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Questions and Answers
UNACCEPTABLE RISK:
Child Sexual Abuse and AIDS
by
A.
Kenneth Fuller, M.D.
www.seawebdesign.com/risk
What is the most alarming problem facing
sexual abuse workers?
The complex and very real risk of the AIDS virus being passed
onto the most innocent of victims by HIV-infected child molesters.
How common is child sexual abuse?
The incidence child molestation is rising. There have been substantial increases
in child sexual abuse in the past twenty years. From 1986 to 1993 sexual abuse
cases reported to authorities more than doubled to over 300,000 victims.
What is your estimate for the number
of children molested every year?
Research shows that one-fourth of all girls were sexually abused before the
age of sixteen. However, less than six percent of these cases of sexual abuse
were ever reported. By using these figures to extrapolate a truer incidence
of sexual victimization, we may infer that between three and five million American
children are victims of sexual mistreatment every year.
These are frightening statistics.
What are the kinds of activities that qualify as child sexual abuse?
Child molestation is the misuse of a child for the sexual pleasure of an adult
or significantly older person. There are a wide range of activities that can
be considered sexual abuse: talking to children in a sexual way, showing them
sex organs, peeping at them while they are undressing, making obscene phone
calls, or showing pornographic pictures or videos. Touching offenses include
fondling, oral sex, intercourse, sodomy, and children prostitution. Child molesters
are even using the on-line computer networks, the so-called "information
superhighway," to sexually abuse victims.
What can the average citizen do when
he or she suspects child abuse?
Since child sexual abuse is likely to continue unless an outside force stops
it, I believe that the average citizen has a moral obligation to report child
abuse. Anyone may report child abuse. The reporting party does not have to
be one of the professionals who are required to report. The mandate is to report
suspected abuse, not confirmed abuse.
What happens once a report is made?
Reporting sets into motion an investigation by the child protection team, which
may involve a mental health consultation. Child protection teams
and legal authorities are usually the ones to rescue the victim and put an end
to their sufferings.
How many child molesters are there in
the United States?
There are and estimated one-half million child molesters. Thirty-seven percent
of all U.S. sex offenders are child molesters. The number of people incarcerated
for sexual offenses against juveniles increased by 39 % between 1991 and 1997
-- the number went up to over 60,000.
Is there a profile to help identify child
molesters?
Unfortunately, no. The most striking feature of the child molester is how
ordinary and average the person is. A family member, friend, clergyman, or
a co-worker of many years may be abusing children, and no one knows about it.
Many people think that all child molesters are "dirty old men," "crazy
people," or "sex fiends." Child molesters who fit these stereotypes
are found, but they are the exceptions.
Do child molesters come from a common
background?
Sexual abusers come from every income group, from all educational levels, from
urban and rural areas, and from all religions. Child sexual abuse, like the
AIDS epidemic, involves all ages and all races.
How many child molesters are infected
with the AIDS virus?
One to two percent of the population may have the AIDS virus. In subsets of
the population, such as urban, young black males, the number rises to a frightening
ten percent. If we apply the one-percent rate of infection to the estimated
number of one-half million child molesters, we may infer that five thousand
child molesters are HIV positive.
How firm is that figure of five thousand
HIV-infected child molesters?
There are shortcomings to the extrapolation of statistics in this way, but
we can say credibly that thousands of child molesters might be infected with
the AIDS-causing virus.
If HIV transmission is such an alarming
problem, why has it not been publicized more?
HIV status has become super-confidential information,
and the pendulum has swung so far toward protection of individual rights that
children have been ignored.
Other barriers to recognizing the role of child molestation
in the transmission of HIV include lack of recognition among lay persons and
professionals; hesitation and fear to get involved in the controversy; legal
barriers to HIV testing of molesters and abused children; lack of monitoring
of sexual abuse as an exposure category for HIV transmission; poor access to
HIV status of accused molesters; and a reluctance to consider molestation as
the route of infection if any other risk factors can be identified.
You write, “The unveiling of the HIV-infected child molester is not a
fluke, but the predicable outcome of the collision of child sexual abuse and
the AIDS epidemic.” What evidence is there to support that assertion?
Even with these barriers to reporting child molestation associated HIV transmission;
evidence is emerging, albeit slowly. Most information comes from individual
clinicians. The following anecdote, from researchers at New York University,
is typical of such case reports.
A four-year-old girl underwent testing for HIV along
with her mother and two younger brothers because her stepfather was diagnosed
with AIDS. She tested positive and was found to have enlarged glands in her
neck, armpits, and groin. During a careful sexual abuse evaluation, sexual
molestation by the stepfather was confirmed.
On a broader scale, the Duke Pediatric AIDS Clinic
found that out of ninety-six HIV-infected children, fourteen had been sexually
abused. Ten children had additional high risk factors other than molestation.
As a result, they were excluded, even though these children may have gotten
HIV through sexual abuse. However, because of the bias against sexual abuse
as an exposure category, they had to be eliminated. In other words, these ten
children had other risk factors and may or may not have contracted HIV from
sexual abuse. Four percent of the Duke population definitely had gotten
the AIDS virus from child molestation.
In another report, a known child molester with AIDS sexually abused fifteen
children. Three of these victims became infected with HIV. That is a twenty-
percent infection rate.
The literature confirms the thesis that child molesters
with AIDS exist.
How many children have contracted HIV
via child sexual abuse?
The number of children who have acquired HIV from child molesters is unknown.
A large group of children may have been exposed to HIV infection.
Although sexual transmission of HIV in adults has received intense investigation,
sexual transmission of the AIDS virus to children has received almost no inquiry.
Why?
Organized health care has ignored this important issue. In the early years
of the AIDS epidemic, HIV infection was thought of as a homosexual problem.
Gay and lesbian groups lobbied to prevent further stigmatization. For example,
they successfully fought to protect a person's HIV test results against unnecessary
disclosure.
How did you come up with the title Unacceptable Risk?
The greatest problem in America may not be murder, drug abuse, cancer, or heart
disease, but rather the exposure of children to abuse. It is unacceptable to
condition youth to accept maltreatment as normal, to diminish their enjoyment
of life, or to shorten their lives. Yet, this is happening more frequently,
as the incidences of HIV infection and sexual abuse are both increasing. The
risk is unacceptable!
Why is it so important to identify HIV
transmission?
Now that the treatment of AIDS is showing documented benefits, it is even more
important to identify and test victims of sexual abuse for HIV. Public health
authorities need to spend more energy on early detection, mandatory reporting,
and contact tracing.
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