Hogrefe author Dr. Christine Wekerle writes about helping male victims of child sexual abuse speak out and asking ourselves as professionals some serious questions: Are we ready to hear about boys’ sexual violence victimization? Are we ready to ask the question and prepared to offer the empathic response victims are hoping to hear?
Christine Wekerle, PhD
Christine Wekerle, PhD, is Associate Professor of Pediatrics, Associate Member, Psychiatry and Behavioural Neurosciences, and is a facilitator for medical foundations courses at McMaster University. Dr. Wekerle has conducted research over the past 25 years into child maltreatment and related areas, particularly prevention of adolescent dating violence, trauma and adverse childhood experiences (ACEs). Dr. Wekerle has developed a resilience app, JoyPop, showing improvements in depression and emotion regulation (youthresilience.net).
Child sexual abuse (CSA) is a difficult topic for victims to confront. It challenges male victims much more to realize they live in a society that still believes in myths about men and boys, such as males cannot be rape victims, that they do not have emotional problems and can toughen out any situation, and that they are not as wonderful as nurturers as any other gender. As a society, we still have a way to go towards encouraging men and boys to be both self-compassionate and compassionate towards others.
The Difficult Conversation
Child sexual exploitation (CSE) refers to a legal minor involved in sexual activity in exchange for something, or the promise of something, from a perpetrator directly (e.g., money, food, clothes, shelteror, opportunity to travel) or third-party person (recruiter, handler, trafficker) (Interagency Working Group on Sexual Exploitation of Children, 2016). The 2000 United Nations (UN) Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children, specified the “use” of a victim “for a purpose”. In the case of a legal minor, under the age of 18, coercion is assumed given their dependency status (UN, 2000). The full consideration of definitions, including the distinction with child sexual abuse (CSA), was the work of the Interagency Working Group on Sexual Exploitation of Children (2016). The primary distinction is the notion of “exchange” in CSE, an element that is considered absent or to occur to a lesser degree in CSA. In research, CSE has been termed also as “child prostitution”, “child pornography”, “transactional sex”, and “survival sex”. All of these terms are meant to suggest that the child victim receives some form of personal gain, in exchange for the CSE act to the perpetrator. However, where legal minors are involved, the concept of gain is seriously challenged, both by the global consensus on child rights (i.e., UNCRC), and the state's agreed upon responsibilities and stipulatory obligations.
The 1989 United Nations Convention on the Rights of the Child (UNCRC) - with ratification by 194 countries globally - guarantees that the child has the right to live a life worth living and more. The countries that have not ratified this document protecting “the best interests of the child” include, the United States of America (US), Somalia, and South Sudan. The UNCRC and its accompanying subsequent documents, notably the optional additional protocols detailing the sale of children and child pornography and prostitution (2000), require the provision of basic needs, education, and a right to be free of violence. Signatory countries are required to submit reports every five years, noting that, since 2011, rights violations can be filed to the Committee on the Rights of the Child. In the US, the Trafficking Victims Protection Act was passed in 2000. The United Kingdom (UK) Investigative Inquiry in Child Sexual Abuse encountered CSE cases emanating from organized networks in England and Wales. Beyond adult traffickers, adolescents and young adults may coordinate CSE via online communications, indicating a wide range of parties invested in CSE. Herein, we consider the upper age limit for examining CSE as 18 years old, the age by which most countries identify legal majority and/or consent to sexual activity (i.e., kissing and fondling to sexual intercourse). A prior review from our research team (Moynihan et al., 2018) pointed to clinician gaps in recognizing males are victims of sexual exploitation and service-seeking is challenged by stigma. Further, Saewyc and colleagues (2021) highlight that youth are spending some time living in the family home, while being exploited on the street. Caregiver and guardian protection remains a key prevention pathway.
Wekerle and colleagues have partnered with ECPAT International to review the up-to-date peer-reviewed and grey literature, with 69 studies informing conclusions and recommendations (https://ecpat.org/wp-content/uploads/2021/09/Global-Boys-Initiative-Literature-Review-ECPAT-International-2021.pdf). Among CSE boy victims, we see impact themes of struggles with mental health, substance abuse, self-harm and sexual health. Further, discrimination when service-seeking, threats of police arrest and detention, homelessness, and a lack of supports to gender-diverse youth all point the critical importance of trauma-informed care, training for professionals, as well as a recognition of the overlap among CSE and other forms of childhood maltreatment. Consideration of the emotional and psychological implications for boy survivors is not evident, where only one study employed evidence-based practice (trauma-informed cognitive behavior therapy).
Based on this extant literature, we advocate for a standardization and enforcement of the age of sexual consent laws. Most countries have laws in the mid-adolescent to late adolescent ranges (ages 14 to 18); however, some countries identify pre-adolescents, and some countries do not specify or specify conditions (e.g., must be married). This knowledge, along with child and youth rights, is needed to universal, age-appropriate sex and gender education. Gender-diverse youth advocate for safe spaces to discuss sex and their experiences - moving from the question of "what's wrong with you?" to "what's happened to you?" Clinicians can always consider the potential presence of family violence and CSE in working with youth and young adult clients; child sexual abuse was the most studied risk factor for CSE. Given the global rise in child sexual abuse material on-line, as well as rates of child luring online (Statistics Canada), we can all speak up when we see something is wrong. Prevention remains a priority. The clear question to practice and policy remains: have we done enough (Simon & Conte, 2020)?
Speaking out is a big ask for anyone who has been through sexual trauma and this is especially true for males, who are far less likely to disclose a history of CSA. Research shows that male survivors are more reluctant to vocalize their abuse than females, with a very wide range of reported rates, with some studies showing higher rates than the generally accepted rate of less than 10% (Moynihan, Mitchell, Pitcher, Havaei, Ferguson, & Saewyc, 2018). Without support, people who have been abused are at risk of isolation and negative consequences for their health and wellbeing. Whilst female victimization is undoubtedly more common, male victimization presents a complex and distinct set of challenges.
To address these challenges I have been leading a team in Canada who are undertaking an innovative new set of studies in which male survivors of CSA are put at the fore, active on social media with #CIHRTeamSV (see here). By exploring experiences of men and boys who have been victims of this violence, we hope to help develop ways to better intervene, and ultimately prevent sexual violence. Our team has been looking at prevalence, resilience, and interventions. In a review on interventions, Moynihan, Pitcher, and Saewyc (2018) found that most programs were gender-specific, targeting girls and young women with just one being for boys and young men only.
The Effects of Abuse on Young Males
CSA is a common experience of young people who were involved in welfare services in Canada, as our study, which was funded by the Canadian Institutes for Health (CIHR), has shown (Wekerle, Goldstein, Tanaka, & Tonmyr, 2017). In the study of almost 300 youths aged 14–17, 38.3% had experienced this type of abuse. All of the young people in this study – the first to evaluate motives for sexual behaviours in young people who have experienced sexual abuse – were sexually active. A history of sexual abuse was more commonly linked to risky sexual behaviours (including multiple partners and unprotected sex) for both genders. Compared with males who had not experienced sexual violence as a child, victims of this abuse were more likely to use sex as a coping mechanism to deal with negative emotions and to seek peer approval, using sex to manage distress. We argue that this fits with conforming to traditional male stereotypes.
A study from our team used Quebec population data of youth with a substantiated CSA report and who have either aged out of child welfare care (average age = 18 years) or remain in care (average age = 18 years) (Daigneault, Esposito, Bourgeois, Hébert, Delaye, & Frappier, 2017). Mental health service needs were five times greater for youth with CSA experiences than the general population, and this frequent service need did not differ between the aging out versus younger youth. There was an increase in need for physical health services from ages 17 to 18 (on average 3.22 more consultations). This suggests that health needs will continue post exit from child welfare. For males, instead of acknowledging and dealing with the range of emotions that CSA can inflict on a young person, and promptly taking care of physical health issues, males may retreat into anger and cycles of negative health risk behaviours. For youth who have made it into a service system, a transition plan for health seems essential. A key theme from CIHRTeamSV is that emotion regulation is key to determining healthy coping strategies, as well as sexual and relationship behaviours in adolescence. We need to be ready to consider the particular needs of males who have experienced child sexual abuse.
Distressingly, the research also highlights that victims of childhood abuse also experience sexual coercion from partners, and that more needs to be done to understand how to help young people avoid re-abuse in future relationships. The work of CIHRTeamSV also focuses on resilience: we are currently developing an app which contains games that might be relevant for male youth who struggle to manage emotions and behaviour. We need to meet male youth victims where they are at, in the worlds they inhabit, to be successful at that critical outreach.
Learning to Listen
I advocate that in order to build the necessary support networks around boys that are vital to helping young people cope, we must be ready to listen to males and accept that they too can be victims. As the overwhelming majority of sex abuse is perpetrated by men, we are challenged in how we view “maleness.” Our contemporary conversation reflects this in developing a male #MeToo approach to allow all victims to come forward, and movies and documentaries such as “Spotlight”, “The Mask We Live in”, and “The Heart of a Man” are putting this conversation into broader view. Cultural and societal ideas of masculinity make it more difficult for young men to seek help for emotional issues, which may play a role in the high rates of suicide seen in this demographic and the ten-fold increase in risk in being hospitalized for a physical health problem compared with people in the general population. Fixed, long-standing stereotypes around “alpha” males – so-called toxic masculinity – make it difficult for men to admit that they have been abused and reach out for help and nurturance, rather than resort to destructive approaches to numb the pain. These stereotypes affect us all – for example, child welfare case workers were found to note less often that males have experienced emotional harm as a result of their abuse (Wekerle et al., 2017). This is a disconnect with research showing that many male victims experience symptoms of post-traumatic stress disorder (PTSD), yet are more than twice as likely to seek treatment for mental health problems than female victims. As professionals, we need to ask ourselves if we are preparing our pediatric clients for what they may encounter as young adults and across adulthood. Healthcare professionals need to bring youth into the wellness visit strategy that goes beyond following a vaccination schedule. Violence and mental health have evidence-based inoculations as well (Daigneault, Vézina-Gagnon, Bourgeois, Esposito, & Hébert, 2017).
The Way Forward
Our research points to a number of actions that need to be taken in order for male victimisation to be addressed. These include acknowledging sex and gender and accepting that males can also be victims, having a trauma-informed healthcare provision, ensuring safety in young people’s relationships, and tackling sexual violence from a public health perspective (see Wekerle, 2017). We can advance boys’ initiatives without diminishing the important strides that need to be made for all victims. That said, the United Nation’s ratified Sustainable Development Goal (5) on sexual violence is specific to females, as in most parts of the world, female victimization is higher than male victimization.
By bringing male victims of sexual violence to the fore of our research, we give hope to boys and men – and those who care for them – that they will find support to cope with their experiences and that researchers are paying attention and are willing to listen. Confiding in trustworthy adults is the most effective way that children can be helped out of sexual violence. Support from education, social, and health services is the best way for survivors to be supported to deal with ongoing psychological effects as a result of this violence. Together, we can bring light to darkness, hope to helplessness, resilience to wrongs, and thriving to surviving.
This article is based on an article originally published online by Research Features here
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Wekerle, C. (2017, November 1). Specially Commended Institute of Healthy Development and Child and Youth Health (IHDCYH) Video Talks 2017: Boys’ and men’s health: Child sexual abuse prevention [Video file]. Retrieved from https://www.youtube.com/watch?v=k1qvzGhOWU4
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