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Perhaps the most definitive evaluation to date found that court-ordered treatment had no positive effect on rates of physical violence or threats of violence (as measured by self-reports, victim reports. and police records), or on key beliefs about wife beating and personal control of violence (Harrel 1991). Unlike other studies, this study compared men ordered by the court to obtain treatment with a group of men not ordered to attend treatment-a true control group. In addition, it compared men’s rate of violence before court intervention with their rate of violence after court involvement but before treatment, thus allowing researchers to evaluate whether the measured were due solely to treatment or due in part to the justice system’s involvement. The study found that rates of violence were lower after arrest and court hearing, but that treatment itself added no additional benefit. These findings suggest that most of the positive benefits attributed to treatment may actually come from the justice system’s intervention rather than from treatment.
It would be premature, however, to conclude that treatment holds no promise for reducing future domestic violence. Treatment and evaluation methods are still in their infancy, and new treatment approaches may yet prove effective. And investigators note that failure to impose harsh penalties for abuse or for failure to attend treatment may undermine the efficacy of treatment. Harrel’s (1991) results indicated that none of the men in the treatment or the non-treatment groups believed that they would suffer significant legal or social consequences from committing violence in the future.
In addition to batterer treatment, there is a long tradition in North America and Europe of attempting to treat sex offenders. Techniques have ranged from psychosurgery and pharmacologic interventions (for example, treatment with medrosyprogesterone acetate, or MPA, an androgen antagonist) to cognitive and behavioral therapy. ID the United States roughly three quarters of all sex offender treatment programs are community-based, although 40 states were treating adult sex offenders in prison in 1990 (down from 48 in the mid 1980s; Sapp and Vaughn 1991). In recent years increasing emphasis has been placed on identifying and treating adolescent sex offenders to stop aggressive sexual behavior before it escalates. Research on 411 adult sex offenders treated as outpatients shows that 58 percent began their deviant sexual behavior during early adolescence and that the average adolescent male sex offender has 380 victims during his lifetime (Abel and others 1985, as cited in Stops and Mays 1991). Definitive evaluations of the outcomes of treatment for adult offenders, although scarce, show that at least some programs appear to reduce recidivism (based on rear restrates) among pedophiles and exhibitionists, but none has proved effective with hardcore rapists (Marshall and others 1990).
Treatment programs and evaluation methods for sex offenders-like those for batterers-are still in their infancy, so the possibility that they can provide effective intervention should not be dismissed. Nonetheless, addressing perpetrators one by one after their patterns of abusive behavior have been forged (and reinforced by social norms) is not a particularly promising approach to addressing violence against women. Although treatment may help prevent the future abuse of one or more women, true prevention requires creating a generation of individuals who see violent behavior as inappropriate.
Box 9 Priority research needs on gender-based violence and health.
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1Division of Gastroenterology, University of California at San Francisco, San Francisco, California.
Hepatitis C virus (HCV) is transmitted mainly by contact with infected blood. However, in up to 50% of cases the transmission route cannot be identified. The role of sexual route in the transmission of the virus is still controversial. The prevalence of anti-HCV antibody among the sexual partners of chronic hepatitis C (CHC) patients ranges between 0% and 27% (1-8). The duration of marriage has been correlated with the rate of HCV infection (4) and the presence of HCV in semen has been reported (9). Male-to-female transmission seems to be more common than female-to-male transmission (10).
The prevalence of HCV infection is higher among prostitutes, male homosexuals, and partners of intravenous drug abusers. There seems to be a positive correlation between the HCV infection and the number of sexual partners, sexual activities involving a trauma or anal intercourse, history of other sexually transmitted diseases, and those coinfected with HIV.
A total of 600 patients with chronic HCV infection (320 male (53%) and 280 female (47%), mean age 49.9 yr, ranging between 18 yr and 79 yr) were followed by three university hospitals from January 1999 to November 2002 and were enrolled in this study. Chronic HCV-associated liver disease was defined as elevated liver enzymes for at least 6 months and a positive anti-HCV antibody test with a second-generation ELISA. One hundred and seventeen patients (19.5%) had cirrhosis and 483 (80.5%) had chronic hepatitis. The diagnosis was confirmed by liver biopsy in 546 patients (91%). In 306 (51%) cases, the route of transmission of HCV infection was unknown; parenteral exposure was considered as the source of infection in the remainder. No index case was coinfected with HIV.
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