ABSTRACT South Africa has a high incidence of violence and death due to unnatural causes. Gunshot and/or multiple stab wounds to the trunk are consequently injuries commonly seen in South African hospitals. Penetrating injuries often necessitate explorative surgical intervention to identify and treat injuries to the internal organs. Patients are managed in the intensive care unit and frequently return to theatre for abdominal lavage prior to eventual wound closure. Critical illness with prolonged mechanical ventilation and immobilization results in some degree of muscle dysfunction. Survivors of critical illness suffer from poor functional capabilities and decreased quality of life. No formal rehabilitation programmes exist in South Africa for these patients following discharge. Purpose: To determine if patients that survived penetrating trunk trauma recover adequately spontaneously following critical illness over the first six months following discharge from the hospital. Methods: A prospective, observational study was conducted. Patients with penetrating trunk trauma were recruited from four intensive care units in Johannesburg. Patients who received mechanical ventilation < 5 days were placed in Group 1 and those who received mechanical ventilation 5 days were placed in Group 2. Lung function tests, dynamometry, quality of life, six-minute walk distance and oxygen uptake tests were performed over six months following discharge from the hospital. The obtained results for dynamometry, exercise capacity and quality of life were compared between groups and to that measured for a healthy (age and sex-matched) control group. Results and Discussion: No pulmonary function abnormalities were detected for subjects in Groups 1 or 2. Distance walked during 6MWD test was significantly reduced for subjects in Group 2 compared to the control group [one-month (p = 0.00), three-months (p = 0.00)]. Morbidity correlated significantly with distance walked by subjects in Group 2 during 6MWD test [three-months (p = 0.03), six-months (p = 0.02)]. No statistically significant differences were found between subjects during the VO2peak test although subjects in Group 1 performed better clinically than those in Group 2. At one-month there was a significant reduction in upper and lower limb strength for subjects in Group 2 compared to those in Group 1 and the controls (p = 0.00 – 0.04). Similar results were detected at the three- and six-month assessments. ICU and hospital length of stay did demonstrate a significant relationship with muscle strength at one and three months following discharge for subjects in Group 2. Severity of illness and morbidity in ICU did not have a significant relation to muscle strength for subjects in Groups 1 or 2 at any of the assessments. Subjects in Group 1 had a significant reduction in right deltoid and triceps strength compared to the controls at one-month (p = 0.00 respectively) only. No significant differences in upper and lower limb muscle strength were detected between the control group and subjects in Group 1 three and six months after discharge. Subjects in both groups had similar limitations in physical and mental aspects of quality of life one-month after discharge. Subjects in Group 1 reported a quality of life comparable to the control group by three-months. Subjects in Group 2 had significant limitations in the physical components of quality of life at three- and six-months compared to those in Group 1 and the controls [p = 0.00 – 0.02]. Conclusion: Subjects in Group 1 recovered adequately on their own within three months after discharge from hospital with regard to muscle strength, exercise capacity and all aspects of quality of life. Subjects in Group 2 presented with significant limitations in exercise capacity, muscle strength and the physical aspects of quality of life even at six months after discharge. Impaired function was related to the duration of critical illness and immobility. A physiotherapist-led rehabilitation programme may be indicated for survivors of penetrating trunk trauma that received prolonged mechanical ventilation to address cardiovascular endurance and peripheral muscle strength retraining between one and three months after discharge to address the physical disabilities observed in these subjects.

The relationship between alexithymia, PTSD symptoms, attachment, and depression was examined using archival data from a university-based trauma clinic. Participants were 62 women and 20 men, ages ranging from 17 to 59, with childhood histories of physical or sexual abuse. Measures included the Structured Clinical Interview on Childhood Sexual Abuse History (SI-SA), Impact of Events Scale-Revised (IES-R), Attachment Style Questionnaire (ASQ), Beck Depression Inventory-Second Edition (BDI-II), and Toronto Alexithymia Scale-20 (TAS-20). As predicted, alexithymia, PTSD symptoms, and depression were negatively correlated with secure attachment and positively correlated with insecure attachment. Also as predicted, depression and insecure attachment styles containing negative models of the self (need for approval, discomfort with closeness) mediated the relationship between alexithymia and PTSD symptoms while styles involving positive models of the self (confidence, relationships as secondary) did not. Preoccupation with relationships was excluded from mediation analyses because alexithymia was not a significant predictor of this construct. Results suggest that the symptom profile of adult survivors of childhood abuse can be complex and may require interventions that target a broad range of symptoms and difficulties including alexithymia, attachment, and depression.

The current study sought to determine the utilization and effectiveness of art therapy with adult survivors of childhood sexual abuse, as perceived by mental health professionals. A total of 33 participants consisting of marriage and family therapists, masters of social work level clinicians and one doctorate level were surveyed. A self-constructed survey, created by the researcher was distributed to the participants. Results demonstrate that about one third of participants perceived art therapy to be moderately effective in reducing male and female issues surrounding childhood sexual abuse. No significant results were found when comparing the effectiveness of art therapy on males versus females. The study also shows that art therapy is under-utilized. The current study is limited by a small sample size, as well as little experience with art therapy utilization. This study contributes to social work knowledge by providing an awareness of art therapy treatment utilization with adult survivors of childhood sexual abuse. Future research regarding art therapy should consider mental health practitioners’ lack of knowledge and possible under-utilization of art therapy in order to determine its true effectiveness

Past research on adult memory for childhood sexual abuse (CSA) has provided support for the phenomenon of forgetting and subsequent recovery of the memories, after a period of time. This phenomenon, however, remains a source of debate and is still not fully understood by researchers and psychological and legal practitioners. The research has provided conflicting evidence about the factors which are thought to lead to CSA forgetting for extensive periods of time, in addition to the processes involved in forgetting, triggering and later remembering of the abuse memories by adult survivors. This study utilised a mixed method to investigate and explore the factors and processes associated with CSA forgetting, triggering and later remembering, in a sample of Australian adult CSA survivors (N = 77). Participants were asked to complete a test booklet, containing the Traumatic Events Questionnaire (TEQ), Symptom Checklist-90-Revised (SCL-90-R), Dissociative Experiences Scale II (DES II), Impact of Events Scale - Revised (IES-R), a scale designed to measure persistence of memory (Loftus), and a scale designed to measure emotional intensity at the time of the abuse and now (Williams). Participants were then asked to participate in a semi-structured interview. Seventy-one participants completed the interview process. Five separate analyses were conducted on the data. Methodological issues, such as the use of retrospective data and corroboration of the abuse were outlined. All participants were asked to provide details about any corroboration they had received that the abuse had occurred. The participants were streamed into one of three categories of forgetting (Always Remembered, n = 28; Partial Forgetting, n = 16; and Extensive Forgetting, n = 33). The first analysis (Stage One Analysis One) examined the factors thought to be associated with CSA forgetting, such as abuse parameters (TEQ), current psychological functioning (SCL-90-R), persistence of memory (Loftus), emotional intensity at the time of the abuse and now (Williams), the trauma response experienced at the time of the abuse (IES-R), and current dissociation (DES II), to determine the significant differences between the three groups. A significant difference was found regarding the age at which the abuse commenced, with the Extensive Forgetting group reporting an earlier age at which the abuse commenced. Significant differences were found on the variable that related to being abused by an aunt or uncle, and on the current experience of hostility (SCL-90-R sub-scale), and on the current levels of anger (Williams Emotional Intensity) experienced by the participants. Significant differences between the groups were also found on two of the Persistence of Memory items, namely clarity of memory and participants' memory of the tastes related to the abuse. Finally, a significant difference was found on the participants' current dissociation levels, with the Extensive Forgetting group reporting higher levels of current dissociation than the other two groups. Statistical profiles for each of the three groups were constructed, based on the mean scores of the SCL-90-R, IES-R and DES II, for use in the Stage Two, Analysis Two, profile comparison. Stage Two, Analysis One, provided a qualitative analysis relating to the experience of always remembering the abuse. The aim of this analysis was to provide a deeper understanding of why some participants (n = 23) did not forget about their abuse, when other participants reported being able to forget for a period of time. The results indicated that participants' responses formed clusters, such as older age at abuse onset, failed dissociative mechanisms, constant reminders, and others. Stage Two, Analysis Two, presented and compared each participant's profile against the statistical profiles constructed in Stage One. The participant's profiles included a summary of their TEQ responses and interview responses, in addition to their Stage One test booklet scores. The comparison was made, firstly, on a specific basis against the mean scores obtained by each category of forgetting, and secondly, on a broader basis, against the score range for each measure of the statistical profile. This was done to determine if there was a "typical" member of each category of forgetting and to investigate the within-group differences. The specific profile comparison demonstrated that there was no "typical" member of any of the three groups, with participants varying widely in their scores and patterns of scores. However, when the profile comparison was broadened to include score ranges, 61% of participants, who always remembered the abuse, 44% of participants who partially forgot the abuse, and 47% of participants who extensively forgot their abuse, matched the profile of a "typical" member of their relevant category of forgetting. Stage Two, Analysis Three, provided an in-depth qualitative exploration on the process involved in CSA forgetting, triggering and later remembering, for a selection of participants who reported partially forgetting the abuse (n = 6), and extensively forgetting the abuse (n = 10). Participants' interview responses were transcribed verbatim and analysed, using Interview Analysis. This analysis explored the differences between participants, from the two categories of forgetting, on their experiences of CSA forgetting, triggering and later remembering, in addition to exploring how these participants were able to forget about the abuse; what events triggered their abuse memories; and how the initial memories returned. Issues of memory recovery, while in therapy or under hypnosis, were also explored. Stage Two, Analysis Four, presented the case study of a participant, who had been identified as an "outlier", due to her high score on the DES II, claims of being able to remember abuse incidents that occurred prior to the age of two years, diagnosis of DID, and the substantiated conviction and sentencing of her abuser, based on her recovered memories of the abuse and corroboration from her sister and mother. Her case was examined against some of the criticisms often made by false memory supporters. This thesis found that some CSA survivors forgot about their abuse, either partially or extensively. The thesis also found support for some, but not all, of the factors that previous researchers have identified as being associated with CSA forgetting by adult survivors, specifically the individual's age at the time the abuse commenced and the individual's ability to dissociate from the abuse. The research then explored, in-depth, the issues of: CSA remembering, CSA survivor profiling, and the "how" of CSA forgetting, triggering and later remembering, by adult survivors.

INTRODUÇÃO: As adversidade precoces (APs) são um grupo de experiências negativas vivenciadas durante o desenvolvimento e associadas a diversos desfechos clínicos e psiquiátricos. A literatura sobre os transtornos mentais (TMs) e cognições e comportamentos suicidas (CCS) destaca que a exposição a APs durante a infância se relaciona com essas condições na vida adulta. Contudo, o tamanho e a qualidade do efeito das APs nas CCS varia entre os estudos. Como os TMs também determinam CCS, é preciso avaliar a contribuição concomitante de APs e TMs nos CCS. OBJETIVOS: Investigar a relação associativa entre APs e CCS na vida adulta e os fatores determinantes dessa relação. MÉTODOS: Este estudo é uma investigação transversal, multiestratificada e probabilística da população geral da Região Metropolitana de São Paulo. O instrumento Composite International Diagnostic Interview versão 3.0 foi aplicado em 5037 indivíduos adultos. Os fatores sociodemográficos, 12 APs, 20 TMs ao longo da vida e CCS ao longo da vida foram coletados por meio de entrevistas no domicílio do respondente. Foram calculadas as prevalências das APs e estimados os modelos fatoriais, modelos de resposta ao item e modelos de redes para descrever as APs, para amostra total e por sexo. Correlações entre APs e subsequentes TMs ou CCS foram testadas e análises de trajetória avaliaram a mediação da associação entre APs e CCS pelos TMs. RESULTADOS: As APs atingiram 53,6% da amostra e 48,4% apresentaram duas ou mais APs na vida, sendo as mulheres significativamente mais expostas que os homens (59,0% vs 47,66%). Nas análises fatoriais confirmatórias, a solução com três fatores (\"Violência Familiar e Desajuste Parental\"; \"Uso indevido de Substâncias, Criminalidade e Abuso Sexual\"; e \"Adversidade Econômica e Perda Parental\") foi mais ajustada para os homens e a de dois fatores (\"Violência Familiar e Desajuste Parental\" e \"Abuso Sexual e Perda Parental\") mais ajustada para as mulheres. Nas análises de rede, apesar de similaridades na estrutura global, homens e mulheres tem diferenças em APs específicas. O \'TM parental\' (Odds ratio [OR] = 1,99 a 2,27) e a \'violência familiar\' (OR = 1,55 a 1,99) foram as APs mais consistentemente associadas à TM em todas as faixas etárias. Os \'TM parentais\' e as \'adversidades econômicas\' foram associados as quatro classes de TMs examinados (transtornos de humor, ansiedade, controle do impulso e do uso de substâncias). Quando a associação entre APs e CCS foi controlada por TMs, somente o \'abuso físico\' foi associado a tentativas de suicídio em todos os estágios de vida subsequentes (OR = 2,1). Nas análises estruturais, o efeito dos TMs como mediadores da associação entre APs e CCS foi confirmado, sendo essa mediação mais importante nas mulheres. CONCLUSÕES: As APs são um grupo heterogêneo e interrelacionado de fatores de risco. Sua exposição é diferente em meninos e meninas. As APs foram consistentemente associadas a TMs e embora algumas APs tenham sido associadas a CCS, os papéis desempenhados pelos diferentes tipos de APs na infância variam em magnitude, levando a resultados diversos e diferentes níveis de gravidade / BACKGROUND: Adverse childhood experiences (ACEs) are a group of negative events experienced during development that has been associated with various clinical and psychiatric outcomes. The literature on mental disorders (MDs) and on suicidality highlights the association of these conditions during adulthood with the previous exposure to ACEs. However, the size and quality of the effect of ACEs on suicidality varies between studies. Since MDs also predict suicidality, it is necessary to evaluate the concomitant contribution of ACEs and MDs on suicidality. OBJECTIVES: The aims of this study were to investigate the association between ACEs and suicidality in adulthood and the determinants of this relationship. METHODS: This is a cross-sectional, multistratified and probabilistic study of the general population of São Paulo Metropolitan Area. The Composite International Diagnostic Interview version 3.0 was applied in 5037 adult subjects. Sociodemographic data, 12 ACEs, 20 lifetime MDs, and lifetime suicidality were collected in household interviews. The prevalence of suicidality was estimated and factor models, item response theory models and network analysis models were calculated to describe ACEs for total sample and by sex. Correlations between ACEs and subsequent MDs or suicidality were tested. Path analyzes assessed the mediation of the association between APs and suicidality by MDs. RESULTS: ACEs were reported by 53.6% of the sample and 48.4% presented two or more ACEs early in life and women were significantly more exposed than men (59.0% vs 47.66%). In confirmatory factor analyzes, the three-factor solution (\"Family Violence and Parental Maltreatment\", \"Substance Misuse, Criminality and Sexual Abuse\", and \"Economic Adversity and Parental Loss\") was more adjusted for men and the two-factors solution (\"Family Violence and Parental Maltreatment\", and \"Sexual Abuse and Parental Loss\") was more adjusted for women. In network analyzes, despite similarities in overall network structure, men and women have differences in specific ACEs. The \'parental MD\' (Odds Ratio [OR] = 1.99 to 2.27) and \'family violence\' (OR = 1.55 to 1.99) were the most consistently disorders associated with ACEs across all age groups. \'Parental MD\' and \'economic adversity\' were associated with the four classes of MDs examined (mood, anxiety, impulse control and substance use disorders). When the association between ACEs and suicidality was controlled by MDs, only \'physical abuse\' was associated with suicide attempts in all subsequent stages of life (OR = 2.1). In the path analyzes, the effect of the MDs as mediators of the association between ACEs and suicidality was confirmed, being this mediation effect more important in women than in men. CONCLUSIONS: ACEs are a heterogeneous and interrelated group of risk factors. Their exposure profile is different in boys and girls. ACEs were consistently associated with MDs and although some ACEs were associated with suicidality, the roles played by different types of ACEs vary in magnitude, leading to varying results and different levels of severity

INTRODUÇÃO: As adversidade precoces (APs) são um grupo de experiências negativas vivenciadas durante o desenvolvimento e associadas a diversos desfechos clínicos e psiquiátricos. A literatura sobre os transtornos mentais (TMs) e cognições e comportamentos suicidas (CCS) destaca que a exposição a APs durante a infância se relaciona com essas condições na vida adulta. Contudo, o tamanho e a qualidade do efeito das APs nas CCS varia entre os estudos. Como os TMs também determinam CCS, é preciso avaliar a contribuição concomitante de APs e TMs nos CCS. OBJETIVOS: Investigar a relação associativa entre APs e CCS na vida adulta e os fatores determinantes dessa relação. MÉTODOS: Este estudo é uma investigação transversal, multiestratificada e probabilística da população geral da Região Metropolitana de São Paulo. O instrumento Composite International Diagnostic Interview versão 3.0 foi aplicado em 5037 indivíduos adultos. Os fatores sociodemográficos, 12 APs, 20 TMs ao longo da vida e CCS ao longo da vida foram coletados por meio de entrevistas no domicílio do respondente. Foram calculadas as prevalências das APs e estimados os modelos fatoriais, modelos de resposta ao item e modelos de redes para descrever as APs, para amostra total e por sexo. Correlações entre APs e subsequentes TMs ou CCS foram testadas e análises de trajetória avaliaram a mediação da associação entre APs e CCS pelos TMs. RESULTADOS: As APs atingiram 53,6% da amostra e 48,4% apresentaram duas ou mais APs na vida, sendo as mulheres significativamente mais expostas que os homens (59,0% vs 47,66%). Nas análises fatoriais confirmatórias, a solução com três fatores (\"Violência Familiar e Desajuste Parental\"; \"Uso indevido de Substâncias, Criminalidade e Abuso Sexual\"; e \"Adversidade Econômica e Perda Parental\") foi mais ajustada para os homens e a de dois fatores (\"Violência Familiar e Desajuste Parental\" e \"Abuso Sexual e Perda Parental\") mais ajustada para as mulheres. Nas análises de rede, apesar de similaridades na estrutura global, homens e mulheres tem diferenças em APs específicas. O \'TM parental\' (Odds ratio [OR] = 1,99 a 2,27) e a \'violência familiar\' (OR = 1,55 a 1,99) foram as APs mais consistentemente associadas à TM em todas as faixas etárias. Os \'TM parentais\' e as \'adversidades econômicas\' foram associados as quatro classes de TMs examinados (transtornos de humor, ansiedade, controle do impulso e do uso de substâncias). Quando a associação entre APs e CCS foi controlada por TMs, somente o \'abuso físico\' foi associado a tentativas de suicídio em todos os estágios de vida subsequentes (OR = 2,1). Nas análises estruturais, o efeito dos TMs como mediadores da associação entre APs e CCS foi confirmado, sendo essa mediação mais importante nas mulheres. CONCLUSÕES: As APs são um grupo heterogêneo e interrelacionado de fatores de risco. Sua exposição é diferente em meninos e meninas. As APs foram consistentemente associadas a TMs e embora algumas APs tenham sido associadas a CCS, os papéis desempenhados pelos diferentes tipos de APs na infância variam em magnitude, levando a resultados diversos e diferentes níveis de gravidade / BACKGROUND: Adverse childhood experiences (ACEs) are a group of negative events experienced during development that has been associated with various clinical and psychiatric outcomes. The literature on mental disorders (MDs) and on suicidality highlights the association of these conditions during adulthood with the previous exposure to ACEs. However, the size and quality of the effect of ACEs on suicidality varies between studies. Since MDs also predict suicidality, it is necessary to evaluate the concomitant contribution of ACEs and MDs on suicidality. OBJECTIVES: The aims of this study were to investigate the association between ACEs and suicidality in adulthood and the determinants of this relationship. METHODS: This is a cross-sectional, multistratified and probabilistic study of the general population of São Paulo Metropolitan Area. The Composite International Diagnostic Interview version 3.0 was applied in 5037 adult subjects. Sociodemographic data, 12 ACEs, 20 lifetime MDs, and lifetime suicidality were collected in household interviews. The prevalence of suicidality was estimated and factor models, item response theory models and network analysis models were calculated to describe ACEs for total sample and by sex. Correlations between ACEs and subsequent MDs or suicidality were tested. Path analyzes assessed the mediation of the association between APs and suicidality by MDs. RESULTS: ACEs were reported by 53.6% of the sample and 48.4% presented two or more ACEs early in life and women were significantly more exposed than men (59.0% vs 47.66%). In confirmatory factor analyzes, the three-factor solution (\"Family Violence and Parental Maltreatment\", \"Substance Misuse, Criminality and Sexual Abuse\", and \"Economic Adversity and Parental Loss\") was more adjusted for men and the two-factors solution (\"Family Violence and Parental Maltreatment\", and \"Sexual Abuse and Parental Loss\") was more adjusted for women. In network analyzes, despite similarities in overall network structure, men and women have differences in specific ACEs. The \'parental MD\' (Odds Ratio [OR] = 1.99 to 2.27) and \'family violence\' (OR = 1.55 to 1.99) were the most consistently disorders associated with ACEs across all age groups. \'Parental MD\' and \'economic adversity\' were associated with the four classes of MDs examined (mood, anxiety, impulse control and substance use disorders). When the association between ACEs and suicidality was controlled by MDs, only \'physical abuse\' was associated with suicide attempts in all subsequent stages of life (OR = 2.1). In the path analyzes, the effect of the MDs as mediators of the association between ACEs and suicidality was confirmed, being this mediation effect more important in women than in men. CONCLUSIONS: ACEs are a heterogeneous and interrelated group of risk factors. Their exposure profile is different in boys and girls. ACEs were consistently associated with MDs and although some ACEs were associated with suicidality, the roles played by different types of ACEs vary in magnitude, leading to varying results and different levels of severity

Increasing tourism numbers in third world countries affect their economies and certain aspects of their society positively; however, there are concomitant negative effects that expose the dark side of the tourism industry. One of these is the escalating commercial sexual exploitation of children (CSEC), particularly child prostitution (CP) in the context of tourism, a phenomenon known as child sex tourism (CST). Although tourism plays an important role in creating the perfect storm of poverty-stricken children colliding with wealthy tourists, it is not solely responsible for this phenomenon. Internationally and nationally, the lacuna of knowledge on CST in particular hampers an informed response by way of resource allocation and coordinated service delivery to both victims and perpetrators. Utilising a qualitative research approach, and the collective case study and phenomenological research designs complemented by an explorative, descriptive and contextual strategy of inquiry, the researcher explored the status of the knowledge of and response to the CSEC through the lens of closely associated role players, who were purposively selected for inclusion in the study. These were adult survivors who were as children engaged in sex work and victims of child sex tourism, social workers and non-social workers involved in rendering child welfare and protection services, members of the Family Violence Child Protection and Sexual Offences (FCS) Unit of the South African Police Service (SAPS) and representatives of the hospitality and tourism industry. Data was collected via individual in-depth semi-structured interviews, telephone interviews, and email-communication and thematically analysed. The researcher found that a range of microsystem level factors, such as poverty and family dysfunction, pushed children to the street, and as a means to survive engage in sex work, enabling tourists (i.e. local - out of towners) and foreigners, mainly men from varied sexual orientation) to commercially sexually exploit both boys and girls, from as young as nine years of age, and of different race groups, which leave them with physical and psychological scars. The following main findings surfaced: The social workers, in comparison to the non-social workers, who have a primary responsibility to provide child welfare and protection services were ill-informed in terms of identifying CST as phenomenon, untrained and/or slow to respond appropriately with interventions directed to the victims and perpetrators of CSEC. The service provider groups, as microsystems interfacing on a mesosystem, were fraught with perceptions that the social workers and the SAPS were being inadequate. Furthermore a lack of cooperation, collaboration and communication between the service provider groups to respond to CSEC existed. The hospitality and tourism industry service representatives were also ill-informed about the phenomena of CP and CST with a response that at best can be labelled as fluctuating between an indirect response to that of turning a blind-eye. From the findings, recommendations for social work practice, education and training and recommendations specific for the other closely associated role players in responding to the CSEC were forwarded. / Social Work / D.Phil. (Social Work)

Increasing tourism numbers in third world countries affect their economies and certain aspects of their society positively; however, there are concomitant negative effects that expose the dark side of the tourism industry. One of these is the escalating commercial sexual exploitation of children (CSEC), particularly child prostitution (CP) in the context of tourism, a phenomenon known as child sex tourism (CST). Although tourism plays an important role in creating the perfect storm of poverty-stricken children colliding with wealthy tourists, it is not solely responsible for this phenomenon. Internationally and nationally, the lacuna of knowledge on CST in particular hampers an informed response by way of resource allocation and coordinated service delivery to both victims and perpetrators. Utilising a qualitative research approach, and the collective case study and phenomenological research designs complemented by an explorative, descriptive and contextual strategy of inquiry, the researcher explored the status of the knowledge of and response to the CSEC through the lens of closely associated role players, who were purposively selected for inclusion in the study. These were adult survivors who were as children engaged in sex work and victims of child sex tourism, social workers and non-social workers involved in rendering child welfare and protection services, members of the Family Violence Child Protection and Sexual Offences (FCS) Unit of the South African Police Service (SAPS) and representatives of the hospitality and tourism industry. Data was collected via individual in-depth semi-structured interviews, telephone interviews, and email-communication and thematically analysed. The researcher found that a range of microsystem level factors, such as poverty and family dysfunction, pushed children to the street, and as a means to survive engage in sex work, enabling tourists (i.e. local - out of towners) and foreigners, mainly men from varied sexual orientation) to commercially sexually exploit both boys and girls, from as young as nine years of age, and of different race groups, which leave them with physical and psychological scars. The following main findings surfaced: The social workers, in comparison to the non-social workers, who have a primary responsibility to provide child welfare and protection services were ill-informed in terms of identifying CST as phenomenon, untrained and/or slow to respond appropriately with interventions directed to the victims and perpetrators of CSEC. The service provider groups, as microsystems interfacing on a mesosystem, were fraught with perceptions that the social workers and the SAPS were being inadequate. Furthermore a lack of cooperation, collaboration and communication between the service provider groups to respond to CSEC existed. The hospitality and tourism industry service representatives were also ill-informed about the phenomena of CP and CST with a response that at best can be labelled as fluctuating between an indirect response to that of turning a blind-eye. From the findings, recommendations for social work practice, education and training and recommendations specific for the other closely associated role players in responding to the CSEC were forwarded. / Social Work / D. Phil. (Social Work)

Afrikaans text / Hierdie studie bied vanuit 'n ekosistemiese benadering 'n verduideliking van die lewenswereld van die volwasse persoon wat as kind gemolesteer is. Enkele uitgangspunte van die ekosistemiese benadering word bespreek wat dien as vertrekpunt waarvolgens die navorser konstruksies oor die as kind gemolesteerde volwassene konstrueer. Daar word gefokus op die langtermyneffekte van die kindermolestering met spesifieke verwysing na die effek op die • fisiese gedrag van die volwassene; • die aard van die seksuele verhoudings van die volwassene; en • die aard van die interpersoonlike verhoudings van die volwassene. Tydens hierdie bespreking word die oorlewingstrategiee, wat die volwassene aanwend om met die l angtermyneffekte te oorl eef, duidel i k belig. Die he l i ngsproses waardeur 'n vol wassene vol gens sy of haar ei e pas beweeg ten einde die effek van die molestering te verwerk, word volledig bespreek. Die teorie is toegepas in die navorsing om die uitwerking van die kindermolestering op volwassenes te beskryf asook enkele gebeure (events) van die helingsproses waardeur 'n volwassene beweeg het. Gevolgtrekkings en aanbevelings word geformuleer ten einde die bruikbaarheid van hierdie studie in die praktyk aan te dui. / In this study the world of the adult survivor of sexua 1 abuse is described in terms of the eco-systemic approach, as well as certain constructions within the approach. These constructions served as a base on which the researcher construed further constructions of the adult survivor of sexual abuse. The study focuses on the 1 ong term effects of the child abuse with specific reference to the effect on • the physical behaviour of the adult; • the nature of the sexual relationships of the adult; and • the nature of the interpersonal relationships of the adult. The strategies of the adult in surviving with these long term effects are also highlighted in the discussion. The healing process through which the adult survivor passes in healing the sexual trauma according to his or her own pace, is fully discussed. In the empirical research the theory is applied to describe the effect of sexual abuse on the lives of adults as well as on certain events of the healing process. Conclusions and recommendations are formulated to indicate the usefulness of this study for the field. / Social Work / D.Phil. (Maatskaplike Werk)

Afrikaans text / Hierdie studie bied vanuit 'n ekosistemiese benadering 'n verduideliking van die lewenswereld van die volwasse persoon wat as kind gemolesteer is. Enkele uitgangspunte van die ekosistemiese benadering word bespreek wat dien as vertrekpunt waarvolgens die navorser konstruksies oor die as kind gemolesteerde volwassene konstrueer. Daar word gefokus op die langtermyneffekte van die kindermolestering met spesifieke verwysing na die effek op die • fisiese gedrag van die volwassene; • die aard van die seksuele verhoudings van die volwassene; en • die aard van die interpersoonlike verhoudings van die volwassene. Tydens hierdie bespreking word die oorlewingstrategiee, wat die volwassene aanwend om met die l angtermyneffekte te oorl eef, duidel i k belig. Die he l i ngsproses waardeur 'n vol wassene vol gens sy of haar ei e pas beweeg ten einde die effek van die molestering te verwerk, word volledig bespreek. Die teorie is toegepas in die navorsing om die uitwerking van die kindermolestering op volwassenes te beskryf asook enkele gebeure (events) van die helingsproses waardeur 'n volwassene beweeg het. Gevolgtrekkings en aanbevelings word geformuleer ten einde die bruikbaarheid van hierdie studie in die praktyk aan te dui. / In this study the world of the adult survivor of sexua 1 abuse is described in terms of the eco-systemic approach, as well as certain constructions within the approach. These constructions served as a base on which the researcher construed further constructions of the adult survivor of sexual abuse. The study focuses on the 1 ong term effects of the child abuse with specific reference to the effect on • the physical behaviour of the adult; • the nature of the sexual relationships of the adult; and • the nature of the interpersonal relationships of the adult. The strategies of the adult in surviving with these long term effects are also highlighted in the discussion. The healing process through which the adult survivor passes in healing the sexual trauma according to his or her own pace, is fully discussed. In the empirical research the theory is applied to describe the effect of sexual abuse on the lives of adults as well as on certain events of the healing process. Conclusions and recommendations are formulated to indicate the usefulness of this study for the field. / Social Work / D.Phil. (Maatskaplike Werk)