One boy's experience: ashamed and afraid

Thirteen-year-old Mukesh (not his real name) was visiting his aunt when an older boy from the neighborhood lured him to a secluded area and forced him to have sexual relations. Ashamed and afraid of the consequences of reporting the incident, Mukesh did not tell his parents. Nor did he ever indicate that the abuse had occurred more than once. But it likely had, based on the fact that he developed painful anal sores and lesions symptomatic of a sexually transmitted infection. Disturbed by those symptoms, Mukesh informed his brother, who brought him to a hospital for treatment.

Mukesh's experience occurs all too frequently. In studies conducted in India, urban, semi-urban, and rural male youth from both institutional and community-based settings not uncommonly report sexual coercion by male peers and older boys and men. (1) Approximately a quarter of 23 patients seeking sexual abuse treatment at a health care facility in urban Thane City, India, were boys between ages six and 16 years. (2) And a third of 811 higher secondary semi-urban and rural school students (mean age, 16 years) participating in a study in urban Goa, India, reported at least one type of sexual abuse in the previous year. Multiple types of abusive sexual experiences, involving both male and female perpetrators, were common. (3)

Gender norms in India create a situation that is conducive to such male sexual coercion. Compared with girls, boys are afforded much greater freedom of mobility and are questioned little about their whereabouts. Social taboos against boys congregating at "adaas" (local dens where boys meet) do not exist.

Yet, the sexual coercion that is more apt to occur under these conditions is associated with various harmful consequences for many male youth. The nature of the association is unclear but, compared with boys not experiencing coercive sexual relations, boys who have been forced to have sex have poorer educational performance, poorer physical and mental health, more substance abuse, poorer relationships with their parents, and more consensual sex. (4) Sexual abuse has been associated with some young men growing anxious about their sexuality, sexual identity, and how peers perceive them. Many adopt harmful behaviors (such as abusing drugs and alcohol) or engage in risky sexual behaviors (such as unprotected, casual sexual relationships), seemingly to prove their masculinity. (5)

Given the high prevalence of sexual victimization of males in some settings, educational programs for young men that promote healthy sexual attitudes and development are essential. Workshops conducted by trained peers, counselors, and social workers are also needed to address boys' anxieties about sexual behavior and to educate them about the health risks of coerced sex, such as sexually transmitted infections, including HIV.

In school settings, bullying and violence must be aggressively discouraged, and teachers and significant others need to learn to be sensitive to adolescents' and young men's sexual health needs and concerns. Male students should be informed of the risk of sexual abuse and be taught that it is not acceptable. They need to be encouraged to develop and maintain healthy relationships with peers. Special programs to teach parents and older members of the community how to communicate with adolescents and address issues of sexuality and reproductive health should be organized by community-based organizations. Finally, resource centers are needed in communities to provide youth-friendly sexual health information, counseling, and other related services for boys and young men, such as self-help groups for victims.

In one sense, Mukesh was fortunate. Doctors in the hospital's outpatient department had been taught to screen for sexual abuse and were prepared to provide immediate support and referrals for further counseling and sexual health services at the hospital's adolescent center.

Mukesh asked for outpatient services and was counseled to take advantage of them. However, like many boys in his situation, he did not return for follow-up. As a result, his medical condition was never diagnosed or treated at the hospital. Perhaps he did not return for economic reasons or--more likely--because of the shame and stigma associated with his abuse. As in most cultures, admitting that he had been a victim of sexual abuse by another male could well have called Mukesh's masculinity into question. Like many young men, he may have been more willing to risk his health than to have others doubt his masculinity.