ABSTRACT

OBJECTIVES

Identifying and mapping the literature regarding sexual violence against Brazilian boys and men, as well as describing its underreporting, prevalence, and associated factors.

METHODS

We conducted a scoping review by searching PubMed, Biblioteca Digital Brasileira de Teses e Dissertações, Biblioteca Virtual em Saúde, Scopus, and Web of Science databases. The inclusion criteria were: (a) surveys including data on sexual violence; (b) inclusion of boys or men as victims of sexual violence; (c) presenting statistical data on prevalence, underreporting, and factors associated with sexual violence among Brazilian boys and men.

RESULTS

We found a total of 1,481 papers. Ultimately, 53 were included and had their data extracted. Most studies are quantitative in nature (n = 48). The total number of participants across studies was 1,416,480 and the prevalence of sexual violence ranged from 0.1% to 71%. It is important to note that underreporting statistical data was cited in several studies. The group with the highest prevalences was men who have sex with men and those with sexual dysfunctions. Increased tendency to drug use, social isolation, unprotected anal sex, suicidal ideation, sexual dysfunction, and post-traumatic stress disorder were statistically significant predictors for having experienced sexual violence.

CONCLUSIONS

Despite the prevalence of sexual violence being high against Brazilian boys and men, this area of is surprisingly understudied and there are few studies with this exclusive scope. Social cultural issues, such as sexism, contribute to the underreporting of sexual violence. Additionally, we identified issues related to mental, sexual and reproductive health to be associated with sexual violence. Based on our findings, we recommend the implementation and development of a structural infrastructure aimed at supporting boys and men who are victims of sexual violence, and preventing negative outcomes for this affected group.

Men; Crime Victims; Sex Offenses; Domestic Violence; Underregistration; Review

INTRODUCTION

Sexual violence against boys and men is often neglected by various social sectors, resulting in an evidence gap around the topic1,²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... . The available information on sexual violence is mostly related to female victims, especially female children and adolescents³3. Barth J, Bermetz L, Heim E, Trelle S, Tonia T. The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. Int J Public Health. 2013;58(3):469-83. https://doi.org/10.1007/s00038-012-0426-1
https://doi.org/10.1007/s00038-012-0426-... .

From an analysis of the notification data from the Sistema de Informação de Agravos de Notificação (Sinan), between 2009 and 2013, it was possible to observe an increase in notifications of 291.92% of sexual violence against boys and men. In 2013, cases against this population accounted for 12.58% of all reported cases⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... . Data from an epidemiological bulletin from the Ministry of Health, between 2011 and 2017, show that the proportion of total notifications of this kind of violence against male children was 25.8% and against adolescents, 7.6%⁵5. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Análise epidemiológica da violência sexual contra crianças e adolescentes, 2011 a 2017. Bol Epidemiol. 2018;49(27):1-17..

The Brazilian Public Security Forum, a non-governmental organization (NGO), systematizes, through the Public Security Yearbook, all occurrences registered in the police stations and reported to the State Public Security Secretariats. According to the analysis of this data, published in 2019, sexual violence against boys and men accounted for 14.3% of all cases reported to the police⁶6. Fórum Brasileiro de Segurança Pública. Anuário Brasileiro de Segurança Pública 2020. São Paulo: FBSP; 2020.. Disque Direitos Humanos, in turn, reported in an annual report, also published in 2019, 18% of all reported cases⁷7. Ministério da Mulher, da Família e dos Direitos Humanos (BR), Ouvidoria Nacional dos Direitos Humanos. Relatório 2019. Brasília, DF; 2020..

A review of the sexual violence literature in Brazil identified a range of prevalence among men from 1% to 35%⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... . According to the author, although the variation is large, the included studies indicate a higher occurrence than presented in the official statistics of the reporting systems. Among the 40 papers included in this review, only 14 included data on the prevalence of this violence in the male population.

In an analysis of the Public Security Yearbook data, the authors state that sexual crimes are among the least reported, which can be attributed to factors such as fear of the aggressor, judgments, or guilt⁹9. Fórum Brasileiro de Segurança Pública. Anuário Brasileiro de Segurança Pública 2019. São Paulo: FBSP; 2019.. A study conducted with men and women from a representative sample of the urban population of São Paulo concluded that experiences of sexual violence are more difficult to report when compared to other aggressions¹⁰10. Coêlho BM, Santana GL, Viana MC, Andrade LH, Wang YP. Gender-related dimensions of childhood adversities in the general population. Rev Bras Psiquiatr. 2018;40(4):394-402. https://doi.org/10.1590/1516-4446-2017-2366
https://doi.org/10.1590/1516-4446-2017-2... . However, because of the way men are raised in a patriarchal society, it may be more difficult for them to talk about victimization experiences, producing a major problem in the reporting of rapes against men and boys²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... .

Aside from the prevalence of sexual violence against men in Brazil being often neglected and under-reported when compared to the violence suffered by women, the characteristics of these rapes are also worthy of further investigation. In this sense, this paper aims to identify and map in the scientific literature the studies dealing with sexual violence against Brazilian boys and men in the period between 2015 and 2020, seeking to obtain data on prevalence, underreporting, and factors associated with sexual violence.

METHODS

We developed a scoping review, according to the methodology proposed by the Joanna Briggs Institute¹¹11. Peters MDJ, Godfrey C, McInerney P, Munn Z, Trico A, Khalil H. Chapter 11: Scoping reviews. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide (AU): The Joanna Briggs Institute; 2020.. Scoping review is a form of evidence synthesis that employs a systematic method to map all scientific literature on a given subject, such as key concepts, study characteristics, specific data according to the study objectives, and evidence gaps¹²12. Tricco AC, Lillie E, Zarin W, O’Brien K, Colquhoun H, Kastner M, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2021;16:15. https://doi.org/10.1186/s12874-016-0116-4
https://doi.org/10.1186/s12874-016-0116-... .

Search Process

To construct the research question, the acronym PCC was used: population (boys aged 0 to 18 years and men, over 18 years), concept (victims of sexual violence) and context (studies conducted with Brazilian boys or men)¹³13. Peters MDJ, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. The Joanna Briggs Institute reviewers’ manual 2015: methodology for JBI scoping reviews. Adelaide (AU): The Joanna Briggs Institute; 2015., resulting in the research question: “What are the data on underreporting, prevalence and factors associated with sexual violence against Brazilian boys and men published between 2015 and 2020?”.

Searches were conducted on July 27, 2020, in the PubMed, Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), Biblioteca Virtual em Saúde (BVS), Scopus and Web of Science databases, and in all of them using the following descriptors: Sexual Violence OR Violência Sexual OR Abuso Sexual OR Sexual Abuse OR Boys AND Men OR Meninos OR Homens AND Brazil OR Brasil.

Inclusion and Exclusion Criteria

The type of studies selected to conduct this review included peer-reviewed articles, dissertations, and theses. The inclusion criteria were: (a) surveys including data on sexual violence; (b) inclusion of boys or men as victims of sexual violence; (c) presenting data on prevalence, underreporting, and factors associated with sexual violence among Brazilian boys and men. We excluded studies that did not present data stratified by sex, that did not have men as victims, that did not include Brazilian boys or men as victims, and that focused on other forms of violence.

Data Screening and Extraction

The database searches yielded 1,481 papers. After removing duplicates and articles that were not available, the titles and abstracts of 1,458 studies were read, of which 1,371 were excluded because they did not match the inclusion criteria. In total, 87 texts were read in their entirety for eligibility, of which 34 were excluded: nine for not presenting data stratified by sex, nine in which men appeared only as sexual aggressors and not as victims, eight for not presenting data on Brazilian men, and eight for presenting forms of violence other than sexual (supplementary table^aaSupplementary table available from: https://docs.google.com/document/d/1pEAF7l6BcZFZS1V36MvJZvE0hf99L7gx/edit?usp=sharing&ouid=114531022125527350337&rtpof=true&sd=true ). In total, 53 papers were included in this review.

The data from the included articles were populated in a spreadsheet including: year of publication; location; type of publication; authors’ names; type of design; study objective; participants; data collection method; main findings; and prevalence of sexual violence.

Figure presents the flow chart of study selection and eligibility. The selection, eligibility, and extraction processes were performed by one researcher (DFG) and checked by another researcher (PPM).

As is the practice in scoping reviews, the results will be presented starting with the characteristics of the studies and then presenting the main findings regarding the study objectives.

RESULTS

A total of 53 studies were included, most of them quantitative in approach (n = 48), 38 cross-sectional studies¹⁴14. Silva AN, Marques ES, Silva LS, Azeredo CM. Wealth inequalities in different types of violence among Brazilian adolescents: National Survey of School Health 2015. J Interpers Violence. 2021;36(21-22):10705-24. https://doi.org/10.1177/0886260519888184
https://doi.org/10.1177/0886260519888184... , one exploratory descriptive⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017., three longitudinal⁵²52. Nisida IVV, Boulos MIC, Silva LMB, Mayaud P, Avelino-Silva VI, Segurado AC. Predictors of adherence to HIV post-exposure prophylaxis and retention in care after an episode of sexual violence in Brazil. AIDS Patient Care STDS. 2019;33(9):399-405. https://doi.org/10.1089/apc.2019.0080
https://doi.org/10.1089/apc.2019.0080... , one observational time-series ⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... and one case series⁵⁵55. Costa MCO, Musse JO, Reiter J, Cruz NLA, Amorim HPL. Violência sexual perpetrada em crianças e adolescentes: estudo dos registros de conselhos tutelares em uma década. Rev Adolesc Saude. 2017;14(2):8-16.. The remaining papers consisted of: four qualitative⁵⁶56. Mann CG, Monteiro S. Sexualidade e prevenção das IST/aids no cuidado em saúde mental: o olhar e a prática de profissionais no Município do Rio de Janeiro, Brasil. Cad Saude Publica. 2018;34(7):e00081217. https://doi.org/10.1590/0102-311X00081217
https://doi.org/10.1590/0102-311X0008121... , two literature reviews⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,²⁰20. Guimarães RA, Castro VOL, Oliveira SMVL, Stabile AC, Motta-Castro ARC, Carneiro MAS, et al. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry. 2017;1(1):412. https://doi.org/10.1186/s12888-017-1569-7
https://doi.org/10.1186/s12888-017-1569-... , two intervention studies⁶¹61. Nascimento MAF, Uziel AP, Hernandez JG. Young men in juvenile detention centers in Rio de Janeiro, Brazil: gender, sexuality, masculinity and health implications. Cad Saude Publica. 2018;34(2):e00177916. https://doi.org/10.1590/0102-311X00177916
https://doi.org/10.1590/0102-311X0017791... ,⁶²62. Kato-Wallace J, Barker G, Garg A, Feliz N, Levack A, Ports K, et al. Adapting a global gender-transformative violence prevention program for the U.S. community-based setting for work with young men. Glob Soc Welf. 2019;6(2):121-30. https://doi.org/10.1007/s40609-018-00135-y
https://doi.org/10.1007/s40609-018-00135... and one case study⁶³63. Nunes AVA, Nunes SOV, Strano T, Pascolat G, Doria GMS, Ehlke MN. Folie à Deux and its interaction with early life stress: a case report. J Med Case Rep. 2016;10(1):339. https://doi.org/10.1186/s13256-016-1128-8
https://doi.org/10.1186/s13256-016-1128-... . Among the 53 papers reviewed, 13 were conducted with secondary data⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... ,²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³⁹39. Penso MA, Conceição MIG, Costa LF, Said AP, Willians LCA. Boy sexual victimization: characteristics of family configuration and of the offender. Psicol Teor Pesq. 2019;35:e35428. https://doi.org/10.1590/0102.3772e35428
https://doi.org/10.1590/0102.3772e35428... . The total number of participants was 2,831,581, of which 1,416,480 were boys or men. The research with the smallest sample size was a case study (n = 1) and the one with the largest was a study that used data from the 2015 National School Health Survey (n = 1,248,581).

The sampling techniques of the selected papers include representative population samples¹⁰10. Coêlho BM, Santana GL, Viana MC, Andrade LH, Wang YP. Gender-related dimensions of childhood adversities in the general population. Rev Bras Psiquiatr. 2018;40(4):394-402. https://doi.org/10.1590/1516-4446-2017-2366
https://doi.org/10.1590/1516-4446-2017-2... ,¹⁴14. Silva AN, Marques ES, Silva LS, Azeredo CM. Wealth inequalities in different types of violence among Brazilian adolescents: National Survey of School Health 2015. J Interpers Violence. 2021;36(21-22):10705-24. https://doi.org/10.1177/0886260519888184
https://doi.org/10.1177/0886260519888184... ,²¹21. Barros CRS, Zucchi EM, Schraiber LB, França Junior I. Individual- and contextual-level factors associated with client-initiated HIV testing. Rev Bras Epidemiol. 2017;20(3):394-407. https://doi.org/10.1590/1980-5497201700030004
https://doi.org/10.1590/1980-54972017000... ,²²22. Fontes LFC, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Cien Saude Coletiva. 2017;22(9):2919-28. https://doi.org/10.1590/1413-81232017229.11042017
https://doi.org/10.1590/1413-81232017229... ,²⁵25. Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, et al. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016;72:51-7. https://doi.org/10.1016/j.jpsychires.2015.10.011
https://doi.org/10.1016/j.jpsychires.201... ,²⁹29. Schäfer JL, Teixeira VA, Fontoura LP, Castro LC, Horta RL. Exposure to physical and sexual violence and suicidal ideation among schoolchildren. J Bras Psiquiatr. 2017;66(2):96-103. https://doi.org/10.1590/0047-2085000000156
https://doi.org/10.1590/0047-20850000001... ,⁴⁶46. Costa FBS, Miranda CES, Rodrigues MTP, Mascarenhas MDM. Violência sexual entre adolescentes escolares brasileiros. Rev Adolesc Saude. 2018;21(2):72-80., Respondent-driven sampling (RDS)¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,⁴⁵45. Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Med (Baltimore). 2018;97(1 Suppl):S62-8. https://doi.org/10.1097/MD.0000000000009079
https://doi.org/10.1097/MD.0000000000009... , convenience sampling²³23. Barros CRS, Schraiber LB. Intimate partner violence reported by female and male users of healthcare units. Rev Saude Publica. 2017;51:7. https://doi.org/10.1590/S1518-8787.2017051006385
https://doi.org/10.1590/S1518-8787.20170... ,⁴³43. Sanvicente-Vieira B, Rovaris DL, Ornell F, Sordi A, Rothmann LM, Niederauer JPO, et al. Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users. PLoS One. 2019;14(6):e0218334. https://doi.org/10.1371/journal.pone.0218334
https://doi.org/10.1371/journal.pone.021... ,⁴⁷47. Albuquerque PP, Williams LCA. “Minha pior experiência escolar”: caracterização retrospectiva da vitimização de estudantesMy. Estud Psicol (Natal). 2018;23(2):133-44. https://doi.org/10.22491/1678-4669.20180014
https://doi.org/10.22491/1678-4669.20180... ,⁵⁰50. Gilchrist G, Radcliffe P, Noto AR, Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison 36(1):34-51. https://doi.org/10.1111/dar.12436
https://doi.org/10.1111/dar.12436... ,⁶⁵65. Raffaelli M, Santana JP, Morais NA, Nieto CJ, Koller SH. Adverse childhood experiences and adjustment: a longitudinal study of street-involved youth in Brazil. Child Abuse Negl. 2018;85:91-100. https://doi.org/10.1016/j.chiabu.2018.07.032
https://doi.org/10.1016/j.chiabu.2018.07... , birth cohort⁵⁴54. Gallo EAG, De Mola CL, Wehrmeister F, Gonçalves H, Kieling C, Murray J. Childhood maltreatment preceding depressive disorder at age 18 years: a prospective Brazilian birth cohort study. J Affect Disord. 2017;217:218-24. https://doi.org/10.1016/j.jad.2017.03.065
https://doi.org/10.1016/j.jad.2017.03.06... ,⁵³53. Soares ALG, Howe LD, Matijasevich A, Wehrmeister FC, Menezes AMB, Gonçalves H. Adverse childhood experiences: prevalence and related factors in adolescents of a Brazilian birth cohort. Child Abuse Negl. 2016;51:21-30. https://doi.org/10.1016/j.chiabu.2015.11.017
https://doi.org/10.1016/j.chiabu.2015.11... and multistage conglomerate survey⁴⁹49. Carvalho LS, Assis SG, Pires TO. Violência sexual em distintas eesferas relacionais de adolescents. Rev Adolesc Saude. 2017;14(1):14-21.. Eight other studies did not collect primary data, using secondary data or testimony from other research¹⁶16. Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542-9. https://doi.org/10.1177/0956462419825944
https://doi.org/10.1177/0956462419825944... ,²³23. Barros CRS, Schraiber LB. Intimate partner violence reported by female and male users of healthcare units. Rev Saude Publica. 2017;51:7. https://doi.org/10.1590/S1518-8787.2017051006385
https://doi.org/10.1590/S1518-8787.20170... ,²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... ,⁴⁸48. Silva WS, Barroso-Junior UO. Child sexual abuse confirmed by forensic examination in Salvador, Bahia, Brazil. Am J Forensic Med Pathol. 2017;38(1):54-8. https://doi.org/10.1097/PAF.0000000000000283
https://doi.org/10.1097/PAF.000000000000... ,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁹59. Oliveira AAB. Meninos traídos: abuso sexual e constituição da masculinidade [dissertação]. Belo Horizonte, MG: Universidade Federal de Minas Gerais; 2017..

Objectives of the Studies

Due to the diversity of methods used, we chose to categorize the objectives of the studies into: describing and/or analyzing factors associated with sexual violence against men (n = 23)¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,¹⁶16. Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542-9. https://doi.org/10.1177/0956462419825944
https://doi.org/10.1177/0956462419825944... ,¹⁸18. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, child sexual abuse, and mental health in a Brazilian National Sample. J Interpers Violence. 2020;37(1-2):NP944-67. https://doi.org/10.1177/0886260520915546
https://doi.org/10.1177/0886260520915546... ,¹⁹19. Sanchez ZM, Santos MGR, Sanudo A, Carlini CM, Martins SS. Sexual aggression in Brazilian nightclubs: associations with patron’s characteristics, drug use, and environmental factors. Arch Sex Behav. 2019;48(2):609-18. https://doi.org/10.1007/s10508-018-1322-4
https://doi.org/10.1007/s10508-018-1322-... ; understanding the phenomenon of sexual violence against this population and its impacts (n = 17)²⁰20. Guimarães RA, Castro VOL, Oliveira SMVL, Stabile AC, Motta-Castro ARC, Carneiro MAS, et al. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry. 2017;1(1):412. https://doi.org/10.1186/s12888-017-1569-7
https://doi.org/10.1186/s12888-017-1569-... ,³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... ,³⁵35. Sudbrack R, Manfro PH, Kuhn IM, Carvalho HW, Lara DR. What doesn’t kill you makes you stronger and weaker: how childhood trauma relates to temperament traits. J Psychiatr Res. 2015;62:123-9. https://doi.org/10.1016/j.jpsychires.2015.01.001
https://doi.org/10.1016/j.jpsychires.201... ; estimating the prevalence and incidence of such violence (n = 10)⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... ,⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,¹⁴14. Silva AN, Marques ES, Silva LS, Azeredo CM. Wealth inequalities in different types of violence among Brazilian adolescents: National Survey of School Health 2015. J Interpers Violence. 2021;36(21-22):10705-24. https://doi.org/10.1177/0886260519888184
https://doi.org/10.1177/0886260519888184... ,¹⁷17. Massaro LTS, Adesse L, Laranjeira R, Caetano R, Madruga CS. Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports. Cad Saude Publica. 2019;35(2):e00022118. https://doi.org/10.1590/0102-311X00022118
https://doi.org/10.1590/0102-311X0002211... ,²³23. Barros CRS, Schraiber LB. Intimate partner violence reported by female and male users of healthcare units. Rev Saude Publica. 2017;51:7. https://doi.org/10.1590/S1518-8787.2017051006385
https://doi.org/10.1590/S1518-8787.20170... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21.,⁴⁴44. Silva JV, Roncalli AG. Prevalence of sexual violence in Brazil: associated individual and contextual factors. Int J Public Health. 2018;63(8):933-44. https://doi.org/10.1007/s00038-018-1136-0
https://doi.org/10.1007/s00038-018-1136-... ,⁵³53. Soares ALG, Howe LD, Matijasevich A, Wehrmeister FC, Menezes AMB, Gonçalves H. Adverse childhood experiences: prevalence and related factors in adolescents of a Brazilian birth cohort. Child Abuse Negl. 2016;51:21-30. https://doi.org/10.1016/j.chiabu.2015.11.017
https://doi.org/10.1016/j.chiabu.2015.11... ; analyzing the perceptions of health professionals (n = 1)⁵⁶56. Mann CG, Monteiro S. Sexualidade e prevenção das IST/aids no cuidado em saúde mental: o olhar e a prática de profissionais no Município do Rio de Janeiro, Brasil. Cad Saude Publica. 2018;34(7):e00081217. https://doi.org/10.1590/0102-311X00081217
https://doi.org/10.1590/0102-311X0008121... ; and evaluating intervention processes to reduce violence (n = 2)⁶¹61. Nascimento MAF, Uziel AP, Hernandez JG. Young men in juvenile detention centers in Rio de Janeiro, Brazil: gender, sexuality, masculinity and health implications. Cad Saude Publica. 2018;34(2):e00177916. https://doi.org/10.1590/0102-311X00177916
https://doi.org/10.1590/0102-311X0017791... ,⁶²62. Kato-Wallace J, Barker G, Garg A, Feliz N, Levack A, Ports K, et al. Adapting a global gender-transformative violence prevention program for the U.S. community-based setting for work with young men. Glob Soc Welf. 2019;6(2):121-30. https://doi.org/10.1007/s40609-018-00135-y
https://doi.org/10.1007/s40609-018-00135... .

Of the studies on factors associated with violence, only 14 focused on sexual violence as the main objective and, based on this, identified the factors associated with it ¹⁸18. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, child sexual abuse, and mental health in a Brazilian National Sample. J Interpers Violence. 2020;37(1-2):NP944-67. https://doi.org/10.1177/0886260520915546
https://doi.org/10.1177/0886260520915546... ,¹⁹19. Sanchez ZM, Santos MGR, Sanudo A, Carlini CM, Martins SS. Sexual aggression in Brazilian nightclubs: associations with patron’s characteristics, drug use, and environmental factors. Arch Sex Behav. 2019;48(2):609-18. https://doi.org/10.1007/s10508-018-1322-4
https://doi.org/10.1007/s10508-018-1322-... ,²²22. Fontes LFC, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Cien Saude Coletiva. 2017;22(9):2919-28. https://doi.org/10.1590/1413-81232017229.11042017
https://doi.org/10.1590/1413-81232017229... ,²⁵25. Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, et al. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016;72:51-7. https://doi.org/10.1016/j.jpsychires.2015.10.011
https://doi.org/10.1016/j.jpsychires.201... . Among these papers, which focused on sexual violence and associated factors, only two exclusively discussed violence against boys and men²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019,⁴⁵45. Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Med (Baltimore). 2018;97(1 Suppl):S62-8. https://doi.org/10.1097/MD.0000000000009079
https://doi.org/10.1097/MD.0000000000009... .

The papers included in the category “understanding the phenomenon of sexual violence against boys and men and its impacts” were studies conducted to explain the dynamics of sexual violence and its impacts. Mostly, these studies do not describe the characteristics of the victim, the aggressor, the type of violence, and the frequency. Of these surveys, only nine considered exclusively boys and men³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21..

Ways to Identify Sexual Violence

A number of ways to identify sexual violence have been used, ranging from surveys that included questions about forced sex to instruments validated for this purpose. Among the 53 studies reviewed, only 27 reported how they investigated the presence of sexual violence. Most asked whether participants had ever been victims of forced sex in their lives (n = 11)¹⁴14. Silva AN, Marques ES, Silva LS, Azeredo CM. Wealth inequalities in different types of violence among Brazilian adolescents: National Survey of School Health 2015. J Interpers Violence. 2021;36(21-22):10705-24. https://doi.org/10.1177/0886260519888184
https://doi.org/10.1177/0886260519888184... ,¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,¹⁷17. Massaro LTS, Adesse L, Laranjeira R, Caetano R, Madruga CS. Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports. Cad Saude Publica. 2019;35(2):e00022118. https://doi.org/10.1590/0102-311X00022118
https://doi.org/10.1590/0102-311X0002211... ,¹⁸18. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, child sexual abuse, and mental health in a Brazilian National Sample. J Interpers Violence. 2020;37(1-2):NP944-67. https://doi.org/10.1177/0886260520915546
https://doi.org/10.1177/0886260520915546... ,²²22. Fontes LFC, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Cien Saude Coletiva. 2017;22(9):2919-28. https://doi.org/10.1590/1413-81232017229.11042017
https://doi.org/10.1590/1413-81232017229... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,²⁹29. Schäfer JL, Teixeira VA, Fontoura LP, Castro LC, Horta RL. Exposure to physical and sexual violence and suicidal ideation among schoolchildren. J Bras Psiquiatr. 2017;66(2):96-103. https://doi.org/10.1590/0047-2085000000156
https://doi.org/10.1590/0047-20850000001... ,³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... ,⁴⁵45. Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Med (Baltimore). 2018;97(1 Suppl):S62-8. https://doi.org/10.1097/MD.0000000000009079
https://doi.org/10.1097/MD.0000000000009... ,⁴⁶46. Costa FBS, Miranda CES, Rodrigues MTP, Mascarenhas MDM. Violência sexual entre adolescentes escolares brasileiros. Rev Adolesc Saude. 2018;21(2):72-80.. Nine studies used validated instruments, such as: Assessment of childhood trauma³⁵35. Sudbrack R, Manfro PH, Kuhn IM, Carvalho HW, Lara DR. What doesn’t kill you makes you stronger and weaker: how childhood trauma relates to temperament traits. J Psychiatr Res. 2015;62:123-9. https://doi.org/10.1016/j.jpsychires.2015.01.001
https://doi.org/10.1016/j.jpsychires.201... , Sexual Experiences Survey (SES-SFV)⁴²42. D’Abreu LCF, Krahé B. Vulnerability to sexual victimization in female and male college students in Brazil: cross-sectional and prospective evidence. Arch Sex Behav. 20165(5):1101-15. https://doi.org/10.1007/s10508-014-0451-7
https://doi.org/10.1007/s10508-014-0451-... , Student Alienation and Trauma Survey - R (SATS-R), Adverse childhood experiences (ACE)⁵⁰50. Gilchrist G, Radcliffe P, Noto AR, Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison 36(1):34-51. https://doi.org/10.1111/dar.12436
https://doi.org/10.1111/dar.12436... , National Institute of Child Health and Human Development (NICHD)⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... and Childhood Trauma Questionnaire (CTQ)⁴³43. Sanvicente-Vieira B, Rovaris DL, Ornell F, Sordi A, Rothmann LM, Niederauer JPO, et al. Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users. PLoS One. 2019;14(6):e0218334. https://doi.org/10.1371/journal.pone.0218334
https://doi.org/10.1371/journal.pone.021... ,⁵⁴54. Gallo EAG, De Mola CL, Wehrmeister F, Gonçalves H, Kieling C, Murray J. Childhood maltreatment preceding depressive disorder at age 18 years: a prospective Brazilian birth cohort study. J Affect Disord. 2017;217:218-24. https://doi.org/10.1016/j.jad.2017.03.065
https://doi.org/10.1016/j.jad.2017.03.06... . Some studies used secondary data, mostly information from medical records of victims of sexual violence, thus they do not include screening questions.

Participants

Most of the studies in this review did not include exclusively boys or men (n = 36). Among the studies not focused entirely on boys or men, 14 of them include children and adolescents of both sexes¹⁴14. Silva AN, Marques ES, Silva LS, Azeredo CM. Wealth inequalities in different types of violence among Brazilian adolescents: National Survey of School Health 2015. J Interpers Violence. 2021;36(21-22):10705-24. https://doi.org/10.1177/0886260519888184
https://doi.org/10.1177/0886260519888184... ,²⁰20. Guimarães RA, Castro VOL, Oliveira SMVL, Stabile AC, Motta-Castro ARC, Carneiro MAS, et al. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry. 2017;1(1):412. https://doi.org/10.1186/s12888-017-1569-7
https://doi.org/10.1186/s12888-017-1569-... ,²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... , eight include adult women and men⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,¹⁰10. Coêlho BM, Santana GL, Viana MC, Andrade LH, Wang YP. Gender-related dimensions of childhood adversities in the general population. Rev Bras Psiquiatr. 2018;40(4):394-402. https://doi.org/10.1590/1516-4446-2017-2366
https://doi.org/10.1590/1516-4446-2017-2... ,¹⁹19. Sanchez ZM, Santos MGR, Sanudo A, Carlini CM, Martins SS. Sexual aggression in Brazilian nightclubs: associations with patron’s characteristics, drug use, and environmental factors. Arch Sex Behav. 2019;48(2):609-18. https://doi.org/10.1007/s10508-018-1322-4
https://doi.org/10.1007/s10508-018-1322-... ,²¹21. Barros CRS, Zucchi EM, Schraiber LB, França Junior I. Individual- and contextual-level factors associated with client-initiated HIV testing. Rev Bras Epidemiol. 2017;20(3):394-407. https://doi.org/10.1590/1980-5497201700030004
https://doi.org/10.1590/1980-54972017000... ,²⁵25. Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, et al. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016;72:51-7. https://doi.org/10.1016/j.jpsychires.2015.10.011
https://doi.org/10.1016/j.jpsychires.201... ,³⁵35. Sudbrack R, Manfro PH, Kuhn IM, Carvalho HW, Lara DR. What doesn’t kill you makes you stronger and weaker: how childhood trauma relates to temperament traits. J Psychiatr Res. 2015;62:123-9. https://doi.org/10.1016/j.jpsychires.2015.01.001
https://doi.org/10.1016/j.jpsychires.201... ,⁴⁴44. Silva JV, Roncalli AG. Prevalence of sexual violence in Brazil: associated individual and contextual factors. Int J Public Health. 2018;63(8):933-44. https://doi.org/10.1007/s00038-018-1136-0
https://doi.org/10.1007/s00038-018-1136-... ,⁶²62. Kato-Wallace J, Barker G, Garg A, Feliz N, Levack A, Ports K, et al. Adapting a global gender-transformative violence prevention program for the U.S. community-based setting for work with young men. Glob Soc Welf. 2019;6(2):121-30. https://doi.org/10.1007/s40609-018-00135-y
https://doi.org/10.1007/s40609-018-00135... , five include drug users²⁴24. Guimarães RA, Rodovalho AG, Fernandes IL, Silva GC, Felipe RL, Vera I, et al. Transactional sex among noninjecting illicit drug users: implications for HIV transmission. ScientificWorldJournal. 2016;2016:4690628. https://doi.org/10.1155/2016/4690628
https://doi.org/10.1155/2016/4690628... ,³²32. Roglio VS, Borges EN, Rabelo-da-Ponte FD, Ornell F, Scherer JN, Schuch JB, et al. Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil. PLoS One.2020;15(5):e0232242. https://doi.org/10.1371/journal.pone.0232242
https://doi.org/10.1371/journal.pone.023... ,³³33. Madalena TS, Sartes LMA. Crack cocaine users in treatment in Therapeutic Communities: profile and prevalence. Arq Bras Psicol. 2018;70(1):21-36.,⁴³43. Sanvicente-Vieira B, Rovaris DL, Ornell F, Sordi A, Rothmann LM, Niederauer JPO, et al. Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users. PLoS One. 2019;14(6):e0218334. https://doi.org/10.1371/journal.pone.0218334
https://doi.org/10.1371/journal.pone.021... ,⁶⁶66. Zhu Y, Liu J, Chen Y, Zhang R, Qu B. The relation between mental health, homosexual stigma, childhood abuse, community engagement, and unprotected anal intercourse among MSM in China. Sci Rep. 2018;8:3984. https://doi.org/10.1038/s41598-018-22403-9
https://doi.org/10.1038/s41598-018-22403... , two focus on patients in health services²¹21. Barros CRS, Zucchi EM, Schraiber LB, França Junior I. Individual- and contextual-level factors associated with client-initiated HIV testing. Rev Bras Epidemiol. 2017;20(3):394-407. https://doi.org/10.1590/1980-5497201700030004
https://doi.org/10.1590/1980-54972017000... ,⁵²52. Nisida IVV, Boulos MIC, Silva LMB, Mayaud P, Avelino-Silva VI, Segurado AC. Predictors of adherence to HIV post-exposure prophylaxis and retention in care after an episode of sexual violence in Brazil. AIDS Patient Care STDS. 2019;33(9):399-405. https://doi.org/10.1089/apc.2019.0080
https://doi.org/10.1089/apc.2019.0080... , two focus on health professionals³⁶36. Ziliotto FPO, Antunes MC, Aznar-Blefari C, Rocha GVM. Characterization of sexual abuses committed by women. Trends Psychol. 2020;28(2):165-79. https://doi.org/10.9788/s43076-019-00007-0
https://doi.org/10.9788/s43076-019-00007... ,⁵⁶56. Mann CG, Monteiro S. Sexualidade e prevenção das IST/aids no cuidado em saúde mental: o olhar e a prática de profissionais no Município do Rio de Janeiro, Brasil. Cad Saude Publica. 2018;34(7):e00081217. https://doi.org/10.1590/0102-311X00081217
https://doi.org/10.1590/0102-311X0008121... , two target university students⁴²42. D’Abreu LCF, Krahé B. Vulnerability to sexual victimization in female and male college students in Brazil: cross-sectional and prospective evidence. Arch Sex Behav. 20165(5):1101-15. https://doi.org/10.1007/s10508-014-0451-7
https://doi.org/10.1007/s10508-014-0451-... ,⁴⁷47. Albuquerque PP, Williams LCA. “Minha pior experiência escolar”: caracterização retrospectiva da vitimização de estudantesMy. Estud Psicol (Natal). 2018;23(2):133-44. https://doi.org/10.22491/1678-4669.20180014
https://doi.org/10.22491/1678-4669.20180... , and one focuses on adolescents and adults¹⁸18. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, child sexual abuse, and mental health in a Brazilian National Sample. J Interpers Violence. 2020;37(1-2):NP944-67. https://doi.org/10.1177/0886260520915546
https://doi.org/10.1177/0886260520915546... .

Among the studies exclusively with boys or men, five of them are with men who have sex with other men¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,¹⁶16. Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542-9. https://doi.org/10.1177/0956462419825944
https://doi.org/10.1177/0956462419825944... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,³⁴34. Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, et al. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health. 2015;105(5):e95-102. https://doi.org/10.2105/AJPH.2014.302402
https://doi.org/10.2105/AJPH.2014.302402... ,⁴⁵45. Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Med (Baltimore). 2018;97(1 Suppl):S62-8. https://doi.org/10.1097/MD.0000000000009079
https://doi.org/10.1097/MD.0000000000009... , five on male children and adolescents³⁹39. Penso MA, Conceição MIG, Costa LF, Said AP, Willians LCA. Boy sexual victimization: characteristics of family configuration and of the offender. Psicol Teor Pesq. 2019;35:e35428. https://doi.org/10.1590/0102.3772e35428
https://doi.org/10.1590/0102.3772e35428... ,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... ,⁵⁸58. Carvalho FA. Homem não chora: o abuso sexual contra meninos. Jundiaí, SP: Paco Editorial; 2020. 180 p.,⁶¹61. Nascimento MAF, Uziel AP, Hernandez JG. Young men in juvenile detention centers in Rio de Janeiro, Brazil: gender, sexuality, masculinity and health implications. Cad Saude Publica. 2018;34(2):e00177916. https://doi.org/10.1590/0102-311X00177916
https://doi.org/10.1590/0102-311X0017791... , three focus on service patients (mostly health services)²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019,³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21.,⁶³63. Nunes AVA, Nunes SOV, Strano T, Pascolat G, Doria GMS, Ehlke MN. Folie à Deux and its interaction with early life stress: a case report. J Med Case Rep. 2016;10(1):339. https://doi.org/10.1186/s13256-016-1128-8
https://doi.org/10.1186/s13256-016-1128-... and two focus on drug users³⁸38. Canfield M, Radcliffe P, D’Oliveira AFPL, Gilchrist G. Factors associated with the severity of IPV perpetrated by substance using men towards current partner. Adv Dual Diagn. 2019;13(1):32-45. https://doi.org/10.1108/ADD-04-2019-0003
https://doi.org/10.1108/ADD-04-2019-0003... ,⁵⁰50. Gilchrist G, Radcliffe P, Noto AR, Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison 36(1):34-51. https://doi.org/10.1111/dar.12436
https://doi.org/10.1111/dar.12436... .

Underreporting

Underreporting of sexual violence against boys and men has been a topic discussed in several papers. For the authors, the reasons that could explain the problem are: the inability of men to perceive themselves in the place of victim and confusion regarding sexual orientation, caused by the fact that most sexual assaults are provoked by other men¹1. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: teoria e Intervenção. Curitiba, PR: Juruá; 2014. 138 p.,²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21.,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... ,⁵⁹59. Oliveira AAB. Meninos traídos: abuso sexual e constituição da masculinidade [dissertação]. Belo Horizonte, MG: Universidade Federal de Minas Gerais; 2017., the macho culture¹1. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: teoria e Intervenção. Curitiba, PR: Juruá; 2014. 138 p.,²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... ,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁸58. Carvalho FA. Homem não chora: o abuso sexual contra meninos. Jundiaí, SP: Paco Editorial; 2020. 180 p.,⁵⁹59. Oliveira AAB. Meninos traídos: abuso sexual e constituição da masculinidade [dissertação]. Belo Horizonte, MG: Universidade Federal de Minas Gerais; 2017., the greater difficulty of talking about sexual violence when compared to other forms of aggression¹⁰10. Coêlho BM, Santana GL, Viana MC, Andrade LH, Wang YP. Gender-related dimensions of childhood adversities in the general population. Rev Bras Psiquiatr. 2018;40(4):394-402. https://doi.org/10.1590/1516-4446-2017-2366
https://doi.org/10.1590/1516-4446-2017-2... , the lack of training of the agents involved in the notification process³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21., the fear of reproduction of the abuse, of the parents’ reaction, of a family breakdown, and the fear of the aggressor’s reactions due to his threats³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21..

Since part of the work was based on secondary data, there are also questions about the accuracy of data recording. These data recording problems range from filling out errors³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... to missing important information, namely, the sex of the victim and the offender⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017..

Prevalence of Sexual Violence

Most of the studies included in this review present data on prevalence of sexual violence (n = 36). Among the 17 studies conducted exclusively with boys or men, only eight present this information¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,¹⁶16. Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542-9. https://doi.org/10.1177/0956462419825944
https://doi.org/10.1177/0956462419825944... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019,³⁴34. Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, et al. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health. 2015;105(5):e95-102. https://doi.org/10.2105/AJPH.2014.302402
https://doi.org/10.2105/AJPH.2014.302402... ,³⁸38. Canfield M, Radcliffe P, D’Oliveira AFPL, Gilchrist G. Factors associated with the severity of IPV perpetrated by substance using men towards current partner. Adv Dual Diagn. 2019;13(1):32-45. https://doi.org/10.1108/ADD-04-2019-0003
https://doi.org/10.1108/ADD-04-2019-0003... ,⁴⁵45. Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Med (Baltimore). 2018;97(1 Suppl):S62-8. https://doi.org/10.1097/MD.0000000000009079
https://doi.org/10.1097/MD.0000000000009... ,⁵⁰50. Gilchrist G, Radcliffe P, Noto AR, Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison 36(1):34-51. https://doi.org/10.1111/dar.12436
https://doi.org/10.1111/dar.12436... .

The lowest prevalence described was 0.1% in a study carried out with a representative sample of the urban population of the city of São Paulo, which counted on information from 5,037 people, of whom 2,187 were men¹⁰10. Coêlho BM, Santana GL, Viana MC, Andrade LH, Wang YP. Gender-related dimensions of childhood adversities in the general population. Rev Bras Psiquiatr. 2018;40(4):394-402. https://doi.org/10.1590/1516-4446-2017-2366
https://doi.org/10.1590/1516-4446-2017-2... . The highest prevalence, on the other hand, was 71%, presented in a study also carried out in São Paulo with 80 men who presented complaints of sexual dysfunctions seen at a specialized service²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019.

The groups with the highest prevalences are men who have sex with other men (14.9–59.50%)¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,¹⁶16. Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542-9. https://doi.org/10.1177/0956462419825944
https://doi.org/10.1177/0956462419825944... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,³⁴34. Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, et al. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health. 2015;105(5):e95-102. https://doi.org/10.2105/AJPH.2014.302402
https://doi.org/10.2105/AJPH.2014.302402... ,⁴⁵45. Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Med (Baltimore). 2018;97(1 Suppl):S62-8. https://doi.org/10.1097/MD.0000000000009079
https://doi.org/10.1097/MD.0000000000009... , men with sexual dysfunction (10–71.3%)²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019 and alcohol or drug users (3.5-30.8%)²⁰20. Guimarães RA, Castro VOL, Oliveira SMVL, Stabile AC, Motta-Castro ARC, Carneiro MAS, et al. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry. 2017;1(1):412. https://doi.org/10.1186/s12888-017-1569-7
https://doi.org/10.1186/s12888-017-1569-... ,²⁴24. Guimarães RA, Rodovalho AG, Fernandes IL, Silva GC, Felipe RL, Vera I, et al. Transactional sex among noninjecting illicit drug users: implications for HIV transmission. ScientificWorldJournal. 2016;2016:4690628. https://doi.org/10.1155/2016/4690628
https://doi.org/10.1155/2016/4690628... ,³²32. Roglio VS, Borges EN, Rabelo-da-Ponte FD, Ornell F, Scherer JN, Schuch JB, et al. Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil. PLoS One.2020;15(5):e0232242. https://doi.org/10.1371/journal.pone.0232242
https://doi.org/10.1371/journal.pone.023... ,³³33. Madalena TS, Sartes LMA. Crack cocaine users in treatment in Therapeutic Communities: profile and prevalence. Arq Bras Psicol. 2018;70(1):21-36.,³⁸38. Canfield M, Radcliffe P, D’Oliveira AFPL, Gilchrist G. Factors associated with the severity of IPV perpetrated by substance using men towards current partner. Adv Dual Diagn. 2019;13(1):32-45. https://doi.org/10.1108/ADD-04-2019-0003
https://doi.org/10.1108/ADD-04-2019-0003... ,⁴³43. Sanvicente-Vieira B, Rovaris DL, Ornell F, Sordi A, Rothmann LM, Niederauer JPO, et al. Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users. PLoS One. 2019;14(6):e0218334. https://doi.org/10.1371/journal.pone.0218334
https://doi.org/10.1371/journal.pone.021... ,⁵⁰50. Gilchrist G, Radcliffe P, Noto AR, Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison 36(1):34-51. https://doi.org/10.1111/dar.12436
https://doi.org/10.1111/dar.12436... .

The variation in the prevalence data presented from Table 1 can be explained by the way the participants were selected, as well as the manner in which they were asked about their experience of sexual violence. Broader questions, such as about sexual experience before age 13 with someone five years older or more, may reveal a higher prevalence (59%)¹⁶16. Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542-9. https://doi.org/10.1177/0956462419825944
https://doi.org/10.1177/0956462419825944... and narrower or more specific questions may produce lower response rates in participants. In the survey with men with sexual dysfunctions, when asked about rape or attempted rape (sex with penetration) the prevalence was 10%; however, when these same men were asked about any non-consensual sexual experience before the age of 12, the prevalence increased to 71.3%²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019.

The research that investigated sexual assaults in nightclubs in São Paulo was one of the few to include male and female people, and the prevalence of sexual violence was higher among men: 1.4% of men and 0.7% of women reported attempted rape; regarding sexual assault, the numbers were 11.7% and 11.1%, respectively¹⁹19. Sanchez ZM, Santos MGR, Sanudo A, Carlini CM, Martins SS. Sexual aggression in Brazilian nightclubs: associations with patron’s characteristics, drug use, and environmental factors. Arch Sex Behav. 2019;48(2):609-18. https://doi.org/10.1007/s10508-018-1322-4
https://doi.org/10.1007/s10508-018-1322-... . Another study in which the prevalence of sexual violence was higher among boys was conducted among adolescents of both sexes, students in the second year of high school in ten Brazilian capitals. In this study, the prevalence among boys was 12.5%⁴⁹49. Carvalho LS, Assis SG, Pires TO. Violência sexual em distintas eesferas relacionais de adolescents. Rev Adolesc Saude. 2017;14(1):14-21.. In the others, with people of both sexes, the prevalence of sexual violence was higher among girls and women⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,²⁰20. Guimarães RA, Castro VOL, Oliveira SMVL, Stabile AC, Motta-Castro ARC, Carneiro MAS, et al. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry. 2017;1(1):412. https://doi.org/10.1186/s12888-017-1569-7
https://doi.org/10.1186/s12888-017-1569-... ,⁴⁶46. Costa FBS, Miranda CES, Rodrigues MTP, Mascarenhas MDM. Violência sexual entre adolescentes escolares brasileiros. Rev Adolesc Saude. 2018;21(2):72-80.,⁵³53. Soares ALG, Howe LD, Matijasevich A, Wehrmeister FC, Menezes AMB, Gonçalves H. Adverse childhood experiences: prevalence and related factors in adolescents of a Brazilian birth cohort. Child Abuse Negl. 2016;51:21-30. https://doi.org/10.1016/j.chiabu.2015.11.017
https://doi.org/10.1016/j.chiabu.2015.11... , as well as in the studies in which risk was estimated: girls and women were identified at higher risk of being raped than men¹⁸18. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, child sexual abuse, and mental health in a Brazilian National Sample. J Interpers Violence. 2020;37(1-2):NP944-67. https://doi.org/10.1177/0886260520915546
https://doi.org/10.1177/0886260520915546... ,⁵⁴54. Gallo EAG, De Mola CL, Wehrmeister F, Gonçalves H, Kieling C, Murray J. Childhood maltreatment preceding depressive disorder at age 18 years: a prospective Brazilian birth cohort study. J Affect Disord. 2017;217:218-24. https://doi.org/10.1016/j.jad.2017.03.065
https://doi.org/10.1016/j.jad.2017.03.06... .

Characteristics of Sexual Violence

Only 23 papers present information that identified the aggressor, most of them people known to the victims. Violence perpetrated by the father or stepfather was common in eight studies²²22. Fontes LFC, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Cien Saude Coletiva. 2017;22(9):2919-28. https://doi.org/10.1590/1413-81232017229.11042017
https://doi.org/10.1590/1413-81232017229... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... ,³⁹39. Penso MA, Conceição MIG, Costa LF, Said AP, Willians LCA. Boy sexual victimization: characteristics of family configuration and of the offender. Psicol Teor Pesq. 2019;35:e35428. https://doi.org/10.1590/0102.3772e35428
https://doi.org/10.1590/0102.3772e35428... ,⁴⁶46. Costa FBS, Miranda CES, Rodrigues MTP, Mascarenhas MDM. Violência sexual entre adolescentes escolares brasileiros. Rev Adolesc Saude. 2018;21(2):72-80.,⁴⁸48. Silva WS, Barroso-Junior UO. Child sexual abuse confirmed by forensic examination in Salvador, Bahia, Brazil. Am J Forensic Med Pathol. 2017;38(1):54-8. https://doi.org/10.1097/PAF.0000000000000283
https://doi.org/10.1097/PAF.000000000000... ,⁵⁸58. Carvalho FA. Homem não chora: o abuso sexual contra meninos. Jundiaí, SP: Paco Editorial; 2020. 180 p.,⁵⁹59. Oliveira AAB. Meninos traídos: abuso sexual e constituição da masculinidade [dissertação]. Belo Horizonte, MG: Universidade Federal de Minas Gerais; 2017.. Authors who have not described who the perpetrators are point to known and/or familiar figures⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... ,⁶⁵65. Raffaelli M, Santana JP, Morais NA, Nieto CJ, Koller SH. Adverse childhood experiences and adjustment: a longitudinal study of street-involved youth in Brazil. Child Abuse Negl. 2018;85:91-100. https://doi.org/10.1016/j.chiabu.2018.07.032
https://doi.org/10.1016/j.chiabu.2018.07... . There are also studies that describe violence committed by intimate partners⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,²³23. Barros CRS, Schraiber LB. Intimate partner violence reported by female and male users of healthcare units. Rev Saude Publica. 2017;51:7. https://doi.org/10.1590/S1518-8787.2017051006385
https://doi.org/10.1590/S1518-8787.20170... ,³⁸38. Canfield M, Radcliffe P, D’Oliveira AFPL, Gilchrist G. Factors associated with the severity of IPV perpetrated by substance using men towards current partner. Adv Dual Diagn. 2019;13(1):32-45. https://doi.org/10.1108/ADD-04-2019-0003
https://doi.org/10.1108/ADD-04-2019-0003... ,⁵⁰50. Gilchrist G, Radcliffe P, Noto AR, Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison 36(1):34-51. https://doi.org/10.1111/dar.12436
https://doi.org/10.1111/dar.12436... . It is noteworthy that women appeared in six studies as sexual rapists²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... ,³⁶36. Ziliotto FPO, Antunes MC, Aznar-Blefari C, Rocha GVM. Characterization of sexual abuses committed by women. Trends Psychol. 2020;28(2):165-79. https://doi.org/10.9788/s43076-019-00007-0
https://doi.org/10.9788/s43076-019-00007... ,³⁹39. Penso MA, Conceição MIG, Costa LF, Said AP, Willians LCA. Boy sexual victimization: characteristics of family configuration and of the offender. Psicol Teor Pesq. 2019;35:e35428. https://doi.org/10.1590/0102.3772e35428
https://doi.org/10.1590/0102.3772e35428... ,⁴⁶46. Costa FBS, Miranda CES, Rodrigues MTP, Mascarenhas MDM. Violência sexual entre adolescentes escolares brasileiros. Rev Adolesc Saude. 2018;21(2):72-80.,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁸58. Carvalho FA. Homem não chora: o abuso sexual contra meninos. Jundiaí, SP: Paco Editorial; 2020. 180 p..

A minority of the studies (n = 11) indicate where the violence occurred, and almost all of them (n = 10) report that the cases occurred at the victim’s or perpetrator’s home⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... ,²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... ,³⁶36. Ziliotto FPO, Antunes MC, Aznar-Blefari C, Rocha GVM. Characterization of sexual abuses committed by women. Trends Psychol. 2020;28(2):165-79. https://doi.org/10.9788/s43076-019-00007-0
https://doi.org/10.9788/s43076-019-00007... ,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁵55. Costa MCO, Musse JO, Reiter J, Cruz NLA, Amorim HPL. Violência sexual perpetrada em crianças e adolescentes: estudo dos registros de conselhos tutelares em uma década. Rev Adolesc Saude. 2017;14(2):8-16.,⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... . Most also did not report whether the assault was repeat violence: only 12 studies provided this information4,²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019,²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³¹31. Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet. 2015;20(3):655-65. https://doi.org/10.1590/1413-81232015203.15242014
https://doi.org/10.1590/1413-81232015203... ,³⁶36. Ziliotto FPO, Antunes MC, Aznar-Blefari C, Rocha GVM. Characterization of sexual abuses committed by women. Trends Psychol. 2020;28(2):165-79. https://doi.org/10.9788/s43076-019-00007-0
https://doi.org/10.9788/s43076-019-00007... ,⁴³43. Sanvicente-Vieira B, Rovaris DL, Ornell F, Sordi A, Rothmann LM, Niederauer JPO, et al. Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users. PLoS One. 2019;14(6):e0218334. https://doi.org/10.1371/journal.pone.0218334
https://doi.org/10.1371/journal.pone.021... ,⁴⁸48. Silva WS, Barroso-Junior UO. Child sexual abuse confirmed by forensic examination in Salvador, Bahia, Brazil. Am J Forensic Med Pathol. 2017;38(1):54-8. https://doi.org/10.1097/PAF.0000000000000283
https://doi.org/10.1097/PAF.000000000000... ,⁴⁹49. Carvalho LS, Assis SG, Pires TO. Violência sexual em distintas eesferas relacionais de adolescents. Rev Adolesc Saude. 2017;14(1):14-21.,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... ,⁵⁹59. Oliveira AAB. Meninos traídos: abuso sexual e constituição da masculinidade [dissertação]. Belo Horizonte, MG: Universidade Federal de Minas Gerais; 2017..

Factors Associated with Sexual Violence

Several factors have been described to be associated with sexual violence. Negative mental health outcomes were the most frequently cited, including: post-traumatic stress disorder (PTSD)²⁵25. Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, et al. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016;72:51-7. https://doi.org/10.1016/j.jpsychires.2015.10.011
https://doi.org/10.1016/j.jpsychires.201... ,⁶⁶66. Zhu Y, Liu J, Chen Y, Zhang R, Qu B. The relation between mental health, homosexual stigma, childhood abuse, community engagement, and unprotected anal intercourse among MSM in China. Sci Rep. 2018;8:3984. https://doi.org/10.1038/s41598-018-22403-9
https://doi.org/10.1038/s41598-018-22403... ; suicidal ideation²⁹29. Schäfer JL, Teixeira VA, Fontoura LP, Castro LC, Horta RL. Exposure to physical and sexual violence and suicidal ideation among schoolchildren. J Bras Psiquiatr. 2017;66(2):96-103. https://doi.org/10.1590/0047-2085000000156
https://doi.org/10.1590/0047-20850000001... ; drug use and social isolation¹⁷17. Massaro LTS, Adesse L, Laranjeira R, Caetano R, Madruga CS. Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports. Cad Saude Publica. 2019;35(2):e00022118. https://doi.org/10.1590/0102-311X00022118
https://doi.org/10.1590/0102-311X0002211... ,²²22. Fontes LFC, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Cien Saude Coletiva. 2017;22(9):2919-28. https://doi.org/10.1590/1413-81232017229.11042017
https://doi.org/10.1590/1413-81232017229... ,⁶⁷67. França DDS, Del-Rios NHA, Carneiro MAS, Guimarães RA, Caetano KAA, Reis MNG, et al. HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: prevalence and molecular characteristics. PLoS One. 2018;13(7):e0199606. https://doi.org/10.1371/journal.pone.0199606
https://doi.org/10.1371/journal.pone.019... ; and psychosis⁶³63. Nunes AVA, Nunes SOV, Strano T, Pascolat G, Doria GMS, Ehlke MN. Folie à Deux and its interaction with early life stress: a case report. J Med Case Rep. 2016;10(1):339. https://doi.org/10.1186/s13256-016-1128-8
https://doi.org/10.1186/s13256-016-1128-... . In addition to mental health issues, having unprotected anal sex¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... and sexual dysfunction²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019 were also related to sexual violence.

Other forms of violence were associated with sexual violence, among them: abuse in childhood and physical violence³²32. Roglio VS, Borges EN, Rabelo-da-Ponte FD, Ornell F, Scherer JN, Schuch JB, et al. Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil. PLoS One.2020;15(5):e0232242. https://doi.org/10.1371/journal.pone.0232242
https://doi.org/10.1371/journal.pone.023... ; discrimination due to sexual orientation²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ; intimate partner violence³⁴34. Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, et al. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health. 2015;105(5):e95-102. https://doi.org/10.2105/AJPH.2014.302402
https://doi.org/10.2105/AJPH.2014.302402... ; rape in adulthood¹⁸18. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, child sexual abuse, and mental health in a Brazilian National Sample. J Interpers Violence. 2020;37(1-2):NP944-67. https://doi.org/10.1177/0886260520915546
https://doi.org/10.1177/0886260520915546... . In a study that analyzed the victims’ records, it was possible to identify that the duration and severity of the abuse were associated with the sexual violence suffered by boys³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... . Table 1 describes the main characteristics of the studies.

DISCUSSION

Our study indicates a lack of research that exclusively studies sexual violence perpetrated against the adult or child male population. We also identified the underreporting of this kind of violence, an aspect cited in several studies, which may have causes in cultural norms, making it difficult for boys and men to perceive themselves as victims or even to talk about experiences that may indicate some fragility. However, prevalence studies show that sexual violence against this part of the population is a problem of great magnitude, with a significant variety of associated factors, such as negative mental health outcomes, behavioral or socialization problems, and clinical issues. Few studies had representative samples and the nature of the screening questions profoundly influenced the variation in estimated prevalences. In the surveys in which people of both genders were included, the prevalence was higher for females, corroborating the results of other studies that point to women and girls as the main victims of sexual violence⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,¹²12. Tricco AC, Lillie E, Zarin W, O’Brien K, Colquhoun H, Kastner M, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2021;16:15. https://doi.org/10.1186/s12874-016-0116-4
https://doi.org/10.1186/s12874-016-0116-... ,⁶⁸68. Pereda N, Guilera G, Forns M, Gómez-Benito J. The international epidemiology of child sexual abuse: a continuation of Finkelhor (1994). Child Abuse Negl. 2009;33(6):331-42. https://doi.org/10.1016/j.chiabu.2008.07.007
https://doi.org/10.1016/j.chiabu.2008.07... .

According to a study conducted in 2013 by the Institute for Applied Economic Research (IPEA), only 10% of cases of sexual violence are notified⁶⁹69. Cerqueira DRC, Coelho DSC. Estupro no Brasil: uma radiografia segundo os dados da Saúde. Brasilia, DF: IPEA; 2014. (Nota Técnica; nº 11 (Diest). and, although researchers show an evolution of 291.92% in the notifications of this violence against the male population between 2009-2013⁴4. Gaspar RS, Pereira MUL. Evolução da notificação de violência sexual no Brasil de 2009 a 2013. Cad Saude Publica. 2018;34(11):e00172617. https://doi.org/10.1590/0102-311X00172617
https://doi.org/10.1590/0102-311X0017261... , underreporting still appears as a major problem. The reasons listed by the authors to explain this underreporting are: confusions in relation to sexual orientation, because the abuses are mostly committed by men; the sexist and patriarchal culture that makes it impossible for men to perceive themselves as victims and to talk about their emotions; fear of family breakdown; fear of the aggressor; the choice of the aggressors for very young boys, i.e., not mature enough to understand that they are being victimized; and the fear of reproduction of the abuse¹1. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: teoria e Intervenção. Curitiba, PR: Juruá; 2014. 138 p.,²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... ,³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... ,³⁷37. Conceição MIG, Costa LF, Penso MA, Williams LCA. Abuso sexual infantil masculino: sintomas, notificação e denúncia no restabelecimento da proteção. Psicol Clin. 2020;32(1):101-21.,⁵¹51. Said AP. Abuso sexual de vítimas do sexo masculino: notificações e prontuários no Distrito Federal [dissertação]. Brasília, DF: Universidade de Brasília; 2017.,⁵⁷57. Hohendorff JV, Habigzang LF, Koller SH. “A boy, being a victim, nobody really buys that, you know?”: dynamics of sexual violence against boys. Child Abuse Negl. 2017;70:53-64. https://doi.org/10.1016/j.chiabu.2017.05.008
https://doi.org/10.1016/j.chiabu.2017.05... ,⁵⁹59. Oliveira AAB. Meninos traídos: abuso sexual e constituição da masculinidade [dissertação]. Belo Horizonte, MG: Universidade Federal de Minas Gerais; 2017..

Underreporting is a problem in many ways, but the fact that boys are not able to talk about their sexual trauma until much later may be associated with more severe and longer-lasting abuse³⁰30. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychol Health Med. 2019;24(6):739-48. https://doi.org/10.1080/13548506.2018.1556397
https://doi.org/10.1080/13548506.2018.15... . In a study carried out with surveillance data, sexual violence against men and boys happened earlier when compared to girls, and the explanation for this phenomenon lies in the incapacity of the younger child to recognize the situation as violating and to break the silence²⁸28. Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: autores, vítimas e consequências. Cien Saude Colet. 2018;23(4):1019-31. https://doi.org/10.1590/1413-81232018234.11362016
https://doi.org/10.1590/1413-81232018234... . This becomes even more difficult when one considers the sociocultural expectation that men are strong and resilient, generating a possible constraint for those who suffer sexual violence⁶6. Fórum Brasileiro de Segurança Pública. Anuário Brasileiro de Segurança Pública 2020. São Paulo: FBSP; 2020.,²⁰20. Guimarães RA, Castro VOL, Oliveira SMVL, Stabile AC, Motta-Castro ARC, Carneiro MAS, et al. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry. 2017;1(1):412. https://doi.org/10.1186/s12888-017-1569-7
https://doi.org/10.1186/s12888-017-1569-... .

Although there is a major problem regarding the underreporting of sexual violence against men, the prevalence data described in the studies range from 0.1% to 71%. Men who have sex with men, men with sexual dysfunctions, and drug users had higher prevalences than the other groups. In a population-based study with a representative sample from the USA, researchers found that bisexual and homosexual men were more likely to have a history of childhood sexual violence than heterosexual men⁷⁰70. Sweet T, Welles SL. Associations of sexual identity or same-sex behaviors with history of childhood sexual abuse and HIV/STI risk in the United States. J Acquir Immune Defic Syndr. 2012;59(4):400-8. https://doi.org/10.1097/QAI.0b013e3182400e75
https://doi.org/10.1097/QAI.0b013e318240... . Another aspect identified in the studies that make up this review is that most of them were about children and adolescents or investigated aggression in childhood. Only three studies investigated violence in adulthood, indicating a gap in evidence on sexual violence against adult men.

The National Health Survey (PNS), conducted for the second time in 2019, included questions to screen for sexual violence and pointed out that 2.5% of men aged 18 years or older participating in the survey had experienced sexual violence once in their lifetime, which represents approximately two million men⁷¹71. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2019: acidentes, violência, doenças transmissíveis, atividade sexual, características do trabalho e apoio social. Rio de Janeiro: IBGE; Ministério da Saúde, Coordenação de Trabalho e Rendimento; 2021.. In a literature review on the prevalence of sexual violence and its characteristics, the author identified prevalence ranging from 1% to 35% among males, but only 35% of the papers included in the review contained information on male victims. This corroborates the need for more studies on Brazilian men who suffer or have suffered sexual violence²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... .

The definition of sexual violence adopted by the researchers changed the prevalence results. Studies investigating all forms of sexual violence found higher prevalences; studies with more specific questions, on the other hand, showed lower prevalences. We find it difficult to choose a screening question that can be used widely, but we see the need for debate around this issue.

Regarding the factors associated with sexual violence against men and boys, this review points to a diversity of outcomes, from negative mental health outcomes (PTSD, drug use and abuse, suicidal ideation)²⁵25. Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, et al. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016;72:51-7. https://doi.org/10.1016/j.jpsychires.2015.10.011
https://doi.org/10.1016/j.jpsychires.201... ,⁶⁶66. Zhu Y, Liu J, Chen Y, Zhang R, Qu B. The relation between mental health, homosexual stigma, childhood abuse, community engagement, and unprotected anal intercourse among MSM in China. Sci Rep. 2018;8:3984. https://doi.org/10.1038/s41598-018-22403-9
https://doi.org/10.1038/s41598-018-22403... to clinical problems (erectile dysfunction and premature ejaculation, and chronic pelvic pain)²⁷27. Pap AD. A relação entre a experiência de abuso sexual na infância e queixas de dor pélvica crônica e disfunção sexual masculina [dissertação]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2019 and behavioral issues (frequent HIV testing, unprotected anal sex, social isolation, and commercial sex)¹⁵15. Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High rates of unprotected receptive anal intercourse and their correlates among young and older MSM in Brazil. AIDS Behav. 2020;24(3):938-50. https://doi.org/10.1007/s10461-019-02459-y
https://doi.org/10.1007/s10461-019-02459... ,¹⁷17. Massaro LTS, Adesse L, Laranjeira R, Caetano R, Madruga CS. Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports. Cad Saude Publica. 2019;35(2):e00022118. https://doi.org/10.1590/0102-311X00022118
https://doi.org/10.1590/0102-311X0002211... ,²²22. Fontes LFC, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Cien Saude Coletiva. 2017;22(9):2919-28. https://doi.org/10.1590/1413-81232017229.11042017
https://doi.org/10.1590/1413-81232017229... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,⁶⁷67. França DDS, Del-Rios NHA, Carneiro MAS, Guimarães RA, Caetano KAA, Reis MNG, et al. HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: prevalence and molecular characteristics. PLoS One. 2018;13(7):e0199606. https://doi.org/10.1371/journal.pone.0199606
https://doi.org/10.1371/journal.pone.019... . Several studies also indicate the presence of suicidal thoughts, social isolation, sexually transmitted infections (STIs), guilt, low self-esteem, psychosomatic illnesses, and physical and emotional development problems in victims²2. Hohendorff JV, Habigzang LF, Koller SH. Violência sexual contra meninos: dados epidemiológicos, características e consequências. Psicol USP. 2012;23(2):395-416. https://doi.org/10.1590/S0103-65642012005000007
https://doi.org/10.1590/S0103-6564201200... ,²⁶26. Sabidó M, Kerr LRFS, Mota RS, Benzaken AS, Pinho AA, Guimarães MDC, et al. Sexual violence against men who have sex with men in Brazil: a respondent-driven sampling survey. AIDS Behav. 2015;19(9):1630-41. https://doi.org/10.1007/s10461-015-1016-z
https://doi.org/10.1007/s10461-015-1016-... ,⁷²72. Koller SH, De Antoni C. Violência intrafamiliar: uma visão ecológica. In: Koller SH, organizadora. Ecologia do desenvolvimento humano: pesquisa e intervenção no Brasil. São Paulo: Casa do Psicólogo; 2004. p. 293-310.

73. Minayo MCS. Violência e saúde. Rio de Janeiro: Fiocruz; 2006. 132 p.-⁷⁴74. Souza TM, Barbosa RB. Abuso sexual intrafamiliar em meninos. Psicol Foco. 2015;5(1):10-12.. In this sense, our results do not differ from other studies, indicating indeed a serious public health problem.

The characteristics of the violence, such as the sex of the aggressor and the place where the violence happened, were one of the points less explored by the researchers, and even so, the results indicate that in relation to the characteristics of the aggression, sexual violence suffered by men and women are similar, because the aggressors and the places have the same identifying features⁸8. Winzer L. Frequency of self-reported sexual aggression and victimization in Brazil: a literature review. Cad Saude Publica. 2016;32(7):e00126315. https://doi.org/10.1590/0102-311X00126315
https://doi.org/10.1590/0102-311X0012631... ,⁷¹71. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2019: acidentes, violência, doenças transmissíveis, atividade sexual, características do trabalho e apoio social. Rio de Janeiro: IBGE; Ministério da Saúde, Coordenação de Trabalho e Rendimento; 2021..

It is important to point out that this scoping review has some limitations that should be considered when interpreting the results. Important databases were chosen to carry out the search for the studies, but it is recognized that there is a limitation in the variety of the type of material analyzed, since government documents and the proceedings of scientific events, for example, were not included.

It is not common practice in scope reviews to adopt quality assessment of the studies and statistical treatment for quantitative data, as is the case for systematic reviews. Therefore, there may be a limitation regarding the quality and scientific rigor of the studies included.

CONCLUSIONS

In the period studied, the underreporting of sexual violence against men and boys seems to be a problem of great magnitude, which can be explained from the cultural norms surrounding the male gender. The prevalence of this violence, although largely variable, is higher than the data found in the notification systems, which may indicate the problem of underreporting in the official systems. Regarding the associated factors, there is a body of data presented indicating that men victim to sexual violence may suffer a series of consequences in several areas of their lives.

In this sense, efforts are needed for the realization of future studies with representative samples, screening questions of sexual violence that capture all forms of non-consensual sexual contact, aiming to understand the violence suffered by the male population, and with primary data, avoiding any bias in filling out the notifications. It is important that future studies are able to describe the characteristics of these assaults against men and boys, such as how long they lasted and how long the victims took to talk about what happened.

In Brazil, the Specialized Reference Centers of Social Assistance (CREAS) serves children and adolescents who are victims of rights violation, but these services are mostly used by female children. We know of only one Brazilian initiative that offers psychological care for male victims of sexual violence: Memórias Masculinas. Ultimately, we suggest that public policy makers should focus on developing strategies to be more inclusive of the male experience with sexual violence, and explore methods to prevent adverse effects.

REFERENCES

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