other variables in the model. Whilst a comparatively low injury prevalence in the consensual group limited interpretation, results revealed possible differences in genital injury typology and pattern resulting from non-consensual and consensual vaginal penetration. Lacerations were seen after both consensual and non-consensual vaginal penetration, while abrasions and bruises were seen exclusively in the non-consensual group.ConclusionThis study demonstrated a significant consent group difference in genital injury prevalence and the highest macroscopically detected genital injury prevalence rate resulting from non-consensual vaginal penetration identified to date. Results also indicate that vaginal penetration with finger/s increases the likelihood of sex-related injury. The difference in type of injury sustained as a result of non-consensual and consensual vaginal penetration was an unexpected finding, and warrants further investigation. These results highlight the importance of a standardised means of detecting genital injury based on consistent injury definitions, examination protocols, and examiner experience and suggest that macroscopic genital examination may be uniquely placed to detect consent group differences in injury typology and pattern if they exist.     

The legal situation concerning notification of sexual partners of HIV/AIDS patients in Costa Rica: problems in contact tracing

Among solutions to the problems of HIV/AIDS, a public health preventive measure has been proposed to notify the sexual partners of patients, this being a justifiable exception to professional secrecy. Every such measure must conform to a legal framework in order to facilitate the task of the health care worker, to respect the patient's right to privacy and to protect life as a juridical value. The General Law governing HIV/AIDS and its Costa Rican regulations propose a procedure to notify sexual partners. This study analyses how the procedure is developing in Costa Rica as well as its legal justificaitons.     

孕妇学校式健康教育对降低艾滋病母婴垂直传播的效果评价

目的通过评价在孕妇学校中增设预防艾滋病母婴垂直传播的专题健康教育课程,对提高孕妇艾滋病知识知晓率及降低艾滋病母婴垂直传播的干预效果,为在全市开展预防艾滋病母婴垂直传播专题健康教育工作的常规化提供科学依据。方法在本市有产科资质医院的孕妇学校中,增设预防艾滋病知识的健康教育课程,对建册孕妇进行艾滋病科普知识及预防艾滋病母婴垂直传播知识健康教育。从中选取12个孕妇学校,对孕妇进行培训前后知识知晓率调查分析,结合全部孕妇学校培训后孕妇主动接受艾滋病抗体检测率、艾滋病阳性确诊孕妇接受规范治疗情况的统计分析结果,评价艾滋病健康教育对阻断母婴垂直传播的干预效果。结果共完成600名孕妇的培训前后知识知晓率调查统计分析,干预后孕妇对预防艾滋病母婴垂直传播的知识及艾滋病的一般防治知识的知晓率明显高于干预前（P〈0.001）。通过孕妇学校的健康教育,3年来孕妇自觉接受艾滋病的检测率〉90%,47例阳性者自觉接受规范治疗,母婴垂直传播率〈2%。结论通过孕妇学校对孕妇系统地进行预防艾滋病健康教育,提高了孕妇对艾滋病科普知识及艾滋病母婴垂直传播防治知识的知晓率,使孕妇在孕期能主动地接受艾滋病检测,阳性者能主动地接受规范治疗,能达到有效地降低艾滋病母婴垂直传播的实效,因此,应制定和完善相应的规范,使开展＂孕妇学校＂式的预防艾滋病母婴垂直传播健康教育干预活动常规化、普及化。     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

AIDS in contemporary Islamic ethical literature

AIDS has been mentioned in Islamic ethical literature since about 1985 as an illness pertaining to European and American homosexuals. Only since about 1990 has the presence of HIV/AIDS in Islamic countries cast light on the fact that the actual sexual behaviour of the population does not always conform to religious norms. The increase in the numbers of people with HIV has compelled religious leaders to take a stand on sexual practices they consider "deviant", from prostitution to homosexuality and extramarital sex. The aim of this paper is to analyse the attitude of Muslim religious authorities towards individual sexual behaviour and AIDS. It is based mainly on contemporary legal responses that largely provide the necessary information on most of Islamic medical ethics. According to Muslim scholars, AIDS is a warning from God not to indulge in illicit conduct. As a remedy against the spread of AIDS, they encourage compliance with traditional family values and the enhancement of faith and devotion and strongly oppose sex education. They oppose promotion of condoms or any form of safe sex outside of marriage, which they perceive as promoting promiscuity and defiance of divine law. All the above-mentioned arguments are not exhaustive of the Islamic attitude towards AIDS. Some religious groups disagree with such a conservative way of conceiving the fight against AIDS as being antithetical to both men's and women's well-being. They support an alternative view of reproductive health and human rights within the Islamic framework and stress the great tolerance of Islam and why it must include people with HIV and AIDS.     

5000m以上高原男性军人性知识及性教育调查

目的掌握5 000 m以上高原男性军人性知识及性教育情况,为高原部队开展性知识教育提供参考依据。方法采用问卷调查的方式,抽样调查了喀喇昆仑山5 000 m以上高原86名17～29岁男性军人的性知识及性教育情况。结果 (1)分别有68.6%和58.1%的高原军人对男性和女性生殖系统及其构成稍有了解。在了解意愿方面,对自身的了解以非常想(51.2%)为主,而对异性的了解以无所谓为主(58.1%)。(2)获取性知识途径第一位的是学校(47.7%),认为艾滋病是性传播疾病的占84.9%,认可性接触可传播性病的占90.7%,误认为一起淋浴可传染性病的占19.8%,最愿意与朋友一同讨论性知识(74.4%)。(3)88.4%的军人认为目前生活环境对性功能会有影响,选择生育能力的占87.2%,82.6%的军人认为在部队有必要开展性知识讲座,最想了解的内容是性卫生知识(82.6%)。结论 5 000m以上高原男性军人性知识比较缺乏,性教育较为薄弱,需要引起高原边防部队和卫生行政部门共同关注,旨在加强军人的性知识普及和性教育工作,维护边防部队守防任务的顺利完成。     

A study on the prevalence of HIV-seropositivity among rape survivals in Transkei, South Africa

BACKGROUND: South Africa has the highest incidence of rape, including child rape, in the world. The country has about 5-million individuals infected with HIV/AIDS. HIV/AIDS is becoming a life-threatening consequence of rape. It is therefore important to provide anti-retroviral drugs and some provinces have already begun to do so. OBJECTIVE: To estimate the prevalence of HIV-seropositivity in the victims of rape in Transkei. METHODS: All the victims of rape who attended Sinawe Rape Crisis Center in Umtata General Hospital during daytime from Monday to Friday between November 2000 and May 2002 were included in the study. All were tested for VDRL and HIV. RESULTS: A total of 243 victims were examined. 22 (9%) were seropositive for HIV. Two blood results were not available. One hundred and sixty six (68.3%) were less than 20 years old, 57 (23.4%) were less than 10 years, and 12 (4.9%) were less than 5 years of age. The highest HIV-positivity (2.8%) was found among the adolescents (15-19 years). No children of less than 5 years were infected with HIV. Only 5 (2.2%) returned for the second HIV test, and one (0.4%) seroconverted after 3 months. CONCLUSION: There were 219 (90%) rape victims who were HIV negative at the time of the incident. Serious consideration must be given to cover rape victims with anti-retroviral agents to prevent them contracting HIV infection.     

Sexual assault of a postmenopausal woman

Postmenopausal women account for small numbers of presentations to sexual assault services. Knowledge of genital anatomical and physiological changes in this population is essential in order to correctly interpret injuries. A case of a postmenopausal victim is described and discussed which illustrates some issues peculiar to older female victims.     

The political economy of health policy in Sub-Saharan Africa

This paper discusses the health status of Sub-Saharan Africa focusing on infectious and parasitic diseases, HIV/AIDS, maternal and child health, famine, and political instability. Its contention is that Africa is stuck in the second stage of the demographic transition (high birth rate, low death rate) and the first stage of the epidemiological transition (deaths related to pestilence, famine, and war). Africa's lack of sustainable development is attributed to ineffective governmental policy and leadership. The prognosis is that the health and well-being of Africa's most vulnerable population, women and children, will improve when government shifts its attention from external funding and affairs to internal and concentrates on retaining Africa's 'talented tenth'; that the 'brain drain' and political instability has robbed Africa of its most talented young people, medical and science professionals, who are needed to provide primary care and development to a region with a high mortality rate, a low life expectancy, and a low per capita income.     

Impeding access? Stigma, individual responsibility and access to post-HIV-exposure prophylaxis (PEP) in South Africa

Opponents of rights-based access to health care services often emphasize individual responsibility for health and well-being, in justifying restrictions on public health care. Where individuals are co-responsible for their ill health, so the argument goes, the public obligation to alleviate their hardship should be limited. This discourse not only denies the socially determined nature of individual behaviour and systemic factors that impact on population health, but also exacerbates the stigmatization of the ill. As such, it is inimical to a human rights approach to health. Unfortunately, it pervades much of health law and policy, especially in relation to HIV/AIDS. This article conducts a human rights analysis of access to postexposure prophylaxis (PEP) treatment for HIV in South Africa. It criticizes the manner in which current South African law and policy in this regard prioritizes access to treatment by persons who display characteristics of'appropriate victimhood', while discouraging access by those regarded as co-responsible for their illness and accordingly as undeserving of treatment. Ultimately, the article advocates for broader and de-stigmatized access to PEP in the public and private health sectors.