Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries

Abstract

Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.

A social ecological approach to understanding service utilization barriers among male survivors of sexual violence in three refugee settings: a qualitative exploratory study

“…The specific barriers identified largely align with other studies that included documentation of barriers to service accessibility among male survivors in refugee settings [13,44]. Additional barriers emerged in other refugee settings, such as limited hours of operation that prohibited refugees who worked from accessing care [13], insecurity [44], the public nature of pursuing legal redress [13], and national laws stipulating the mandatory reporting of public officials [13].…”

“…The specific barriers identified largely align with other studies that included documentation of barriers to service accessibility among male survivors in refugee settings [13,44]. Additional barriers emerged in other refugee settings, such as limited hours of operation that prohibited refugees who worked from accessing care [13], insecurity [44], the public nature of pursuing legal redress [13], and national laws stipulating the mandatory reporting of public officials [13]. More research on the specific service utilization barriers facing men, adolescents, and boy survivors, including those with physical, psychological, and intellectual disabilities, is warranted in other settings of forced displacement as well as a disaggregated approach to the specific barriers of persons with diverse SOGIESC, including gay men, trans women, trans men, lesbians, nonbinary persons, and intersex persons.…”

The Impact of a Community Based Rehabilitation Program in Afghanistan: A Longitudinal Analysis Using Propensity Score Matching and Difference in Difference Analysis

“…Anxiety and distress are a major ill in conflict affected contexts such as Afghanistan. Literature traditionally attributed mental distress to the violence itself (36)(37)(38)(39)(40) including sexual violence and intimate partner violence (41)(42)(43)(44). Increasingly, scholars have also shown that daily stressors play an important role in common and more severe mental disorders, particularly among vulnerable groups.…”

What contextual factors and mechanisms facilitate male involvement in women's sexual and reproductive health in Sub-Saharan Africa? A rapid realist review protocol

“…PM and ADB will undertake a search of the literature in consultation with a University faculty librarian. Databases are likely to include Web of Science, Pubmed, EMBASE, MEDLINE, and PsycInfo, based on other reviews 31 conducted in the SSA context. We anticipate that the literature for this topic will be diverse and hence we will use extensive searching of grey sources, such as OpenGrey, Google Scholar and DODRIA – Africa’s data directory – for relevant documents.…”