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There have been no reports of seroconversion in any patient where the drugs have been used correctly after sexual aggression 12, There has also been no cases of seroconversion in any of our patients. In view of the above considerations, the objective is to discuss the difference between women who seek health care within 72 hours and those who did not, pertaining to socialdemographic factors and dimensions of violence.
The total area of Sao Bernardo is km 2 and its population is approximately , inhabitants , are females , according to the Brazilian Institute of Geography and Statistics 8. Data were obtained from patients' files, which included a questionnaire and a description of the victim's clinical examination.
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The independent variables were: age, school degree, marital status, pregnancy at the time of the aggression, time of arrival at the hospital, previous use of contraception, previous sexual activity, identity of the aggressor, number of aggressors, type of crime, and presence of a police report and physical trauma at the first examination. The dependent variable was the time between sexual aggression and the arrival at the hospital.
Women were divided into three age groups after calculation of mean and standard deviation using quantitative data: adolescents 10 to 19 years old 9. The inclusion criterion was all women who suffered from sexual aggression and who agreed to enroll in the study during the period of ; the exclusion criteria was male gender and cases of chronic sexual abuse against children. In order to evaluate normality of the variables we used the Anderson-Darling test.
Tests of hypotheses for proportions used were chi-square or Fisher exact test. The odds ratio was calculated by logistic regression.
In order to analyze factors such as school degree and marital status, it was assumed that age would be a variable that modified the effect in logistic regression models. We analyzed two models: model A, with the independent variables not controlled by age, and a model B, with variables controlled by age. The total number of patients included in the study was The majority of women The most frequent event was vaginal coitus Two or more events occurred in In As for physical trauma, The aggressor was known by the victim in Controlling for age in multiple regression analysis model B did not alter our findings , there was implying that the high number of young women did not alter results in any variable.
Knowledge of the aggressor was significantly associated with delay in seeking health care.
The fight against sexual violence requires integrated actions of all government sectors including education, justice, social action, civil society and health. This fight includes protecting victims from unwanted pregnancies as well as sexually transmitted diseases and psychological damage 11, This may be related to both the physical attraction toyounger woman as well as their vulnerability to aggression because of their immaturity 12,7. Our findings are consistent with previous reports. We found that the average age of victims was However, our analysis revealed that the victim's age does not contribute to early or delayed seeking of health care services.
HIV infection is serious concern for women subjected to sexual aggression. Previous investigations showed that the risk of infection in these cases ranges between 0. The risk of infection depends on several conditions, including type of sexual exposure anal, vaginal, oral , number of aggressors, susceptibility of women, trauma or genital lesions associated with the aggression, viral status of the aggressor, and, most important, the time elapsed between the contact with the infected person and the onset of prophylactic medications 3,16, There is consensus in the literature that anti-HIV prophylaxis must be initiated as early as possible following the crime , because the virus reaches the bloodstream and is able to infect macrophages after about 48 hours of penetration through the failure of the skin and mucosal barriers.
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This implies that 72 hours is an acceptable limit within which the antiretroviral drugs could exert a protective effect 19, The lack of important technical details discussed before may have contributed to We found that one of the factors that cause delay in seeking health services is the victim's knowledge of the aggressor. Other factors which may contribute to the delay include embarrassment and humiliation experienced by the victim as well as fear of retaliation by an aggressor who may easily find the woman.
This fear may outweigh a woman's fear of pregnancy or infection. Another type of sexual aggression which is unlikely to be recognized or reported is "marital rape" which happens when relationships end in supposedly consensual aggression Intimate partner violence IPV remains a problem of public health significance associated with bruises, wounds, and severe burns at individual level The experience of violence reinforces gendered power inequalities that impact on women's vulnerability, such that women who have less power in their sexual relationship are at higher risk of any kind of violence and its consequences We found that the presence of non-genital trauma and reporting the crime to the police were significantly associated with early arrival of the patient to health care services.
This finding confirms that professionals in police stations and in emergency rooms refer post-sexual aggression victims as soon as possible to the reference health services, which demonstrates an integrated and well coordinated municipal network to assist the victims of crime.
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An unexpected finding from our study was that genital trauma, in similar proportions to the extra-genital trauma, did not influence the time of arrival of women. Most injuries caused by sexual aggression were of small gravity, such as excoriation, bruises light, superficial hematomas and ecchymosis. However, these genital injuries did not contribute to early reporting to police or health care services. It seems that embarrassment and social taboos make it difficult for victims to display injuries to their genital organs, such as lacerations and vulvar or vaginal bleeding.
Thus, diminishing family blame would be more advantageous in cases of severe abuse In conclusion, we found that most victims of sexual aggression sought medical care within 72 hours after the crime. Most victims were young with an average age of Vaginal penetration was the most commonly committed crime, followed by a combination of vaginal penetration and indecent anal or oral aggression.
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The victim's knowledge of the aggressor also resulted in a delay in seeking health care services. Therefore, public policies promoting integration between the different sectors involved in the sexual violence issue can result in a positive impact in reducing and controlling the complications of this crime. World report on violence and health.
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