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Youth in Conflict_Melissa Sharer and Marcy Levy_10.17.13
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Youth in Conflict_Melissa Sharer and Marcy Levy_10.17.13


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  • 1. AIDSTAR-One The Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs Melissa Sharer & Marcy Levy John Snow, Inc. (JSI) AIDS Support and Technical Assistance Resources Project, Sector 1, Task Order 1 (AIDSTAR-One) USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008
  • 2. Background •Estimated 150 million girls and 73 million boys under 18 have experienced sexual violence and exploitation •Estimated 10 to 20 percent of child sexual violence and exploitation cases are reported to authorities •Overarching consequences that can affect immediate and long-term health and well-being •Services often not tailored to the unique needs of children and adolescents, nor to those of girls and boys
  • 3. Gender-based Violence Activities/Resources (children/adolescent specific) •The Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence (Technical Considerations for PEPFAR Programs) - 2012 •Assessments on post-rape care and referrals/linkages (in Lesotho and Mozambique) •Forensic nurses mentorship in Swaziland •A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health Facilities: Lessons and Tools •Case studies from Vietnam, Ecuador, and Swaziland describing GBV services
  • 4. Technical Considerations • No global guidance • AIDSTAR-One led collaborative process • Focus on a comprehensive response • Be adaptable and generalizable – serve as a resource for countries
  • 5. Guiding Principles • Promote the child’s best interest • Ensure the child’s safety • Comfort the child • Ensure appropriate confidentiality • When possible, involve the child in decisionmaking • Strengthen the child’s resilience • Have appropriately trained healthcare providers with experience in sexual violence • Health and welfare takes precedence over evidence collection • Reporting to police should not be a prerequisite for obtaining care • Person-first approach
  • 6. What Is Included •Minimum standards for facilities providing care •The program planning and development process •Medical management •The role of psychosocial and community support services
  • 7. Medical Management • • • • • Signs and symptoms Co-occurring issues Acute exams Non-acute exams Communicating with children • Consent • Taking a developmentally appropriate medical history • Psychological assessment • Physical exam • Ano-genital exam in the pre and post pubertal child • Special considerations • Evidence collection • Interpretation of findings • STIs, HIV and pregnancy • Reporting • Follow-up and referrals
  • 8. Community Support • Establishing and strengthening infrastructure • Education of healthcare • Education of law enforcement • Education of child protection workers • Ensuring access to HIV care • Establishing and connecting resources for referrals • Education of and raising support within the community
  • 9. Annexes • Glossary • Clinical site prep and set up job aid • Understanding informed consent • “Top to toe” physical exam • Describing physical injuries • Medical management job aid • Clinician’s role in evidence collection job aid • Sample history and exam form • Body maps • Nurses, doctors and social workers checklist • Providers role in linking community resources job aid • Promising practices • Care algorithm
  • 10. Practical Application and Next Steps • In September, hosted first country-level meeting in Tanzania • Identify elements from the Technical Considerations and develop preliminary plans on developing post-rape care guidelines and protocols • Relevant to your programs
  • 11. For more information, go to Contact: Melissa Sharer ( or Marcy Levy (