Hesperian Health Guides

Sexual abuse

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HealthWiki > Helping Children Live with HIV > Chapter 14: Preventing and addressing abuse of children > Sexual abuse


Sexual abuse is when adults or adolescents seek out children for sex. It can involve touching children, forcing them to perform or receive oral sex, or having penetrative sex in a child’s vagina or anus. It can also involve showing children sexual photos or films, making children pose for them, or forcing children to say sexual things or watch others having sex.

Almost all sexual abuse happens with someone close to a child, not with a stranger. It can be a relative, a family friend, a teacher, a healer, or a pastor. Usually the abuser is male. Older boys often abuse younger girls and boys.

Keep our chilren safe
No one has the right to use a child for sex
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  • Not a family member (child or adult)
  • Not a family friend
  • Not a neighbor
  • Not a stranger
  • Not a teacher
  • Not a caregiver
Not anyone!

Most abusers use a position of trust or influence to pressure a child to have sex. The abuser uses his power — expressed through “kindness,” gifts, threats, force, or all of these — to take advantage of a child. People may promise a child or her guardian a better life for the child, working as a maid or servant, but she is then abused or sold into prostitution.

Sexual abuse happens all over the world and in all kinds of families. It happens to boys and girls of all ages. Children with no one to look after them are especially vulnerable to sexual abuse. Sometimes when a child and an older man have a sexual relationship, the older man is called a “sugar daddy” because he gives the child money or food, or pays for clothes or school fees. This is still abuse, even if you do not see signs of sexual abuse and no physical force was used.

See below for more information about signs of sexual abuse.

Abuse causes lasting harm

Sexual abuse can cause serious physical harm. Children can be infected with HIV or other sexually transmitted infections, and girls can become pregnant before their bodies are fully grown. Sexual abuse of a baby or young child can cause severe tearing and injury to the vagina or anus, leaving lasting damage.

The emotional harm of sexual abuse is just as serious. Sexual abuse disturbs normal sexual development for children, forcing them to deal with feelings, thoughts, and experiences they are not ready for. Children who have been abused often feel deeply guilty and ashamed. They may also feel confused, afraid, or angry. Because of the abuse, they may later be unable to trust others or have loving adult relationships.

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Sexually abused children may later become violent, use alcohol or other drugs, and suffer from depression or thoughts about killing themselves. Some boys who are abused become abusers later. It is important to stop this cycle of abuse, to help children understand how abuse affects them, and learn how to heal.

Girls and boys who have been abused need support to heal, physically and emotionally. Treating abused children as damaged or ruined can worsen their feelings of guilt, shame, and depression. Working together at a community level to change this stigma is important for the health of our children.

How HIV makes children face more sexual abuse

Children affected by HIV may lack food, clothing, or shelter because of illness or death in their families. They may move into the home of a relative or neighbor. These difficult situations make children easier prey for abusers, who often offer needed items to persuade children to do things they would otherwise not do. Men in the household may feel it is OK to use the child for sex, and stressed caregivers may not notice or be able to deal with what is happening. Children getting used to new relationships to caregivers are more easily abused.

a man in a car speaking to a young girl
Hello, Sandra! Give your sick mama a rest, and come with me to get something to eat.

HIV sometimes causes disabilities in children, such as deafness or mental slowness, that make it difficult for children to understand or communicate about abuse. Also, an abuser may think it is OK to use a child with a disability for sex.

The stigma of HIV makes children and families affected by HIV less able to ask other community members for protection.

A very harmful myth makes some people believe that if a man has sex with a child (a virgin), his HIV will be cured. This dangerous belief is not true. Men who act on this myth can spread HIV to the children they abuse, especially because abuse often causes tears in the child’s skin that allow HIV to pass more easily to the child.

Preventing sexual abuse

To keep children safe, we must confront sexual abuse in our communities. Adults must face the fact that it happens. We can also help children learn what abuse is, be better able to resist it, and know who they can talk to if they are scared or worried about someone.

Caregivers can agree amongst themselves to watch out for the children in the neighborhood or area. Communities can work with the police and courts to ensure that abusers are quickly dealt with, in ways that protect children.

a woman speaking to a child
This kind of touching is not OK for children.
And if someone says you must keep a secret or something bad will happen, that is not true. You must tell me, OK?
OK.

Talk to your child about abuse by explaining different kinds of touching. For example: “Shaking hands is okay, sometimes a hug or a kiss is okay, but if someone touches you in your private parts, it is not okay.”

Talk to your child about secrets and how loving relationships do not involve secrecy and fear, especially not about being touched. Ask young children to say this back to you.

Assure your child you will always believe her.

Communicate with your children. Ask about their day, pay attention to what they say, and watch for signs they are worried or upset. Give extra attention to your child’s safety when he shares a room with adults or older children.

Help your child understand that some body parts are private

a woman speaking to a child
Wash your bottom, Dinah.
What is my bottom?

Children can learn names for different parts of their body by about 18 months old. Use the time you dress or bathe children to help them learn. Include names for their private parts, such as bottom, butt, penis, vagina. By ages 3 to 5 years old, children can understand that these are parts of their body that no one but them should touch. Also tell your child that she should not agree to touch someone else’s private parts or look at pictures of private parts. You can also use pictures or dolls to help your child understand. Be ready to repeat this information.

a woman speaking to a child
Where can you get help if I am away at work?
Aunt Winnie?
Or Nana!

Help your child know where to go for help

Make sure your child knows who he can talk to if someone touches him or asks him to do something that makes him uncomfortable. Name at least 3 people that your child can go to for help. They can be family members, neighbors, or anyone you trust who the child knows well.

a woman speaking to a child
If someone told you to go in the road and run in front of a car, should you do that?
Why not?
No.

Teach your child she can stand up for her rights

Most children are taught from a very young age to obey adults, to do as they are told. Children need to know that sometimes they may disobey.

Try making up different stories with someone asking a child to do things that are dangerous or wrong, or to keep a secret. Ask why the child should disobey, to see if she understands.

a woman speaking to a child
If someone hurts or scares you, yell or say, No! Let’s practice.


Explain to your child that if someone tries to touch her, hurt her, or make her go somewhere, she should yell for help. Help her practice shouting “No!” so she will be able to do it later, if necessary. Practice by telling stories, or using pictures, puppets, or dolls.

a group of children in a class
Yell, “Don’t touch me!”
Kick his knee!
What could she do to stop me?


School-age children can learn self-defense skills, different ways to make noise or say “no,” and how to hurt someone enough to get away.

When groups of girls practice these skills together, they become more prepared, more confident, and better able to use their skills.

How to know if a child has been abused sexually

Young children who are abused may not know how to tell you or may be afraid. Often the abuser warns the child not to say anything. Sometimes the child fears he did something wrong. Since children do not always communicate about abuse, you need to watch for signs. The following signs are not always the result of abuse, but they should always cause concern, especially if a child shows more than 1 of them.

Physical signs include:

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  • unexplained pain, swelling, and redness or bleeding of the mouth, the genitals, or the area around the anus.
  • torn or bloody underwear.
  • difficulty passing urine or stool, or blood in urine or stool.
  • unusual discharge from the vagina, penis, or anus, or a sexually transmitted infection.
  • bruises, headaches, or belly aches.
an older boy speaking
Let me see your wee wee.

Sexually abused children may:

  • stop bathing, or wash themselves more than usual, or refuse to get undressed.
  • play sexually with other children or with toys in a more knowing way or more often than you would expect for their age.
  • know more about sex than other children their age.

Child victims of violence, including sexual abuse, may:

a boy kicking a dog
Abused children often become more violent themselves.
  • seem very fearful, sensitive, and watchful, or suddenly become afraid of certain people or places, or want to be only with a parent.
  • be secretive or want to be alone most of the time.
  • start acting in a younger, more baby-like way.
  • try to run away from home.
  • feel sad most of the time or show no feelings at all.
  • have difficulty sleeping because of bad dreams, fears of the dark, and bed-wetting.
  • not want to be touched or do physical activities.

How abusers may act

a woman thinking while a man is outside the window
Why is he always around just when I leave for work?
Go on to work. I will watch them until your sister comes.

Most abusers are good at hiding their abuse. And sadly, they are often among the most trusted members of a family or community — a helpful uncle, a kind teacher, a priest, or a respected healer. But some ways of acting should raise concern if there are any other signs of abuse:

  • having an overly close relationship with the child, especially one with lots of close physical touching.
  • arranging to be alone with the child, or being found at an unexpected time or place with the child.
  • giving the child gifts and money.
  • strong changes in how the child acts when the adult is near, or in how the child talks about that adult.

If you suspect abuse

Stay calm. Encourage your child to show you what has happened or what she knows. Pay careful attention to what she says or shows you because she may not know enough words (or signs, if she is deaf) to explain herself clearly. She may be afraid no one will believe her.

Sometimes you can learn more about what happened by watching how a child plays or draws.

a woman speaking to a child
Can you use the dolls to show me what he did?

Some children can work out many upsetting feelings about abuse through play, if you allow them. Their play may show fear of the abuser, anger that no one protected them, or desire to punish. You may see signs they feel guilt, they think the abuse was their fault, or they fear that telling someone about it will cause harm. Using play this way takes time, but can help children a great deal.

Supporting a sexually abused child

Strong reactions from others may discourage a child who has been abused from saying more about what happened. Be as calm, reassuring, and loving as possible with the child. To help most:

  • believe what she says or shows you. Children rarely make up stories about sexual abuse. Some abusers are very friendly to parents, to make them less likely to believe or report abuse, and to gain better access to the children.
  • praise her for telling you. Children need to know that they have done the right thing by communicating about the abuse.
  • reassure her that the abuse is not her fault and that you are not angry with her. Use as many ways of communicating this as possible.
  • protect your child’s safety. Try to prevent future contact between the child and the abuser. If this is not possible, make sure you or someone who knows what happened is always with your child when the abuser is present.
  • contact the police or local authorities. Find out if the child should have a physical examination that can be used in court. If the abuse just happened, save any torn or stained clothing (with semen or blood on it), and do not wash the child before the examination.
  • get your child tested for sexually transmitted infections, even if she does not have any signs. Some sexually transmitted infections have no signs, or signs do not show until a child is older. Consider giving the child PEP, medicine that can prevent HIV infection if given within 72 hours of abuse. An older girl should be examined or tested for pregnancy even if she has not yet started her monthly bleeding.
a woman speaking to a crying child
Sarah, this is not your fault. You did nothing wrong. You are brave to tell me.
I know you feel bad. But Victor is the bad one. This should not have happened to you.


As a caregiver, you also need help. Caregivers feel many emotions when they learn their child has been abused, including disbelief, anger, sadness, and shame. Caregivers may blame themselves or each other for what happened. It can help to talk about these feelings with someone you trust. Writing, drawing, playing music or singing, or calming herb teas may help you. Be patient. It takes time for these feelings to change.

There is no shame to the family if a child has been abused. Abuse is a crime like theft. It is not caused by the family.

a woman speaking to a child
Alia, I know you feel bad now. But you will be happy again, and play with your friends and enjoy school —I promise.

A child may have trouble relating to people after being abused. She may feel guilty, sad, fearful, or angry. She may feel nervous or ashamed to see her friends or family. Encourage others to welcome her with understanding and caring. It may take time for the child to trust others again, but gradually she will resume doing normal things. It may help her to reassure her of this.

The community must help both abused children and their caregivers. Families need to be accepted and not avoided, insulted, or excluded. A child who is given support and treated kindly can recover well from abuse.

Sometimes children who were abused seem fine at first but become upset later. Watch for changes in behavior and continue to offer support.

Working in the community to stop sexual abuse

group holding a sign saying "My body belongs to me!"

Most people are not comfortable talking about sexual abuse, but creating awareness and helping people report and respond to abuse are important ways to protect children. Speak with teachers, health workers, religious leaders, police, service organizations and others to make sure they know how harmful child abuse is, and how common.

Community meetings and programs in schools can educate the entire community about sexual abuse. Acting out short plays or skits about the effects of sexual abuse sometimes makes it easier for people to discuss abuse as a group.

Here are some ways for communities to work to prevent sexual abuse:

  • Show abusers and children you will not remain silent. Report abuse when it happens, take abusers to court, and put them in jail if possible. If that is not possible, decide as a community how you will protect children from sexual abusers when they have been identified.
  • Hold workshops to help parents and teachers learn ways to communicate with young children about the danger of sexual abuse. Read written materials aloud with parents if discussion is not yet possible.
  • Train teachers, school staff, nurses, and other health workers how to notice signs of abuse and how to talk with a child who may be a victim of abuse.
  • Educate school children to prevent sexual abuse. This can include teaching children to watch out for each other, and providing age-appropriate education on healthy sexuality, such as the importance of consent.
  • Set procedures for reporting child sexual abuse in schools and institutions and explain them to parents.
How one community is healing from abuse

Our indigenous community has many problems, including unemployment, violence, alcoholism, drug addiction, and depression. But one problem nobody talked about for a long time was sexual abuse. It was a horrible, never-talkedabout secret. Then a group of us who work together began to open up and talk about how we had been abused as children.

It was very painful to share our own experiences of abuse, but it helped us see how much of a problem it was. We learned it was easier to bring it out in the open when when we worked together to make it safe to talk about it. This experience led us to raise the problem of sexual abuse publicly in our community, and we became more confident discussing it. When we brought the discussion to our schools, our children began to disclose that it was happening to them too. The abusers were the men in their families.

a woman speaking
We struggled about what to do. We believed the children when they told us they were being sexually abused, and we knew they needed to be protected and helped.
But we did not believe the Canadian justice system could help men learn how to be different.


When people go into the justice system they may find punishment, but they do not find help. And many families do not want their men jailed, for all the other problems that causes a family.

We saw both sides — the children needed counseling, support, and protection, and the men needed to take responsibility and repair their spirits. We did not want to send the men away only to have them return angry and hardened, and likely to abuse again. We wanted healing. When someone accepts real responsibility for the harm he has done, then healing is possible. We wanted to find a way to keep the men in the community to work on this, separate from the children, to protect them and their own healing process.

a group of men talking to a man
We expect you to change and we know you can change. We can all change.

Some of our men now work closely with men who are accused, which can be very hard work — for all of them. The men do not want to take responsibility. They deny, they try to manipulate the people around them, they make and break agreements. Counselors get mad and frustrated when they see the same behaviors and hear the same excuses time and again. It takes persistance to reach them, to convince them to admit the truth, and to understand the impact of their actions. A men’s group helps a lot, because a man does not feel alone with his guilt and shame there. Still, it takes a lot of time and patience.

We also began consulting our elders about our people’s traditions, the old ways we had given up. We re-learned the cleansing rituals and healing circles and they became important tools to help abusers change, to face what they had done to themselves and their children. These are serious ceremonies that work deeply on all who participate. Some broken families slowly came together again.

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Children depend on the men and women in our families and communities to watch out for them and care for them. We need our men to join in this work, and break the cycle of abuse. Knowing that we are healing by relying on ourselves, on our traditions — not on the white world that only sees us as problems to be ignored, rejected, or imprisoned — has made the whole community stronger.


This page was updated:27 Nov 2019