Violência sexual na infância e adolescência: perfil da vítima e do agressor e adesão ao seguimento ambulatorial

Abstract

Sexual violence against children and adolescents is a public health problem of great proportions that presents risk factors and negative consequences in the lives of victims, who need adequate multidisciplinary care, as well as specialized long-term follow-up. The objectives are to evaluate the profile of victims and aggressors, factors associated with the occurrence of rape, and adherence to outpatient follow-up of sexually assaulted children and adolescents. The study design is cross-sectional. The population was made up of female children and adolescents, located in the age range of 0 to 19 years, seen at the emergency department of the Hospital Geral de Nova Iguaçu (HGNI) and followed up at the follow-up outpatient clinic, the Centro de Assistência Multiprofissional à Violência Sexual (CAMVIS), located in Baixada Fluminense. The analyzed data relate to the period from 2014 to 2018 and were collected from the review of the emergency department attendance bulletins and the outpatient clinic medical records. The sociodemographic variables of the victims, the profile of the aggressor(s), the scenario of sexual assault, and the post-exposure care were analyzed. The variables collected were used in the comparative analyses to identify odds ratios. Data were described using proportions, means, standard deviations, and the respective 95% confidence intervals were estimated. Associations between sexual violence and possible risk factors were assessed using statistical tests. The magnitude of the associations was observed by calculating measures of associations (odds ratio) and respective 95% CIs.Of the 453 children and adolescents evaluated, 264 (58.3%) were <14 years and 189 (41.7%) were between 14-19 years. In the 2 groups, 78% were black. School lag >2 years was 15.6% in the <14 years and 40.5% in the 14-19 years (p<0.001; OR=3.7 (2.1-6.5)). In girls up to 13 years old, abuse generally occurred at home (73.2%), perpetrated by single perpetrator (91%), known to the victim (91.2%). In girls ≥14 years old, 84.1% of rapes took place on the street, perpetrated by single aggressor (74.8%), 57.8% were unknown, and in 91.2% of cases physical force and/or verbal threat was employed. Victims <14 years old were 14 times more likely to experience assault within the family environment (p<0.001; OR=14.3 (8.2-25.6)) and 16 times more likely to be assaulted by acquaintances (p<0.001; OR=16.2 (9.2-29.8)). On the other hand, being ≥ 14 years old triples the chance of being abused by more than one abuser (p<0.001; OR=3.3 (1.8-6.1)). Black girls, especially those under 14 years of age, are more likely to experience sexual violence and revictimization, as they have lower adherence to health service monitoring and suffer aggression more frequently in the family environment. Other factors associated with the vulnerability of the victims were not evaluated and may become the object of future studies and thus help in the creation of public policies for the reduction of the incidence of this grievance