Sexual violence against Black girls: The silenced racial debate in national scientific production

Abstract

This article aims to analyse how national scientific production in the field of health discusses the ethnic-racial issue in studies on sexual violence (SV) against girls. An integrative literature review was conducted, with thematic analysis of the selected studies. Searches were carried out in three indexed databases, covering the years 2013 to 2022. Fifty-seven articles were selected for analysis, organised into four thematic axes: 1. characterization of SV and the profile of children and adolescents; 2. repercussions and consequences of SV; 3. healthcare for SV victims and professionals’ perceptions; 4. Tthe quality and evolution of SV records, reports, and underreporting. Epidemiological studies predominate, yet not all even include the race/colour variable, despite the observed improvement in information quality during the period. The literature reveals a significant gap regarding racial discussion in SV studies, despite the increase in records involving Black girls. The absence of discussion on the impacts of racism and the lack of specific strategies to address the racial dimension of this issue are evident. The invisibility of violence against Black childhood diminishes the reach of actions to combat SV.

Keywords:
Sexual Offenses; Sexual Abuse; Racism; Child; Adolescent.

Resumo

O objetivo deste artigo é analisar como a produção científica nacional do campo da saúde discute a questão étnico-racial nos estudos sobre violência sexual (VS) contra meninas. Foi realizada uma revisão integrativa da literatura, com análise temática dos estudos encontrados. As buscas foram realizadas em três bases indexadas, abrangendo os anos de 2013 a 2022. Foram selecionados 57 artigos para análise, organizados em quatro eixos temáticos: 1. caracterização da VS e perfil das crianças e adolescentes; 2. repercussões e consequências da VS; 3. atenção à saúde das vítimas de VS e; 4. as percepções dos profissionais, e qualidade e evolução dos registros de VS, notificações e subnotificações. Os estudos epidemiológicos predominam, mas nem todos sequer incluem a variável raça/cor, a despeito da melhoria da qualidade da informação observada no período. A literatura revela uma lacuna significativa no que diz respeito à discussão racial nos estudos sobre VS, apesar do aumento de registros envolvendo meninas negras. A ausência de discussão sobre os impactos do racismo e a falta de estratégias específicas para abordar a dimensão racial dessa problemática são evidentes. A invisibilidade das violências contra as infâncias negras diminui o alcance das ações de enfrentamento à VS.

Palavras-chave:
Delitos Sexuais; Abuso sexual; Racismo; Criança; Adolescente.

Introduction

Black Brazilian children and adolescents often experience profound inequalities, facing racial discrimination in several social spaces governed by racism. The harmful effects of racism on childhood transcend generations, manifesting in living conditions characterized by extreme poverty, lack of access to quality educational opportunities, and difficulties in building a positive self-image (Gomes; Araújo, 2023). We observe several mechanisms that produce a feeling of inferiority and prematurely cut short the lives of these children, an event recently termed “necrochildhood” (Noguera, 2020).

In this context, among the several forms of violence experienced in childhood, sexual violence (SV) against girls emerges as a Public Health problem, exacerbated by converging systems of oppression at the intersections of gender, ethnicity, and class (Crenshaw, 2002; Akotirene, 2019). Studies reaffirm that children and adolescents victims of sexual abuse often suffer other types of violence, such as physical and psychological. They may experience growth and cognitive, physical, and emotional development problems, as well as suicidal ideation and attempts. The effects on adulthood are numerous, including the development of mental disorders, post-traumatic stress disorder (PTSD), depression, and substance abuse (Lira et al., 2017; Cruz et al., 2021).

Sexual violence is intrinsically linked to gender inequalities, structurally defined by patriarchal power and materialized through different cultural machismo models. It is a structural system of social, political, and economic relations that perpetuate the subordination of women, producing cycles of violence that systematically make female and feminized bodies vulnerable, creating conditions of vulnerability to further violence (Segato, 2012). However, such segregations are part of a continuous historical process experienced by Black girls, who have faced multiple forms of marginalization, devaluation, and sexual objectification of their bodies since colonization, generating trauma in several spheres of their social life and health, also bringing negative repercussions on sexuality and self-esteem (Werneck, 2016).

Despite underreporting, the 2023 Epidemiological Bulletin reveals that 116,095 reports of sexual abuse cases were recorded against Black and brown girls aged 0-19 and 71,760 against white girls in Brazil from 2015 to 2021. In 2021 alone, 10,829 reports of sexual abuse were recorded against Black girls aged 0-19, and 5,708 against white girls. In 2022, we also witnessed an 8.6% increase in rape cases among vulnerable people against the previous year, totaling 56,820 incidents, and the 10-13 age group was the most affected. The female predominance among victims remains constant, with 88.7% of cases, and Black people continue to be the primary victims, with a proportional increase compared to 2021, representing 56.8% of victims, in contrast to 52.2% in the previous year (FBSP, 2023; Brasil, 2023).

Although the Brazilian Black population is larger and has specific experiences of illness and harm due to violence that are permeated by several types of racism (structural, interpersonal, and institutional), there is still a lack of systematic scientific production of knowledge and coping strategies on these issues.

This article, therefore, aimed to analyze how Brazilian scientific literature in the field of Health addresses the ethnic-racial issue in studies on sexual violence against girls, understanding the importance of focusing discussions and research on Black childhoods, whose presence is often neglected in public policies and research agendas. We analyzed the collection from a theoretical framework that encompasses the categories of gender violence, racism, structural racism, and Black childhoods.

Methods

This integrative literature review presents the state of the art on a given event, enabling a broad and comprehensive analysis of empirical, theoretical, experimental, and non-experimental studies, identifying existing research gaps and providing support for directing the development of intervention strategies in the field of Health (Souza; Silva; Carvalho, 2010). This study adopted the following steps: identification of the theme and guiding question; establishment of inclusion/exclusion criteria; categorization of studies; analysis of studies; interpretation of results, and synthesis of knowledge (Mendes; Silveira; Galvão, 2008).

In the first stage, we formulated the following guiding question: “How does national scientific literature in the field of Health address the ethnic-racial issue in studies on sexual violence against female children and adolescents?”, focusing our research interest on racial and gender issues. In the second stage, we adopted the following inclusion and exclusion criteria to select the studies:

- Inclusion criteria: Scientific articles from studies conducted with the Brazilian population, published in Health-related journals (Collective Health, Public Health, Medicine, Nursing, Psychology, among other areas of knowledge), in Portuguese, English, or Spanish, with access to the full text, and whose central theme is sexual violence against female children and adolescents.

- Exclusion criteria: Incomplete articles, gray literature (book chapters, theses, dissertations), articles unrelated to Health, even from related fields (Pedagogy, Law, among others), duplicate articles, articles that did not address sexual violence against female children and adolescents, articles whose central theme was not sexual violence, and international studies and studies outside the pre-established time frame. The time frame was defined between 2013 and 2022.

We conducted the bibliographic search in the Virtual Health Library (BVS), the Brazilian Portal of Open Access Scientific Publications and Data (OASISbr), and the Scientific Electronic Library Online (SciELO). The 594 documents retrieved were exported to Rayyan software (https://www.rayyan.ai/) to manage and organize the bibliographic data. Rayyan organized the articles, eliminating duplicates and facilitating the process of screening titles and abstracts. After exporting the references, 116 duplicate documents were removed, leaving 478 for reading titles and abstracts.

We carefully read the titles and abstracts independently and in pairs. A total of 267 studies were removed because they were either off-topic, related to other age groups/ranges, outside the field of Health, gray literature documents (theses and dissertations), international articles, or outside the time frame (Figure 1). We excluded 154 of the 211 remaining articles after reading them in full: 105 articles did not address SV as the central theme, 26 were outside the field of Health (Criminal Justice and Applied Social Sciences), 15 were incomplete, and eight were related to other populations. After applying all selection/exclusion criteria, we selected 57 articles for qualitative analysis (Figure 1).

Figure 1
Flowchart of the article search and selection process.

For data processing, a table was created containing the title, authors, the publication year, journal/newspaper, field of knowledge (Public Health, Psychology, and the like), gender of the authors, institution, and state of the first author, objectives, methodology used, results, and discussion. Subsequently, an interpretative analysis of each article was performed, questioning these variables, in order to respond to the objectives proposed in the work. To analyze the collection found, the studies were grouped by similarity into categories, a criterion used to perform thematic analysis, the analysis method used in this work (Braun; Clarke, 2006).

The review results were structured into four thematic areas. The first area, characterization of sexual violence and the profile of children and adolescents (n=34), gathers predominantly epidemiological studies, emphasizing the description of reported cases, the sociodemographic profile of victims and perpetrators, the dynamics of abuse, and vulnerability contexts. The second area, repercussions and consequences of SV (n=8), includes investigations that analyze the physical, psychological, and social impacts of violence, highlighting the intersectionality between gender, ethnicity, and structural inequalities in the consequences experienced by victims. The third area, sexual violence victims’ healthcare and professionals’ perceptions (n=9), explores care protocols and the challenges faced by health teams in the face of the complexity of care in cases of child sexual violence, including training gaps, institutional biases, and barriers to care. The fourth area, quality and evolution of sexual violence records, notifications, and underreporting (n=5), discusses the limitations and advances of health information systems.

Results

Collection characterization

Studies conducted by female authors (43) were the most frequent, followed by 12 studies conducted by authors of both genders and two studies conducted by male authors. Regarding the methodological design, 39 studies were categorized as quantitative (cross-sectional, cohort, and ecological), followed by eight studies with a qualitative approach, nine review articles (integrative, systematic, narrative), and one study with a mixed approach.

Studies conducted in the Northeast (22) predominated, with the most significant number of productions in the states of Bahia and Piauí, followed by the Southeast (18), with more studies in the states of São Paulo and Rio de Janeiro, and the South (12), with most studies in the states of Paraná and Rio Grande do Sul. The Midwest (3) and North (2) were more discreetly present. The most frequent institutions of affiliation of the first authors were the Federal University of Piauí (4), the University of São Paulo (3), and the Fernandes Figueira Institute, Fiocruz (3). The national journals that published the most on the topic of SV were Revista Ciência e Saúde Coletiva (12), Research, Society and Development (7), and the Brazilian Journal of Health Review (4).

Area # 1 Characterization of sexual violence and the profile of children and adolescents

Table 1 presents studies that aimed to analyze the profile of sexual abuse victims and characterize the event. Most victims were aged 10-14 years and had not completed Elementary School or were not attending school. Sexual abuse occurred primarily within the home and was committed by male relatives or acquaintances close to the victims.

table 1
Summary of articles characterizing sexual violence and the profile of child and adolescent victims (N = 34)

Authors/Year	Method	Population	Variables	Ethnicity/Raciality
Santos et al., 2013. Trindade et al., 2014. Blake et al., 2014. Oliveira et al., 2014. Justino et al., 2015. Moreira et al., 2015. Silva et al., 2016. Magalhães et al., 2016. Souto et al., 2017. Delziovo et al., 2017. Platt et al., 2018. Santos et al., 2018. Sena; Silva; Neto, 2018. Matos; Pinto; Stelko-Pereira, 2018. Abreu et al., 2019. Santos et al., 2019. Araújo et al., 2019. Kataguiri et al., 2019. Santarém et al., 2020. Margotti e Lima, 2020. Miranda et al., 2020. Nery et al., 2020. Altíssimo et al., 2021. Lemos et al., 2021. Taquette et al., 2021. Maluf et al., 2021. Caracas Moreira et al., 2022. Leite et al., 2022. Santos et al., 2022. Vasconcelos et al., 2022. Pantoja et al., 2022. Castro et al., 2022. Carli; Porfírio; Figueiredo, 2022. Brito; Costa; Souza, 2022.	Estudo transversal (Santos et al., 2013; Justino et al.,2015; Silva et al., 2016; Platt et al., 2018; Matos, Pinto e Stelko-Pereira, 2018; Santos et al., 2019; Santarém et al., 2020; Caracas Moreira et al., 2022; Leite et al., 2022; Santos et al., 2022; Vasconcelos et al., 2022). Descriptive and retrospective study (Trindade et al., 2014; Araújo et al., 2019; Brito, Costa and Souza, 2022). Retrospective study (Blake et al., 2014; Moreira et al., 2015; Maluf et al., 2021). Descriptive study (Magalhães et al., 2016; Santos et al., 2018; Sena; Silva; Neto, 2018; Margotti and Lima, 2020). Comparative study (Souto et al., 2017) Ecological study (Delziovo et al., 2017; Abreu et al., 2019; Kataguiri et al., 2019; Miranda et al., 2020; Nery et al., 2020; Lemos et al., 2021).	Children and adolescents victims of SV of both genders Santos et al., 2013 - (0 - 18 years). Trindade et al., 2014 - (0 - 17 years). Oliveira et al., 2014 - (0 - 18 years) Silva et al., 2016 - (1 - 19 years) Magalhães et al., 2016 - (0 - 18 years) Souto et al., 2017 - (0 - 13 years) Platt et al., 2018 - (0 - 15 years) Santos et al., 2018 - (0 - 19 years) Sena; Silva; Neto, 2018 - (0 - 18 years) Abreu et al., 2019 - (10 - 19 years) Margotti e Lima, 2020 - (06 - 18 years) Miranda et al., 2020 - (0 - 18 years) Nery et al., 2020 - (0 - 19 years) Lemos et al., 2021 - (0 - 14 years) Pantoja et al., 2022 - (0 - 19 years). Castro et al., 2022 - (0 - 19 years) Carli, Porfírio and Figueiredo, 2022 - (0 - 19 years) Brito, Costa and Souza, 2022 - (5 - 19 years) Children of both genders are victims of SV Araújo et al., 2019 - (0 - 9 years).	Sociodemographic variables of victims and data on violence perpetrated, excluding skin color Santos et al., 2013 - (Gender, victim’s education level, income, type of violence, perpetrator’s relationship with the victim); Trindade et al., 2014 - (Gender and age of victims and information about SV - Place of occurrence, time between abuse and investigation, reported complaints). Oliveira et al., 2014 - (Victim’s gender, age group, victim’s guardian, perpetrator’s relationship with the victim, perpetrator’s gender, perpetrator’s age group, use and type of intimidation). Silva et al., 2016 - (Age group, gender, perpetrator’s profile, and place of occurrence). Abreu et al., 2019 - (Age group, information about the violence perpetrated).	Justino et al., 2015; A study in Rio Grande do Sul indicates that 37.8% of the 172 adolescent victims of violence were white and 36.6% were brown or Black, without further analysis of ethnicity. Moreira et al., 2015; Study points to a predominance of white victims (40.7%), followed by brown (39.0%), Black (8.1%), yellow and Indigenous (0.8%), and cases without information (10.6%), without in-depth racial analysis. Souto et al., 2017; The study highlights that analysis by ethnicity/color reinforces social inequality, highlighting the greater vulnerability of black children and adolescents to sexual violence. Delziovo, et al., 2017; In reports of sexual violence in Rio Grande do Sul, 81.8% of victims were white, 11.3% were brown, 5.4% were Black, and 1.5% were Asian/Indigenous. The study grouped categories and did not explore ethnicity. Platt et al., 2018 - A study conducted in Rio Grande do Sul indicates a predominance of white victims of sexual abuse (78.0%), followed by brown (13.6%) and Black (8.3%). In contrast, Indigenous and Asian women represented 0.3% each. The study does not delve into racial analysis.
	Epidemiological, case-series study (Oliveira et al., 2014) Epidemiological, descriptive, cross-sectional cohort study (Taquette et al., 2021). Systematic review (Pantoja et al., 2022). Qualitative-quantitative study (Carli, Porfírio, and Figueiredo, 2022)	Adolescents of both genders are victims of sexual abuse Justino et al., 2015 - (12-14 years). Santos et al., 2019 - (13-17 years) Caracas Moreira et al., 2022 - (13-17 years). Children, adolescents, and adult female victims of SV Blake et al., 2014 - (13-62 years) Moreira et al., 2015 - (0-60+ years) Delziovo et al., 2017 - (10-19 years) Santarém et al., 2020 - (0-60+ years). Taquette et al., 2021 - (10-13 years). Maluf et al., 2021 - (12-60+ years) Santos et al., 2022 - (12-60+ years). Schoolchildren and university students Matos, Pinto and Stelko-Pereira, 2018 - (20-60+ years). Vasconcelos et al., 2022 - (13-17 years). Victims of sexual abuse of any age and gender Kataguiri et al., 2019 - (0-60+ years) Leite et al., 2022 - (0-60+ years).	Miranda et al., 2020 - (Age group e victim’s gender, occurrence (zone and place of occurrence, whether it occurred before, perpetrator’s gender, perpetrator’s relationship with the victim, perpetrator’s suspected alcohol use, and number of people involved). Taquete et al., 2021 - (Sexual violence cases reported by SINAN and respective rates per 100,000 female inhabitants, in the 10-13 years age group, by Brazilian region, from 2012 to 2018). Castro et al., 2022 - (Age group, victims’ gender, place of occurrence of violence, recurrent violence, unknown perpetrator’s type, municipalities of occurrence, and year. Vasconcelos et al., 2022 - (Age group, institution type, perpetrator, administrative region of residence, and federative units).	Santos et al., 2018; Study indicates predominance of white victims (57.1%), followed by Black (41.8%) and others (1.1%), using the term “negros” for Black people, without clarifying whether it includes brown people, and without delving into the racial analysis. Sena, Silva and Neto, 2018; Study indicates predominance of SV victims among children and adolescents with brown skin (80.5%), white (8.2%), Black (1.8%), and without information (9.5%). Estudo sem aprofundamento na análise racial. Study without in-depth racial analysis. Matos, Pinto and Stelko-Pereira, 2018 - The study reveals that brown people are more likely to experience sexual violence and have a lower quality of life. Most participants were women (55.6%), brown (52.3%), and single (58.4%). No in-depth racial analysis was provided. Santos et al., 2019 - A study indicates significantly higher rates of reported sexual violence among female, Black, public school students, and children of uneducated mothers. The main risk factors identified were Black skin color, low maternal education, early employment, and abuse by family members. The study does not present the percentages corresponding to the results.
			Sociodemographic variables of victims, including skin color, and data on the violence perpetrated Justino et al., 2015 - (Gender, age, ethnicity/skin color, schooling, mental disorder, type of SV perpetrated). Moreira et al., 2015 - (Federative Unit, age group, schooling, ethnicity, place of occurrence, abuse type, perpetrator’s characteristics, and referrals made by the health sector.) Souto et al., 2017 - (Region of residence; baby’s year of birth (2011 to 2015); mother’s age (8-13 years); ethnicity/skin color; marital status). Delziovo, et al., 2017 - (Skin color; schooling in study years (0-4, 5-8, 9-11, 12 and over); occupation; other; marital status). Santos et al., 2018 - (Age, gender, ethnicity/skin color, and other variables related to the event, perpetrator, and service).	Araújo et al., 2019 - A study conducted in Paraná identified a higher number of reports of sexual violence among white children (66.8%), followed by brown (18%), Black (3.1%), Indigenous (0.4%), and Asian (0.3%) children. Despite the white majority, the study highlights that Black girls (Black and brown) are the most vulnerable, highlighting racial inequalities in sexual violence. Kataguiri et al., 2019; Study reveals that most sexual violence cases occurred among brown girls (38%), followed by white (27.5%), Black (12%), yellow (0.8%), Indigenous (0.3%), and unknown ethnicity/skin color (21.3%), without delving into the discussion on the racial issue Santarém et al., 2020; A study in Rio Grande do Sul indicates a predominance of cases among brown (33%) and white (30%) women, with 36% of records lacking racial information. The author suggests investigating the underrepresentation of Black women, raising hypotheses such as underreporting, barriers to accessing the CEPID, or omissions in records. The study did not delve into racial analysis.
			Sena, Silva and Neto, 2018 - (Age group, gender, skin color, disability, origin, violence, abuse type, relationship/degree of kinship with the victim, and perpetrator’s gender). Platt et al., 2018 - (Age, ethnicity or skin color, disability or disorder, and place of residence). Matos, Pinto and Stelko-Pereira, 2018 - (Age, gender, ethnicity, conjugality, religious practice, birth, paid work, severe accident, physical activity at least three times a week, chronic disease, receiving psychiatric service, receiving psychological service, and psychiatric medication use). Santos et al., 2019 - (Age group, gender, skin color, school type (public or private), schooling, family arrangement, paid work, mental health, risk behaviors, and daily physical activity practice).	Margotti and Lima, 2020 - The study indicates a predominance of brown (77.6%), white (18%), and Black (4%) victims. The study did not delve into racial analysis. Nery et al., 2020; A study conducted in Bahia identified a predominance of brown (69.3%) and Black (17.9%) victims, highlighting the greater vulnerability of the Black population to sexual violence, associated with socioeconomic inequalities, without delving into the discussion on the racial issue. Lemos et al., 2021; Study points to a predominance of sexual violence among brown people (49.5%), followed by white (36.9%), Black (8.7%), Indigenous (1.2%), and Asian people (0.7%), without delving into racial analysis. Maluf et al., 2021; Study shows predominance of sexual violence among white women (59.9%), followed by other ethnicities/skin colors (36.9%) and Black women (3.2%). The study does not delve into racial analysis.
			Araújo et al., 2019 - (Faixa etária, sexo e raça/cor, número de casos de violência sexual infantil por ano de notificação; regionais de saúde de notificação; local de ocorrência e meio de agressão da violência sexual; tipo de violência sexual; e vínculo-grau de parentesco com o provável autor da violência. Kataguiri et al., 2019 - (Age group, gender, ethnicity/skin color, schooling, municipal population size, place of occurrence, recurrent violence, physical and/or psychological violence, and victim-perpetrator relationship. Santarém et al., 2020 - (Age group, self-declared skin color, schooling, police report, marital status, occupation, sexual orientation, recurrent violence, means adopted, abuse type, number of perpetrators, victim’s physical conditions, HIV prophylaxis, STIs, and contraception, reagent tests, post-violence pregnancy, besides gender, age group and degree of perpetrator’s relationship with the victim).	Caracas Moreira et al., 2022; A study conducted in Pernambuco indicated a higher number of sexual violence cases among brown victims (42.1%), followed by Black (21.1%), white (18.4%), Asian (13.2%), and Indigenous victims (5.3%). The prevalence among brown victims was attributed to the racial composition of the local population, without critically examining the racial issue. Santos et al., 2022; A study indicates that 61% of sexual violence victims were brown children and adolescents. The study does not delve into racial analysis. Carli, Porfírio and Figueiredo, 2022; The study presents a brief discussion on ethnicity/skin color, concluding that, in this context, the profile of victims indicates less inequality between Black and white people compared to other social events. Leite et al., 2022; The study indicates a predominance of Black or brown victims (71.1%), followed by white victims (28.9%), without considering other ethnicities. The racial variable was unified, and there was no analytical discussion on the topic.
			Margotti and Lima, 2020 - (Gender, schooling, ethnicity/skin color, monthly income, religion, rural or urban region, housing type). Nery et al., 2020 - (Gender, age, skin color/ethnicity, and disability.) Lemos et al., 2021 - (Gender, age, skin color/ethnicity). Maluf et al., 2021 - (Service number, notification date and time, municipality and state, notification unit, occurrence date, birth date, age, gender, pregnancy, ethnicity/skin color, schooling, residence data, marital status, occupation, sexual orientation, gender identity, and disability or mental disorder). Caracas Moreira, et al., 2022 - (Gender, age, ethnicity/skin color, living with, religion, household income, working (yes/no), sexual orientation, gender identity, partner).	Brito, Costa and Souza, 2022; The data indicate that, among the victims, 78.2% were brown, 10.6% were white, 1.9% were Black, 0.8% were Asian, 2.6% were Indigenous, and 6.6% had no ethnicity/skin color reported. The study did not provide a critical in-depth analysis of the racial issue.
			Leite et al., 2022 - (Gender, age group, skin color, disability or disorders, and place of residence. The perpetrator was evaluated for age group, gender, relationship with the victim, and suspected alcohol use. Regarding occurrence, the following were considered: number of perpetrators, place of abuse, recurrent violence, and referral to health services or others). Santos et al., 2022 - (Ethnicity/skin color, schooling, marital status or marital status and gestational condition, besides other Information related to the perpetrator, the violent act, and the referral of the notification. Carli, Porfírio e Figueiredo, 2022 - (General analysis of public data on reports of sexual violence against children and adolescents and its epidemiological profile in Brazil and the state of Paraná).
			Brito, Costa and Souza, 2022 - (Female gender, age group, ethnicity/skin color, schooling, place where the occurrence was registered (capital or inland region), and year of occurrence. Other variables Blake et al., 2014 - Frequency of sexual acts, forms of intimidation employed, perpetrator’s profile, and the victim’s activity at the time of the approach. Sexual acts were classified as vaginal, anal, or oral penetration (isolated or combined) and other nonconsensual sexual contact without penetration. The forms of intimidation followed the Brazilian criminal law classification: serious threat, use of violence, and rape of a vulnerable person. Magalhães et al., 2016 - (210 municipalities in the Ceará hinterland, including municipalities that received attention for sexual abuse cases reported against children and adolescents). Did not show variables - Qualitative studies Taquette et al., 2021; Pantoja et al., 2022

In this thematic group, 21 articles included the ethnicity/skin color variable, highlighting the predominance of self-declared brown victims. However, only four studies performed a critical analysis of the data from an ethnic-racial perspective (Santos et al., 2019; Araújo et al., 2019; Santarém et al., 2020; Carli; Porfírio; Figueiredo, 2022).

Furthermore, five studies were conducted in the South with mostly white SV victims, which may be related to the region’s population composition (Justino et al., 2015; Platt et al., 2018; Kataguiri et al., 2019; Maluf et al., 2021; Brito; Costa; Souza, 2022). Eight studies mentioned the Indigenous category in the results (Moreira et al., 2015; Delziovo et al., 2017; Platt et al., 2018; Araújo et al., 2019; Kataguiri et al., 2019; Lemos et al., 2021; Caracas-Moreira et al., 2022; Brito; Costa; Souza, 2022), but did not present a critical data in-depth analysis.

Furthermore, nine studies included other important variables: six analyzed the presence of disability or mental disorders (Justino et al., 2015; Platt et al., 2018; Sena; Silva; Falbo Neto, 2018; Nery et al., 2020; Maluf et al., 2021; Leite et al., 2023), and three considered the victim’s sexual orientation, gender identity, whether they have a partner, religion, occupation, and whether they undergo psychological/psychiatric treatment (Santarém et al., 2020; Maluf et al., 2021; Caracas-Moreira et al., 2022).

Area # 2 Repercussions and consequences of sexual violence

The literature reiterates the negative impacts of sexual abuse on the lives of children and adolescents, affecting their physical, psychological, social, and cognitive development, with shortand long-term consequences. Among the most common repercussions, the consequences for victims’ mental health stand out (table 2).

Table 2
Summary of studies presenting the repercussions of sexual violence (n=8)

Authors/Year	Method	Population	Variables	Main repercussions	Ethnicity/raciality
Henz e Leite, 2013 Florentino, 2015 Fontes; Conceição; Machado, 2017 Lira et al., 2017 Fornari et al., 2018 Oliveira et al., 2020 Aguiar e Ferreira, 2020 Cruz et al., 2021	Bibliographic review (Henz e Leite, 2013; Florentino, 2015; Oliveira et al., 2020; Aguiar and Ferreira, 2020; Cruz et al., 2021). Qualitative studyFontes; Conceição; Machado, 2017; Lira et al., 2017; Fornari et al., 2018).	Children and adolescents of both genders victims of sexual violence Henz and Leite, 2013 - (0-18 years) Florentino, 2015 - (0-18 years). Aguiar and Ferreira, 2020 - (0-18 years) Cruz et al., 2021 - (0-18 years) Ninth-graders Fontes; Conceição; Machado, 2017 - (11-18 years). Women aged 18 and over who were SV victims in childhood Lira et al., 2017; Fornari et al., 2018; Oliveira et al., 2020.	Sociodemographic variables of victims and data on violence perpetrated, excluding skin color Fontes, Conceição & Machado, 2017 - (Gender and information regarding mental health. Loneliness, friends, insomnia). Fornari et al., 2018 - (Gender and age of the victim, place of abuse, the perpetrator’s relationship with the victim, the date and time of publication, and the full report). Did not show variables (Qualitative studies) Henz and Leite, 2013 - (Bibliographic review and content analysis) Florentino, 2015 - (Lira et al., 2017; Oliveira et al., 2020; Aguiar and Ferreira, 2020; Cruz et al., 2021).	Post-traumatic stress disorder (*) Florentino, 2015; Henz and Leite, 2013; Fontes, Conceição & Machado; Lira et al., 2017; Fornari et al., 2018; Oliveira et al., 2020; Aguiar e Ferreira, 2020; Cruz et al., 2021 Difficulty in interpersonal and intra-family relationships (Henz and Leite, 2013; Florentino, 2015; Lira et al., 2017; Fornari et al., 2018; Oliveira et al., 2020; Aguiar and Ferreira, 2020; Cruz et al., 2021). Substance abuse (Fontes; Conceição; Machado, 2017; Lira et al., 2017; Aguiar and Ferreira, 2020). School dropout (Fontes; Conceição; Machado, 2017; Fornari et al., 2018; Oliveira et al., 2020). Consequences to mental health (Henz e Leite, 2013; Florentino, 2015; Fontes; Conceição; Machado, 2017; Lira et al., 2017; Fornari et al., 2018; Cruz et al., 2021). Hypersexualized behavior (Henz and Leite, 2013; Florentino, 2015; Lira et al., 2017). Aggressiveness (Henz and Leite, 2013; Lira et al., 2017). Sexual dysfunctions (Florentino, 2015; Lira et al., 2017). Bullying (Fontes; Conceição; Machado, 2017). Reproduction of violence (Henz and Leite, 2013). Psychotic disorder and somatization (Cruz et al., 2021)	The studies presented do not consider the racial issue in their analyses, highlighting a significant gap in the literature and limiting the understanding of the inequalities that permeate the event investigated.

Post-traumatic stress disorder (PTSD) is a persistent condition, with consequences such as intrusive thoughts, hypervigilance, insomnia, anxiety, and other effects. Fontes, Conceição, and Machado (2017) emphasize that women suffer more from loneliness and isolation than men. The study also highlights the importance of psychological support and proposals for preventing sexual violence in health services. Some studies indicate that not all victims experience the effects immediately, as they vary depending on other factors, as noted by Henz and Leite (2013). These include the child’s age, the duration of the abuse, the abuser’s use of force, the age difference between the abuser and the victim, the type of bond with the abuser, the family relationship, and the degree of secrecy and threat experienced by the child. Some victims only feel the consequences in adulthood. In this sense, Florentino (2015) highlights the difficulty of naming all the effects of sexual violence, since they depend on the experiences and uniqueness of each individual, warning of the importance of not generalizing the impacts of sexual violence. The ethnic-racial issue was not addressed in any of the studies included in this thematic group, and they did not even include the ethnicity/skin color variable, making it impossible to discuss the repercussions of SV from this perspective.

Area # 3 Sexual violence victims’ healthcare and professionals’ perceptions

Health care for child and adolescent victims of sexual violence and the perceptions of professionals who serve this population were addressed in nine studies. Quantitative studies (cohort and cross-sectional) predominated, involving diverse populations, including child and adolescent victims of sexual violence, girls aged 10 and older, health professionals from several fields, and guardians, among others. Five studies did not mention demographic variables, two studies included ethnicity/color, and two studies did not address this variable (table 3).

Table 3
Summary of studies that aimed to analyze the health care provided to victims and the perceptions of professionals who deal with SV cases (n=9)

Authors/Year	Method	Population	Variables	Main results/insights	Ethnicity/raciality
Deslandes and Campos, 2015 Deslandes et al., 2016 Delziovo et al., 2018 Broseguini and Iglesias, 2020 Andrade et al., 2021 Becerra Torres et al., 2021 Conceição et al., 2022 Jesus et al., 2022 Torres et al., 2022	Revisão bibliográfica (Broseguini and Iglesias, 2020) Qualitative study (Deslandes and Campos, 2015; Conceição et al., 2022). Cohort study (Becerra Torres, et al., 2021; Jesus et al., 2022; Torres et al., 2022). Cross-sectional study (Delziovo et al., 2018). Documentary study (Andrade et al. 2021). Case study (Deslandes et al., 2016).	Female children and adolescents victims of SV - 0-18 years old (Andrade et al., 2021; Becerra Torres, et al., 2021). Adolescents aged 10-18 years (Broseguini and Iglesias, 2020; Torres et al., 2022). Women from 10 years of age who are SV victims (Delziovo et al., 2018; Jesus et al., 2022). Health professionals Conceição et al., 2022 - (30 health professionals, female, all identified as cisgender and heterosexual women, mostly Black. Professionals with at least one year of experience in the institution were intentionally included, including nurses, nursing technicians and assistants, doctors, social workers, and psychologists.	Variables excluding ethnicity/skin color Becerra Torres et al., 2021 - (Age, marital status, occupation, and intellectual disability. Characteristics of the sexual violence event: abuse type, time elapsed since the incident, place of the incident, profile of the perpetrator(s), number of people involved, form of intimidation used, type of violence suffered, use of alcohol and/or other psychoactive substances before the incident, subjective perception of the violence. Clinical and psychosocial history: onset of sexual activity, mental disorders, prior history of sexual violence.	Insufficient institutions for specialized service, few professionals trained to provide service to SV (Deslandes and Campos, 2015; Deslandes et al., 2016). Being seen within 72 hours and receiving emergency contraception were protective factors (Delziovo et al., 2018; Jesus et al., 2022). Most adolescent victims of SV did not complete the outpatient follow-up of up to 6 months (Becerra Torres, et al., 2021; Torres et al., 2022).	The studies presented do not consider the racial issue in their analyses, highlighting a significant gap in the literature and limiting the understanding of the inequalities that permeate the event investigated.
		Guardianship counselors (Deslandes and Campos, 2015) Managers and coordinators of reference services (Deslandes et al., 2016).	Emergency service aspects: immediate care procedures, including prophylaxis for sexually transmitted infections (STIs), HIV, and hepatitis B, as well as outpatient follow-up by a multidisciplinary team for up to six months. Social interventions and referrals: notification to the Child Protective Services, summons for outpatient follow-up, police report filing, and service of associated legal and social demands.	Little systematic production of knowledge about care networks for sexual violence victims (Delziovo et al., 2018; Broseguini and Iglesias, 2020). Need for sexual health education and greater training of the multidisciplinary team to address cases (Andrade et al., 2021; Conceição et al., 2022).
			Conceição et al., 2022 - (Sociodemographic and professional variables of the participants, including profession, length of service at the institution, gender identity, affective-sexual orientation, ethnicity/skin color, and marital status. Institutional and contextual variables, such as sector of activity (inpatient units, intensive care, or obstetric center) and work shift (morning, afternoon, or night).
			Torres et al., 2022 - (The study included sociodemographic variables (age, marital status, occupation, intellectual disability), characteristics of the episode of violence (abuse type, time of occurrence, location, number and profile of perpetrators, form of intimidation, substance use, victim’s perception, sexual history, mental disorders and previous violence), aspects of the emergency service (prophylaxis, reception, outpatient follow-up) and physical and psychological reactions during follow-up, in addition to actions of social workers (notification, return, police report and legal and social referrals).
			Sociodemographic variables, including ethnicity/skin color Andrade et al., 2021 - (The study presents sociodemographic variables related to sexual violence and emergency services. Sociodemographic variables include gender (female), age (stratified into children aged 0 to 11 and adolescents aged 12 to 19, according to the ECA), and location of service (IML-SE and MNSL, both in Aracaju). Variables related to sexual violence involve information extracted from medical records and investigation forms, such as the type of violence suffered, the age group of the victim at the time of the abuse, and possibly data on the perpetrator or circumstances of the event, as records permit. In the context of emergency services, variables such as the type of service provided, adopted procedures, and clinical interventions are considered.
			Delziovo et al., 2018 - (Age, schooling, ethnicity/skin color, time elapsed until service, implementation of prophylaxis for sexually transmitted infections, use of emergency contraception, number of perpetrators involved, and recurrent sexual violence). Jesus et al., 2022 - (Age, origin, skin color or ethnicity, marital status, paid activity and schooling; medical variables such as pregnancy, sexual activity, use of contraceptives, and psychiatric conditions; variables related to the circumstances of the abuse such as location, time, number of perpetrators and relationship with the perpetrator; and legal aspects such as the performance of a forensic medical examination and the registration of a police report.
			Do not show variables - (Qualitative studies) Deslandes and Campos, 2015 - (Procedures adopted by the Guardianship Council upon receiving notification of suspected or confirmed cases of sexual abuse and exploitation) Deslandes et al., 2016 - (The study analyzes municipal public services aimed at serving children and adolescents in situations of sexual violence) Broseguini e Iglesias, 2020 - (Characteristics of scientific productions on care networks for adolescents in situations of sexual violence).

Deslandes and Campos (2015) and Deslandes et al. (2016) highlight the lack of specialized institutions for the care of children and adolescent victims of SV, in addition to underlining the growing number of demands that hinder the articulation of the network, while lacking complete multidisciplinary teams, highlighting the lack of basic services, such as mental health, for example. Along the same lines, they delve deeper into the discussion on the need for a more effective intersectoral flow to avoid a fragmented healthcare and minimize victims’ exposure to other forms of violence. Furthermore, the studies highlight the lack of preparation among professionals to meet these demands.

The study by Broseguini and Iglesias (2020) highlights the lack of systematic production and theoretical discussions on the functioning of support networks for victims and their families, highlighting the importance of integrating primary care into this network. Conceição et al. (2022) emphasize that professionals realized that children and adolescents lacked maturity and awareness of their sexuality, highlighting that such a lack of knowledge can contribute to increased vulnerability vis-à-vis SV, understanding the need for sexual health education for victims, their families, and health professionals who meet this demand.

Area # 4 Quality and evolution of sexual violence records, notifications, and underreporting

The studies presented in Table 4 aimed to analyze the quality of records (consistency, completeness, and duplication) and SV notifications. All studies observed a significant growth in SV notifications over the years, as well as an increase in the completion of ethnicity/skin color data. Gaspar and Pereira (2018) analyzed the evolution of SV notifications in Brazil from 2009 to 2013, finding an increase in notifications among the population aged 10-19, females, with low education levels, and recurrent SV cases. There was an increase in notifications among the Indigenous population; however, this study did not delve deeper into this discussion.

Table 4
Summary of articles analyzing the quality and evolution of sexual violence records, notifications, and underreporting (n=5)

Authors/Year	Method	Population	Variables	Main results	Ethnicity/raciality
Gaspar and Pereira, 2018 Delziovo et al., 2018 Viana et al., 2022 Sousa et al., 2022 Platt et al., 2022	Bibliographic review (Sousa et al., 2022). Cross-sectional study (Platt et al., 2022). Observational study (Gaspar and Pereira, 2018) Normative evaluation (Delziovo et al., 2018) Ecological study (Viana et al., 2022).	Children and/or adolescents of both genders who are victims of sexual violence Gaspar and Pereira, 2018 - (0-18 years) Platt et al., 2022 - (0-10 years of age incomplete) Sousa et al., 2022 - (Does not specify age) Women from 10 years of age who are SV victims (Delziovo et al., 2018; Viana et al., 2022).	Sociodemographic variables of victims, including skin color Gaspar and Pereira, 2018 - (Region of origin, age, gender, self-reported ethnicity, and schooling of the victims. Variables related to the type of sexual violence (harassment and rape), the means of abuse employed (such as torture, beating and use of firearms), recurrent violence, the perpetrator’s characteristics (including alleged alcohol use and relationship with the victim), the location of the incident (residence or public road) and the institutional response were also analyzed, emphasizing outpatient referral or hospitalization in health services.	Gaspar and Pereira, 2018 - (A significant increase in reports of sexual abuse was observed in the following groups from 2009 to 2013: adolescents aged 10-19 (364%), Indigenous people (520%), followed by brown (365.57%) and Black people (349.83%), residents of the South (414%), women (331%) and less-educated individuals (343%). There was a 590% increase in the reporting rate of rapes, especially those that occurred in the home.	The studies presented do not consider the racial issue in their analyses, highlighting a significant gap in the literature and limiting the understanding of the inequalities that permeate the event investigated.
			Delziovo et al., 2018 - (Age, schooling, time elapsed until service, provision of prophylaxis for sexually transmitted infections, use of emergency contraception, number of perpetrators involved, and recurrent sexual violence). Viana et al., 2022 - (Variables related to the victim, such as age group, skin color, and schooling; abuse, including year and place of occurrence, suspected alcohol use, recurrent violence; and the perpetrator, considering the relationship with the victim, were analyzed).	Delziovo et al., 2018 - The study indicates that 7.6% of women reported as victims of sexual violence became pregnant, with early service within 72 hours and the use of emergency contraception being significant protective factors against pregnancy. The incidence of sexually transmitted infections was 3.5%, but unlike pregnancy, there was no statistically significant association between STI occurrence and early service or the use of prophylaxis.
			Platt et al., 2022 - (Variables related to the victim (age, gender, ethnicity/skin color, schooling, disability or disorder, municipality of residence), abuse (place of occurrence, recurrence, type and form of sexual violence such as rape, harassment, exploitation, and pornography), and the perpetrator (link with the victim, number of people involved, gender and suspected alcohol use) were evaluated for completeness). No variables - Qualitative study (Sousa et al., 2022).	Viana et al., 2022 - (A total of 96,018 reports of sexual violence against adolescent women were recorded in Brazil from 2011 to 2018. Most victims were aged 10-14 years (67.1%), were brown (48.3%), had up to eight schooling years (54.2%), and suffered abuse at home (59.8%). It was recurrent in 42.7% of cases, and the perpetrators were mostly friends or acquaintances (26.5%). There was a trend of increasing reports in all regions of the country, with the most significant growth in the Southeast (VPA 14.56%) and South (VPA 14.19%) regions).
				Platt et al., 2022 - (Among the 3,489 reported cases of sexual violence, a significant increase of 662.5% was observed in notifications over the analyzed period. This growth was partially explained by the expanded referral centers in the state, responsible for 46.7% of the observed variation. Data quality was satisfactory, with consistency considered excellent in 90% of records and completeness ranging from excellent to good in 92.3% of cases, with a trend toward improvement in 14 variables evaluated. No duplicate records were identified, indicating that the surveillance system showed adequate performance for monitoring sexual violence against children).
				Sousa et al., 2022 - The underreporting of domestic sexual violence against children and adolescents is fueled by factors such as fear of reprisals, threats from the perpetrator, lack of sex education, fear of discredit, and lack of professional training to identify the crime. These data reinforce the urgent need for studies that assess its true prevalence and support effective education, prevention, and victim protection actions.

The temporal trend of sexual violence reports against female adolescents in Brazil was analyzed by Viana et al. (2022), who concluded that there was a general increase in sexual violence reports across all regions of the country, which may be related to the actual increase in cases as well as improved information from reporting agencies. The several factors that contribute to SV underreporting were analyzed by Souza et al. (2022), who identified fear of retaliation by the perpetrator, lack of sex education, fear of being discredited, and lack of professional training to identify this type of violence.

The study by Delziovo et al. (2022) concluded that SV reports, during the study period, showed non-duplicity and consistency rates close to 100%, considered acceptable, and completeness close to 95%, considered excellent. There was a significant increase in the number of reports of SV against women during the study period, and the results indicate the possibility of using SINAN as a reliable source of information for diagnosis, planning, monitoring, evaluation, and implementation of public policies.

Discussion

Sexual violence against children and adolescents is a reality that transcends socioeconomic, racial, and cultural boundaries, affecting individuals across all spheres of society. However, specific social factors and markers can increase the vulnerability of children and adolescents to this type of violence (Platt et al., 2022). The findings on the characterization of victim profiles indicate a familiar, yet still alarming, situation: girls, mainly brown, aged 10-14, are the most affected, corroborating recent research (Brasil, 2023).

The publications analyzed indicate a predominance of research conducted by scientific institutions in the Northeast, which differs from the expected dominance of the Rio de Janeiro and São Paulo regions. Studies conducted by public institutions at the federal and state levels prevail, corroborating a recent study that highlights that public universities account for over 95% of scientific production in Brazil (Moura, 2019). Furthermore, most studies were conducted by women, a trend already known in Brazilian scientific production in the field of Health (Bonan; Guimarães; Brandão, 2021).

Recent literature points to a notable improvement in information systems dedicated to recording violence against children and adolescents, reflected in a significant increase in the volume of notifications and records, as well as a positive evaluation of their quality (Viana et al., 2022). However, this progress has not resulted in a comprehensive inclusion of information on ethnicity/skin color in studies.

Despite these improvements, the persistent underreporting of sexual assault cases is undeniable, influenced by several factors, such as the pact of silence stemming from social taboos regarding sexuality, family dynamics, and the lack of psychological support for victims to report the incident. Recent research during the pandemic (Pantoja et al., 2022; Carli; Porfírio; Figueiredo, 2022) indicates that school closures due to social distancing measures may have increased children’s vulnerability and, consequently, contributed to underreporting.

A greater interest in studies characterizing and describing the phenomenon and its victims can be observed. Epidemiological studies predominate in this group. However, even in this group, the variable of ethnicity and skin color, which is an essential sociodemographic factor, was not included in all studies. Moreover, even when this variable was highlighted, the ethno-racial arrangements involved in the issue were not questioned. Similarly, in studies on the harmful consequences of SV and the provision of healthcare to victims, the systematic exclusion of the sociodemographic variable of ethnicity/skin color and the racial debate is notable.

Among the studies that included the ethnicity/skin color variable, only four addressed the complexity and importance of the racial issue in the debate on sexual violence. These findings suggest that simply including the ethnicity/skin color variable in studies is not in itself sufficient to spark the necessary and urgent dialogue on sexual violence in the context of Black childhoods. Even when this variable was considered, critical reflection on racial dynamics, structural inequalities, and the forms of oppression and discrimination involved was rarely articulated, especially when integrated into the debate on sexual violence. Therefore, it is necessary to reflect on the silencing of racialized mechanisms of oppression against Black girls, as both a social and epistemic problem.

Notably, this is a topic already discussed by Black Brazilian intellectuals. González (1984) and Werneck (2016) point out that the bodies of Black and Indigenous girls and women have been historically exploited and objectified - whether through sexual violence or exhausting and inhumane labor - practices and symbolic devices of domination that have had lasting repercussions on contemporary Brazilian society. In this sense, Lélia González (1982) anticipated Crenshaw’s (2002) intersectional perspective when discussing the triple discrimination against Black women, the amalgam of sexism, racism, and class discrimination.

As Collins (2000) argues, an analysis based exclusively on gender identity in a society structured by sexism is insufficient to explain the complexity of women’s experiences. It is also essential to consider other areas of subordination, such as racialization and class stratification. Collins (2019) also includes nationality, sexuality, and religion as intersectional markers of oppression and their determinants of several forms of violence. By analyzing real cases in Brazil, Congo, Australia, and the USA, she shows how violence against Black women is cloaked in stereotypes that trivialize its lethality.

Silencing racial debate in studies specifically addressing sexual violence, one of the most emblematic expressions of the intertwined oppressions of racism and sexism, also demands reflection on the institutional modes of production of this erasure. This omission cannot be dissociated from the structural dynamics of institutional racism, which permeate the fields of Public Health and knowledge production.

Thus, intersectionality must be understood not only as a descriptive tool but as a critical lens that reveals how social structures marked by the binary of capitalism and coloniality intertwine to produce inequalities. In this context, Public Health policies aimed at addressing SV should be designed from an intersectional perspective, considering the distinct social positions occupied by individuals. As Werneck (2016) points out, institutional racism operates transversally at all levels of the health system, impacting everything from access to and quality of services to how specific topics are or are not investigated and debated academically.

These findings raise a crucial question, “How can we develop effective care strategies that address the specific needs and vulnerabilities of the Black population? More specifically, how can we address racism against Black girls and provide the best care for SV victims when both scientific literature and the services responsible for direct care for this population tend to overlook or neglect this issue systematically?”

A political reflection on Black childhoods in Brazilian society becomes unfeasible without a critical analysis of our colonial-based racist construction. The universalizing approach to children renders invisible the specific stories experienced by racialized children, aspects essential for planning Public Health policies that strive for equity. In this sense, Black movements have been catalysts for change, driving the creation of policies that recognize and address the specific needs of this population (Domingues, 2007; Leal et al., 2021). Their efforts were crucial to the development of the National Policy for Comprehensive Health of the Black Population, which exemplifies powerful resistance and the production of vital knowledge in spaces marked by coloniality.

One of the limitations of our study was the search in only three databases, essentially Brazilian and Latin American, in addition to the exclusion of other forms of academic production, such as theses, dissertations and book chapters, which may have harmed the breadth of the perspectives analyzed on SV, restricting the analysis to Brazilian scientific production, thus not including other Latin American countries with a history of slavery.

Final considerations

The analysis revealed a critical gap in scientific literature on SV regarding the incorporation of ethnic-racial and intersectional debates. Although the topic of SV is approached from several perspectives, the ethnicity/skin color variable is often neglected or addressed superficially, without connecting it to the structural dynamics of racism.

This omission compromises not only the depth of analysis but also the formulation of more integrated and sensitive responses to the inequalities experienced by Black girls and women. The lack of a racial perspective and an intersectional perspective limits the ability of public policies to respond to the demands of this population, contributing to the reproduction of historical patterns of oppression and silencing.

Data Availability Statement

The research data are available within the main text of the article.

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Edited by

• Editors:
  Ivia Maksud, André Luiz Machado das Neves

Publication Dates

• Publication in this collection
  16 Mar 2026
• Date of issue
  2025

History

• Received
  23 Nov 2024
• Reviewed
  16 May 2025
• Accepted
  18 July 2025