10 The sex industry thrives during these difficult times because

10 The sex industry thrives during these difficult times because maybe of both supply and demand. The United Nations Refugee Agency has identified factors that contribute to sexual violence. Some of these factors include male dominance, psychologic stress in refugee camps, lack of protection and support for women, alcohol and drug abuse, and general lawlessness.7 The psychologic effect of sexual violence, manipulation, or both can further prevent women from reintegrating into the society long after the disaster is over. Health care providers during disasters are not always trained to address victims of sexual violence. When attention is primarily focused on life-saving or limb-saving techniques, sexual violence is rarely considered.

Effective measures in caring for rape victims include eliciting a thorough sexual history, treating physical injuries, providing emergency contraception and prophylactic treatment of sexually transmitted infections (STIs), reporting the perpetrator or perpetrators, and establishing safety and order in shelters and camps. Health workers who are experienced in helping victims of sexual violence can also help identify children who might be at risk (eg, orphans and children separated from their families). Women should also be referred to resources to ensure protection from further sexual assaults.11 Access to Contraceptive Care and Prevention of STIs During emergencies, routine behaviors are altered drastically. Women who use contraception may not have access to contraceptive drugs or devices or may forget to take or use them.

In addition, stress and despair create, at best, comfort-seeking behaviors when people crave closeness and intimacy and, at worst, violent sexual behaviors. Unprotected coitus thus places women at risk for pregnancy and STIs. Prevention of unplanned and undesired pregnancies must be at the forefront of emergency-response measures (Table 1). If available, injectable methods of contraception are optimal because they do not require women to remember to use contraception during times of crisis. Table 1 Access to Contraceptive Care During disasters, preventive measures against STIs and the human immunodeficiency virus (HIV) and AIDS are forgotten or ignored. In addition, HIV-positive persons may not have access to their medication, and as a result they are at higher risk for transmitting the disease during this time period.

Thus, preventing the transmission of STIs is a vital part of emergency response (Table 2). Table 2 STI Prevention Strategy Prenatal Care and Delivery in Emergencies In resource-poor nations, prenatal care and delivery can be challenging given the Cilengitide poor facilities and the lack of necessary equipment for emergencies. Pregnancy complications such as placenta previa and placenta accreta, retained placenta, obstructed labor, and fetal distress are challenges in the best of times. During a natural disaster, health care facilities and providers are stretched even further (Table 3).

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