A study on knowledge and prevalence of sexual harassment and abuse among schoolboys in Colombo District

Objectives To determine knowledge of sexual harassment and abuse among schoolboys aged 14 to 19 years, assess prevalence, frequency and severity of various types of sexual harassment and abuse, assess frequency of reporting incidents of sexual harassment and abuse to a trustworthy person, determine reasons for non-reporting and determine characteristics specific to sexually abused schoolboys. Design A descriptive cross sectional study Method Data was collected from 242 schoolboys aged 14-19 years from 2 Colombo district schools using a pre-tested and self-administered questionnaire. Results Among the 242 students surveyed, 3.7% had knowledge on sexual harassment and 31% had knowledge on sexual abuse. 190 (78.5%) students had experienced sexual harassment and 53 (21.9%) had experienced sexual abuse. Commonest type of sexual abuse was oral sex with a prevalence of 9.5%. 10.7% students had been subjected to penetrative sex. Commonest reason for not reporting an incident of sexual harassment and sexual abuse was fear. Prevalence of sexual abuse was highest in the lower social class. Mother working abroad, being separated from both mother and father, not having any reliable friends were possible risk factors for being subjected to sexual abuse. Conclusions Prevalence of sexual abuse in schoolboys exceeds global figures. Prevalence of sexual harassment is on par with global figures. Knowledge on sexual harassment was extremely low and on sexual abuse relatively low. ___________________________________________ 1 Medical Student, Faculty of Medicine, University of Colombo, 2 Senior Lecturer, Department of Community Medicine, University of Colombo. (Received on 3 November 2003) Introduction Child abuse is maltreatment of a child by physical abuse, nutritional neglect, sexual abuse, intentional drugging, neglect of medical care, emotional abuse, and child labour 1 . In the past decade there has been increased global awareness of child sexual abuse and harassment. In 1997 a Presidential task force was set up on child abuse and the National Child Protection Authority (NCPA) instituted in 1998. NCPA has probed many incidents of sexual abuse highlighting them via the media, so that public knowledge and awareness was increased 2 . Child sexual abuse is defined as “The involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which child is not developmentally prepared and cannot give consent, or that violate laws or social taboos of society. Child sexual abuse is evidenced by an activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. This may include but is not limited to inducement or coercion of a child to engage in any unlawful sexual activity; exploitative use of a child in prostitution or other unlawful sexual practices; exploitative use of children in pornographic performances and materials” 3 . Sexual harassment is defined as “Sexual advances, requests for sexual favours, and other verbal or physical conduct of a sexual nature when submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment, education, living environment, or participation in a University activity or such conduct has the purpose or effect of unreasonably interfering with an individual’s employment or educational performance or creating an intimidating, hostile, offensive, or abusive environment for that individual’s employment, education, living environment, or participation in a University activity” 4 . Although worldwide, girls have a higher prevalence of sexual abuse, according to studies in Sri Lanka, 21% boys were abused as against 11% girls 1 . This may be because girls are more protected than boys as virginity is traditionally considered important. Furthermore, hormonally primed boys have access only to boys who are less well protected 1 . There are many physical effects of sexual abuse in children. Studies show that the risk of contracting sexually transmitted diseases is higher in abused children 5 . Nearly 50% of HIV infected people in the world are under 25 years of age 6 raising the possibility that there could be a large number of abused HIV infected children. Other physical sequelae include abrasions, lacerations, anal redness, usually found shortly after abuse has taken place but often absent later, when compared with girls 5,7 . Psychological effects include post-traumatic stress syndrome, depression, anxiety personality disorders, paranoia, poor self image, bulimia etc. Other effects of sexual abuse include sexual dysfunction, confused sexual identity, hypersexuality, substance abuse, decreased school performance and legal problems. Previously abused boys re-impact the abuse by abusing other children or become future child sex abusers themselves 5 . Emotional problems are commoner in males than females; males are known to externalize their emotions while females internalize them at most times 8 .


Introduction
Child abuse is maltreatment of a child by physical abuse, nutritional neglect, sexual abuse, intentional drugging, neglect of medical care, emotional abuse, and child labour 1 .
In the past decade there has been increased global awareness of child sexual abuse and harassment.In 1997 a Presidential task force was set up on child abuse and the National Child Protection Authority (NCPA) instituted in 1998.NCPA has probed many incidents of sexual abuse highlighting them via the media, so that public knowledge and awareness was increased 2 .
Child sexual abuse is defined as "The involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which child is not developmentally prepared and cannot give consent, or that violate laws or social taboos of society.Child sexual abuse is evidenced by an activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person.This may include but is not limited to inducement or coercion of a child to engage in any unlawful sexual activity; exploitative use of a child in prostitution or other unlawful sexual practices; exploitative use of children in pornographic performances and materials" 3 .Sexual harassment is defined as "Sexual advances, requests for sexual favours, and other verbal or physical conduct of a sexual nature when submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment, education, living environment, or participation in a University activity or such conduct has the purpose or effect of unreasonably interfering with an individual's employment or educational performance or creating an intimidating, hostile, offensive, or abusive environment for that individual's employment, education, living environment, or participation in a University activity" 4 .
Although worldwide, girls have a higher prevalence of sexual abuse, according to studies in Sri Lanka, 21% boys were abused as against 11% girls 1 .This may be because girls are more protected than boys as virginity is traditionally considered important.Furthermore, hormonally primed boys have access only to boys who are less well protected 1 .
There are many physical effects of sexual abuse in children.Studies show that the risk of contracting sexually transmitted diseases is higher in abused children 5 .Nearly 50% of HIV infected people in the world are under 25 years of age 6 raising the possibility that there could be a large number of abused HIV infected children.Other physical sequelae include abrasions, lacerations, anal redness, usually found shortly after abuse has taken place but often absent later, when compared with girls 5,7 .
Psychological effects include post-traumatic stress syndrome, depression, anxiety personality disorders, paranoia, poor self image, bulimia etc.Other effects of sexual abuse include sexual dysfunction, confused sexual identity, hypersexuality, substance abuse, decreased school performance and legal problems.Previously abused boys re-impact the abuse by abusing other children or become future child sex abusers themselves 5 .Emotional problems are commoner in males than females; males are known to externalize their emotions while females internalize them at most times 8 .

Objectives
To determine knowledge of sexual harassment and abuse among schoolboys aged 14-19 years, assess prevalence, frequency and severity of various types of sexual harassment and abuse, assess frequency of reporting incidents of sexual harassment and abuse to a trustworthy person, determine reasons for non-reporting and determine characteristics specific to sexually abused schoolboys.

Method
A descriptive cross sectional study was carried out in 2 schools in Colombo district.Study population consisted of schoolboys aged 14-19 from years 10-13.Students from year 10 upwards were selected because they were able to understand and answer our questionnaire better.
Stratified sampling was used.First the grading used by the Department of Education for Colombo district boys' schools was identified.Type 1AB and Type 1C schools were chosen as they had classes from years 1-13 and a student population aged 14-19 years.One each was randomly selected from schools with types 1AB and 1C grading.In the 2 schools, each year of study (10, 11, 12,  13) was considered as a separate stratum and half the number of classes from each stratum randomly selected.Some grades had extra classes.To ensure that every student had an equal probability of being included in sample, half the number of classes were selected from each year of study.All students of selected classes were included in study.To ensure reliability and validity, study sample was targeted at 200.After considering number of students in the 2 schools and our sampling method, we included 42 additional participants.Of the 242 students, 196 were from type 1AB and 46 from type 1C graded schools.
We had to do survey during school hours with minimal interference to academic activities.Thus we planned to collect more data in a limited time.As information obtained from students is highly personal, we used a self-administered questionnaire to collect data.Questionnaire was prepared in English and translated to Sinhalese.It comprised general information, knowledge on sexual harassment and abuse, 11 questions on identified acts of sexual harassment and 5 questions on identified acts of sexual abuse.

The Study
Study was carried out in the 2 schools on 6th and 9th May 2003 during the interval.Students of selected classes assembled in the main halls of the 2 schools.Seating arrangements were made so that there were two seats in between each student.The research was explained through public address system and instructions given.At the end, question papers were collected in a ballot box type of container.Ethical clearance for study was granted by the ethical review panel of Faculty of Medicine.For each form of sexual harassment the following questions were asked.This is not statistically significant (Z score 0.29; p>0.05).There was no significant difference between prevalence for various types of sexual abuse between O/Level and A/Level age groups (p>0.05).

Discussion
Our study involved 242 schoolboys in the 14-19 year age group with a mean age of 15.7.90% were living with their mother.52% mothers had no occupation.72% were living with their fathers.51% fathers were engaged in a middle social class occupation.57% fathers did not consume alcohol.48% received constant support from their relatives.64% had friends with whom they could discuss their problems.
Only According to a study done in High schools in America in grade 8-11 students, prevalence of sexual harassment was 79% 9 .In our study 78.5% students were sexually harassed.In the United States of America the commonest forms of sexual harassment were sexual gestures, comments, jokes, looks accounting for 80% of total 10 .In our study commonest forms of sexual harassment were receiving obscene letters or notes from someone (40.5%), request to join in a sexual activity (31.0%), sexual gestures (26.5%), and being touched on genitals against his wishes (26.0%).Sexual harassment creates confusion, discomfort and fear.It makes the victim embarrassed, ashamed or angry, and often lowers his self confidence and self esteem 9 .
39% students that received obscene letters or notes, 20% who were requested to join in sexual activities, 19% who were subjected to sexual gestures and 30% who were subjected to sexual gestures reported incident to a trustworthy person.Fear (33.3%), shame (25%) and taking it as a joke (19.4%) were the main reasons for non-reporting.
In a study conducted by Prof. Harendra de Silva among A/Level students and university undergraduates the prevalence of sexual abuse in males was 21% 1 .In our study the prevalence of sexual abuse was 21.9%.In a study conducted in Geneva among school children aged 13 to 17 prevalence of sexual abuse of boys was 10.9% 11 .
Oral sex and intercrural sex were the commonest types of sexual abuse.10.7% of study population were subjected to penetrative sex.This is higher than the 1.1% rate recorded in Geneva study 11 .The least common form of abuse was being used for pornographic photos and films with a prevalence of 3.72%.In the Geneva study prevalence for being used for pornography was 0.5% 11 .
Studies on sexual abuse of boys have indicated many reasons for not reporting such incidents.Fear, social stigma against homosexual behaviour, necessity to show self reliance, as they don't like to talk about painful experiences, their pride in being able to handle any situation and concern for loss of independence, were some of the factors identified 5 .In our study fear (50%) and shame (25%) were the 2 most common reasons for not reporting an incident to a trustworthy person.Least number of reportings to a trustworthy person were recorded in incidents of oral sex (8.7%) and pornography (11.1%).WHO world report on violence and health states that males are less likely than females to report sexual assault to authorities 11 .A similar picture was seen in our study.Reasons given for not reporting incident to a trustworthy person were also good descriptions of the psychological impact caused by sexual abuse 8 .
In assessing the degree of severity, been used for pornography and anal sex were at the top, with 66% and 35% of students mentioning that they took part in the activity more than two times in the respective categories.
There was a statistically significant increased prevalence of sexual harassment in sexually abused students compared to non-abused students (p<0.05).
A significant number of abused students had their "mothers working abroad" compared to non-abused (p<0.05).The WHO world report on violence and health states that the child's vulnerability to abuse increases by living with only one parent 12 .Mother living in the country within a reachable distance seems to be a protective factor against sexual abuse.There was no significant difference in the rates of "father working abroad" or "father not alive" between abused and nonabused.18.8% of abused students were living separated from both mother and father in comparison to 5.32% non-abused students (p<0.05).
When the sample population was categorized into various social classes according to fathers occupation prevalence of sexual abuse was significantly higher in the lower social class than middle social class (p<0.05).This was similar to the findings in Prof. De Silva's study 1 .There was no significant difference of prevalence among the middle and higher social classes.
Although WHO world report on violence and health mentions that lack of extended family support is a risk factor for sexual abuse in male child 12 this was not supported by our study.
15% of abused students and 4.7% non abused students had "no reliable friends at all".(p<0.05)Therefore not having a reliable friend is a possible risk factor for the male child to get sexually abused.
There was no significant difference between O/Level and A/Level age groups regarding the prevalence of sexual abuse (p>0.05).Hence the majority of abuse seems to be happening well before the child comes to the Advanced level classes.These findings are consistent with the Geneva study where abuse of boys takes place between the ages of 8 and 15 4 .

Conclusions
This study shows a high prevalence of sexual harassment in the schoolboy on par with global figures.Prevalence of sexual abuse far exceeds global figures.Knowledge on sexual abuse was low and on sexual harassment extremely low This means that many students are sexually harassed by others within the cultural norms of society without even the victim's awareness.Urgent attention is needed in strengthening protective barrier around the boy.

Limitations of study
• We could have obtained valuable information about age of onset of abuse and harassment by including students below 14 years of age.Due to probable inability of such students to answer questionnaire accurately we did not include them.
• We restricted our research to two schools because of lack of time and manpower.A larger sample and a more accurate representation of Colombo district schools would have been ideal.
• We were unable to take equal samples from each school because of sampling method and different school populations.Validity would have increased if the 2 samples were equal.
• As new term for A/Levels had just begun some streams did not have classes.Therefore we were unable to get good representation of advanced level students.
• We could not get details of abuser, place of abuse, details of harasser and place.We also could not include all types of abuse, and had to restrict ourselves to what we thought were the most important types of harassment.
• We wanted to study specific student populations in schools, e.g.hostels, sports teams etc.This could not be done because of difficulty of getting permission as well as time constraints.

Table 5
Distribution according to father's occupation Distribution about friends is shown in table 8.
To determine knowledge on sexual harassment and abuse we asked students to write what they understood by the words 'sexual harassment' and 'sexual abuse' and to give examples.Only 9 (3.7%) students were able to describe sexual harassment correctly.The majority wrote about physical forms of sexual harassment, and did not include written, visual and verbal forms in their explanation.75(31%)studentscould describe what sexual abuse was.Distribution according to knowledge on sexual abuse for each age category is shown in table9.
Prevalence of sexual harassment for each age category is shown in table11.Frequency for various types of sexual harassment in study sample is shown in table 12.We selected the 4 commonest forms of harassment and assessed severity by number of times incident happened to each individual who was subjected to it (table13).
•Has this type of sexual harassment happened to you? • If so how many times?• Did you report this to a person whom you trust?• If you did not report what was the reason for not reporting?
We assessed degree of severity according to number of times each type of sexual abuse happened to the students (table18).
Reasons given by students for not reporting an incident of sexual abuse to a trustworthy person and their frequency are shown in table 20.
Students aged 14-16 are in O/Level age group and those aged 17-19 in A/Level age group.41 (23.6%) of 174 students in O/Level age group were sexually abused compared with 9 (21.4%) of 42 in A/Level age group.
4% students knew what sexual harassment meant.31% students knew what sexual abuse meant.There was increasing knowledge on sexual abuse with age.Whilst at age of 16 years, only 31% had any knowledge on abuse by 18 years it had risen to 71%.