• Adolescent
• Sexual Behaviour
• Sexual Assault

Gang culture and gang-related crime have been areas of government focus over recent years, with the main interest on knife and gun crime.1 Recently, growing numbers of high-profile media cases of sexual violence and sexual exploitation, linked to gangs, has lead to a 2-year inquiry into Child Sexual Exploitation in Gangs and Groups (CSEGG),2 conducted under the powers of the Children's Commissioner in the Children Act 2004. A session at the BASHH Doctors in Training (June 2012) reviewed anonymous clinical cases submitted to the CSEGG phase 1 call for evidence. It was only after attending the training day that I became aware and understood the extent and complexity of the gang-related sexual violence and exploitation faced by young people (YP) presenting to sexual health services.

Trainees were asked within groups to assess the likelihood of gang involvement of several case scenarios of YP attending a sexual health service. Each case was very different and led to active discussion within the groups, with a wide variety of opinion as to whether risk factors and vulnerabilities from the histories were suggestive of being gang related; they all were.

The main learning point from the session was that within sexual health services, identifying those at risk of involvement of gang-related sexual violence/exploitation was extremely difficult using a standardised young person proforma. It was essential to obtain further information where there were areas of concerns by more detailed questioning. However, the skills and knowledge of gang culture to obtain this information were felt to be lacking among most trainees. It highlighted the need for specialised dedicated YP services, run by trained staff, to allow YP a safe space to disclose information related to gangs. This disclosure often occurred at follow-up visits where trust had been built up with staff. Allowing YP to disclose without fear of police involvement means that sexual health services are able to address other issues, such as improving self-esteem and negotiation skills, helping with social issues such as housing, providing support and counselling, and addressing other health needs, such as depression and substance misuse.

Often incidents of rape and assault were not reported to the police because of justified fears of reprisals, and because of the close association of gang members to the affected young person's community networks, family and peer group.

Another issue highlighted was the use of modern technology and the internet. Sexual acts are often filmed and then publicly viewed on social network sites, impacting on how young women are seen within their communities. There seemed to be a lack of understanding with some YP as to what material is appropriate for sharing. Addressing and changing attitudes among YP is an important societal challenge.

One of the most disturbing factors illustrated was the normalisation of assaults “it's what happens to everyone, it's no big deal”. Promoting awareness through sex and relationship education in schools, to clarify what is ‘normal’ behaviour within relationships and what constitutes rape, coercion and sexual assault, is urgently needed as at present there is ambivalence of YP reporting such crimes to responsible adults who can act on the information.

The CSEGG phase 1 call for evidence focuses on establishing the prevalence of the scale, scope and extent of gang-related sexual violence and abuse in England. The findings from the interim report in autumn 2012 are eagerly anticipated as, to date, formal reports are an underestimation of the problem. It is hard to measure the extent in a robust, concise way as gang-related activity is not consistently asked about within clinics or openly disclosed by YP. Anonymised reporting of key risk indicators in YP attending health services to a national database could provide local intelligence to the police and specialised agencies working closely with gangs. Sharing information and engaging with child protection services has to be balanced with providing confidential sexual health services for all YP. If there is mandatory reporting of attendances of those aged under 16 years, this could impact negatively on YP accessing sexual health services and cause a further reluctance to discuss gang-related activity.

Being aware of these local and national gang-related activities and being able to address them in a sexual health setting is a step in the right direction to safeguarding YP from gang-related activity. The CSEGG call for evidence phase 2 is ongoing at the time of writing and concentrates on the identification and dissemination of best practice in order to make practical recommendations for early intervention, prevention, disruption of harm and support for victims. This will inform training and improve the management at a national and local level for frontline staff seeing YP at risk or involved in gang-related sexual exploitation/violence.