Journal of Epidemiology and Community Health 1997;51:103-104

103
GIOVANNI MELEDANDRI
MARIA SOFIA CATTARUZZA
ESTER ZANTEDESCHI
CARLO SIGNORELLI
JOHN FREDERICK OSBORN
Istituto di Igiene,
Universitd "La Sapienza",

LETTERS TO
THE EDITOR

Rome, Italy

Does child abuse influence subsequent

sexual behaviour and risk of AIDS?
SIR We are concerned about the prevalence of child sexual abuse in Italy. It is approaching
5%, which is similar to estimates (from 1-5%) for other western societies.' This implies that in Italy about 450 000 children aged 0-14 years and the same number aged 15-24 years
(data from the census of 1991) are sexually abused each year. It has been estimated that in
1994 in the USA about three million children were abused.2
We are also concerned about the effect that this abuse may have in later life. Indeed, sexually abused children exhibit behavioural indicators such as: bizarre, sophisticated, or unusual sexual behaviour or knowledge; seductive or promiscuous behaviour; poor peer relationships; prostitution; forcing sexual acts on other children; truancy; and self-injurious
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behaviour.2

In a national survey concerned with sexual behaviour which was based on a random sample of young Italian adults in 10 cities, there was a specific question about child abuse.3 The anonymised questionnaire was posted to a randomly selected sample of 8404 men and women 1 % of the total population aged 19-24.
Altogether 2776 questionnaires have been returned completed so far. A possible association between child abuse and risk behaviour, was looked for among the 1339 males. Sixty four (4.7%) of them had experienced sexual abuse during childhood.
Even given the limitations of the data obtained, a prevalence of child abuse that is nearly 5% is alarming.
More of those who were abused in childhood were already sexually experienced
(86%) than those not abused (68%) (odds ratio (OR)=2.97, 95% confidence interval
(95% CI) 1.27,6.96). They were also more likely to have engaged the services of a prostitute (23% versus 11%) (OR=2.35, 95%
CI 1.28,4.31). Even when only those males who were heterosexually experienced were considered, those who had been abused had an OR of 2.27 (95% CI 1.21-4.26) for having experienced sex with prostitutes (29% versus
15%). The tendency to use prostitutes seems to be independent of the tendency to be sexually experienced. Although based on relatively small numbers, the chance of developing homosexual or bisexual tendencies is markedly increased (9.4% versus 0.5%)
(OR= 22.38, 95% CI 6.63,75.49). These activities are also known risk factors for HIV
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infection.

It seems from these preliminary results that sexual abuse in childhood is a trauma which has a lasting effect on psycho-sexual development in adolescence and ultimately in adulthood. Although, the data should be considered with caution because of the possibility of confounding, campaigns aimed at limiting child sexual abuse may have important consequences for AIDS prevention as well.

1 Graham P. Child psychiatry: a developmental approach. 2nd ed. Oxford: Oxford University
Press, 1991.
2 The identification and reporting of child abuse and maltreatment. Albany, New York: New York
State Syllabus. The University of the State of
New York. The State Education Department,
1991.
3 Signorelli C, Cattaruzza MS, Zantedeschi E,
Bossi A, Fara GM. Le abitudini sessuali dei giovani Italiani: risultati di un'indagine nazionale. Panorama della Sanita 1994;38:19-23.

Decline in sex ratios at birth, England and Wales,
1973-90
SIR - In reply to W H James's letter in the
December 1996 issue of the Journal,' we wish to point out the following. We originally analysed the sex ratio for the period 1950-92 using logistic regression and found a significant linear decreasing trend, even after allowing for the proportion of births to older mothers, who are known to be more