Child Abuse: Why The Problem Is Getting Worse
(BlackDoctor.org) — Sadly, there is a growing trend of young victims of childhood sexual abuse becoming infected with sexually transmitted diseases (STDs). In many cases, a child complains of genital pain, and a doctor’s diagnosis of sometimes more than one STD shocks the family.
Authorities are no longer surprised by this disturbing trend. In St. Louis County, about one in 10 child sex abuse cases starts with discovery of a sexually transmitted disease.
Such as in the case of one 4 year old little girl, who was infected with chlamydia by her abuser.
What happened from there did surprise officials. Police and prosecutors developed enough evidence to file charges against the mother’s boyfriend. That, investigators say, happens in only about 1 time in 20 after a child is found to have a sexually transmitted disease.
The substantial obstacles include witnesses who are unable or unwilling to talk, medical privacy laws and inconclusive science.
“It’s discouraging,” said Sgt. Gary Guinn of the county police child abuse unit. “You feel very helpless.”
There were 1,169 children under age 15 in Missouri and Illinois diagnosed with STDs in 2009. Of those, 22 in Missouri were under age 11, 66 in Illinois were under age 10.
Guinn pointed to a fresh file on his desk in Clayton this month that involves a 9-year-old who tested positive for chlamydia and gonorrhea. He said he knows what the reaction will be when he assigns the case to a one of his detectives: a slump in the chair followed by a sigh of frustration.
“They want to do the best they can do, but they know that more than 90 percent of the time, it doesn’t work,” Guinn lamented. “It gets so frustrating, doing all the interviews, getting cooperation, and in the end you don’t know how the child got the disease. The only way to find out is if someone tells you who did it, or if the victim can tell you.”
The 4-year-old did talk with officials, after the doctor who treated her placed a hot line call to the Division of Family Services. That, coupled with physical evidence that doctors discovered during the exam bolstered the case even though the suspect did not cooperate, Guinn said.
James Davis, 19, of East St. Louis was charged Sept. 29 with one count of first-degree statutory rape. He remains at large.
The child’s grandmother declined to be interviewed for this story but said her family was in counseling.
Not An Easy Case
On its face, justice in the case of a child with an STD might seem easy. The doctor who discovers such an infection is required to report it. The culprit will surely be whoever had both access to the child and the same disease.
But the majority of such reports involve nonsupportive families, unwilling to turn in a loved one or afraid of retaliation or losing a breadwinner, Guinn explained.
The 4-year-old’s determined grandmother was perhaps the asset in the investigation, Guinn said.
But when no one’s talking, the source of the disease may be impossible to prove, said St. Louis County Assistant Prosecuting Attorney Kathi Alizadeh.
She heads the Sexual Assault/Child Abuse Unit. Often, she said, Guinn’s detectives cannot develop enough evidence to support a charge, let alone a conviction.
Alizadeh estimated that charges are filed in only 2 to 5 percent of cases of children with STDs. She said her team of seven attorneys was currently handling three with victims under 12.
“Doctors can pinpoint a time frame on bone fractures, so you know you can look at where the child has been in the last week,” she explained. “But when you have an STD that’s not detected for weeks or months at a time … it becomes extremely difficult because the pool of suspects is huge,” she continued. “These cases are nearly impossible without a positive test from someone, or a confession.”
Subpoenas May Not Help
If police can narrow the list of suspects to a reasonable number, Alizadeh files subpoenas for their medical records with the Missouri Department of Health and Senior Services. The agency requires that all medical professionals report all diagnoses of STDs, information that authorities can access by subpoena.
But the 4-year-old’s case brought with it a new challenge: It crossed the state line into Illinois, where medical privacy laws trump subpoenas.
Police tried to serve subpoenas to the Illinois Department of Health to see whether Davis, the suspect, had ever been treated for the same STDs. But medical records are confidential in Illinois, regardless of court orders or subpoenas.
Alizadeh called her counterparts in St. Clair and Madison counties for advice.
“I called to ask, ‘How do you guys get these records?’ They said, ‘Well, we don’t,'” she explained. “When the statute says it’s unavailable, period, there’s not much I can do about it.”
Even if there is a positive STD test from someone with access to the victim, Alizadeh said, the case needs corroboration from a victim or witness. Otherwise: “I can’t prove they got it from that person.”
Most STDs do not have characteristics that can specifically link the infection of one person to another. So even though a suspect and child may have the same disease, doctors cannot swear to a connection.
But doctors often can determine that a disease came from sexual abuse, explained Dr. Ann DiMaio, a member of the Child Protection Team at Cardinal Glennon Children’s Hospital.
“Especially when it comes to chlamydia and gonorrhea, that’s a slam-dunk for us,” she said. “A young child is not going to get them from sharing a washcloth or during diaper changes.”
Looking For Symptoms
In 2009, 18 children younger than 10 tested positive for chlamydia and four for gonorrhea, according to the Missouri Department of Health and Senior Services. In Illinois, 47 children younger than 10 tested positive for chlamydia, and 19 for gonorrhea, according to the Illinois Department of Public Health.
Prepubescent girls are biologically less prone to STDs than adult women because their cervical cells aren’t as mature. So, the presence of an STD in a girl probably means she was repeatedly exposed to the disease through sexual contact that damaged her internal tissues, making them more susceptible to infection, DeMaio said.
In boys, symptoms of STDs — such as lesions, burning during urination or a discharge — may be more obvious. But, overall, there are fewer reports of sexual abuse involving boys and it may not occur to a parent that such symptoms could be from a sex-related disease, DiMaio said.
HIV can be transmitted through a variety of ways beyond sexual contact, making its origin perhaps the most complicated to prove.
HIV and some STDs, such as herpes, have lifelong consequences. Gonorrhea and chlamydia are infections that can be treated with one-time doses of medication and can go away on their own — although they may cause fertility problems later, especially if left untreated.
Officials said infected children could be at risk of medical neglect from parents afraid to invite the interest of the law or who might just not consider the possibility of abuse. “Sometimes people don’t test for STDs and it gets misdiagnosed as a yeast infection or hygiene issues because no one’s considered an STD,” DiMaio suggested.
At the same time, doctors do not recommend STD tests unless there is suspected abuse, because it involves an invasive procedure, said Dr. Donna Eckardt, medical director for pediatric emergencies at St. John’s Mercy Children’s Hospital.
A Last Resort
Despite the difficulties that police, prosecutors and medical professionals face when a child tests positive for an STD, all of them point to the family court system as a last resort to remove the child from danger.
“We’re not going to be able to protect the child from it happening again because we likely won’t be able to prosecute, but we can present the facts to the family court and hope they intervene,” Guinn explained. “Their burden of proof is much lower than ours.”
A medical professional in Missouri or Illinois who discovers that a minor has an STD believed to be the result of sexual abuse is required to notify state officials.
The Missouri Department of Social Services said it investigated 14 such incidents in 2007-09, involving people younger than 18, in St. Louis and St. Louis, St. Charles, Jefferson, Franklin and Lincoln counties.
The Illinois Department of Children and Family Services said it investigated 27 cases in children younger than 17 from July 2007 through June 2010 in Madison, St. Clair and Monroe counties.
Either of those state agencies can petition a family court to have the child placed in protective custody if there appears to be risk of further abuse.
“Even if we can’t prove who the perpetrator is, from a child welfare perspective, if the caretaker allowed someone to abuse the child, then that caregiver may be substantiated for neglect even if they did not commit the abusive act themselves,” said Kendall Marlowe, spokesman for the DCFS. “We can still take actions to protect a child, even if perpetrator is unknown.”
The 4-year-old girl is now in the custody of her grandmother.