 Today, I'm presenting the finding of a study that is ongoing by MSF-OCP Prussel on male sexual violence. Because of the long-term sequelae that sexual violence could have on victims, we really want to mitigate this sequelae. And we believe that by offering the appropriate package of care, we could do this. But we need to improve the access to this package of care. And in this situation, male are considered as a neglected population. So the aim of the study or the main objective of this study to investigate whether the setup of MSF program is actually appropriate to improve the access of male victims. And because of the sensitivity of the context that MSF operates in those countries, we kept the identity of the country as well as the setting of the study concealed. And I would really like to thank everyone who worked on this study. And I really apologize that I can't declare any of the details of people working on the study because of the sensitivity of the data. So, as have been clearly established by WHO, that the definition of sexual violence include acts that are committed against both men and women. And despite this fact and the fact that we have a high global prevalence of sexual violence among child and adolescent males, most people when they hear the term sexual violence, they usually think about women. And unfortunately, most of the program are directed towards female or even integrated inside the maternal and the childhood care services. But in a continent like Africa, we even have more challenges. So, because of the cultural context, people really find a difficult time disclosing this event, especially if they are males. And also, we have an adequate training of the staff that make it difficult sometimes to identify sexual violence among male victims. In addition to the general underreporting of sexual violence. So, as MSF, we offer a uniform package of care for both men and women because they share similar needs. And this package of care include a medical component in the form of physical examination and care for their injuries. A preventive aspect in the form of chemoprophylaxis as well as vaccination, psychological support as well as medical legal certification. So, the main idea here that this package of care is the same in the six African countries or the eight MSF projects that are involved in this study. The only difference that we have so far is the setup of the program, how MSF programs involved in this study are organized. So, we can categorize them into three main groups. So, the first group is a traditional setup inside the maternal and the childhood care services. And this actually four out of the eight MSF programs in this study. The second group is a clinic with a clear SV label or a vertical SV project or sexual violence project, which means that for the victim to access the care, he has to declare that he has been a victim of sexual violence. And the third group is a general care clinic, which is offering service for all types of violence as well as for mental health disorders. And the difference between this category and the first one or the second one is that in the general care facilities, a patient can access our care and then disclose SV later while he's receiving the care. And this includes two out of the eight MSF programs. So, the key message here is that same package of care and the difference is the setup or the entry door through which the patient access the care. So, this was the main idea upon which we built the analysis. So, we really want to know is this difference in the entry door that we have explained, like MSF, MCH centers or SV clinics or general care would actually influence the access of male victims to our care. And also, we wanted to describe the characteristics of SV between men and women after the adjustment for the setup of care. So, in order to be able to do this, we are in a retrospective analysis of the routine MSF program data. And this was actually eight programs in six African countries from 2011 up to 2016. And we have to point out that this is a very unique data set. We are using a standardized case definitions in the eight MSF programs to make the data more or less comparable. And since this is a retrospective analysis, it made the exemption criteria of MSF ERP. So, what we have found out of nearly 12,000 SV victims registered in our databases, as you can see the majority are females and only 7% are males. And by the stratification of the entry door or how the access occur. As you can see that males were more likely to access the general care facilities compared to the other types. And this could be explained by a manufacturer, but one of them is that general care offers more opportunity for disclosure for male victims compared to the other types. So, let's say for MCH, for example, you can see that males only represent 3% of the victim. And this actually makes very sense because the setup of the program is mainly directed towards female. But it's unfortunate that four out of the eight MSF programs in the study that are having an SV component are falling in this category. And some countries belonging to this category are really areas where there is an active conflict. So, we are expecting more male victims to be in those areas. So, if we really want to access those male victims, we should start thinking outside this kind of setup. And for the difference between like SV service and general care, it seems like maybe males were not very comfortable disclosing SV as the entry point. And this might explain why we have a difference between the SV and general care. It's one of the factors that could be related. But there is another important factor we also have to put into consideration which is the age group of the victim. Because when we did the stratification by the age group, we found that young males, those ages from 15 years and below, were more likely to present to clinic with a clear SV or a vertical sexual violence project. And this could be due to many factors, one in my opinion that the cultural context, because an adult male is considered as a source of the power in the community. So, maybe adult males are not comfortable disclosing SV at an earlier set or at an entry point to access the care. And this might explain why they are more likely to access general care compared to the SV. So far, if we really want to think about the access, one of the factors or two factors that we need to consider is the setup of the program as well as the age group that we are targeting. And regarding the characteristics of SV, as you can see, both men and women didn't have associated violence. And the percentage of associated violence between men and women is more or less comparable. And regarding the number of aggressors against the majority, they were attacked by a single aggressor. And although statistically significant difference was found between males and females, but this might be on an operational basis not that significant because we have a very large sample size. And regarding the type of aggressor, the striking difference that we found that females were more likely to report is that they have been attacked by another family member compared to males. And this could be due to many factors, but one of them like maybe females are more exposed, and other factors that it's extremely hard for a male victim to declare that he has been attacked by another family member and he would actually report he had been attacked by a non-civilian military or police instead. And again, this was a statistically significant even after the adjustment for the setup of care. And regarding the time he access to care, we can assume that post-gender suffered more or less the same delay in accessing care. And regarding the utilization of MSF services, generally speaking like we can say that more or less men and women have approximate rates of utilization. Men might have a higher or a better utilization rates for HIV post-exposure prophylaxis and they might have a lower retention rate compared to females. But the key message here is like we need to make male victims access our care and after the access more or less the results are more or less similar to what we have with females. So far we have described the difference in the access or the difference in the uptake of male victim according to the difference in the setup and also the difference in the age group. And the characteristics of SV between both men and women. And as we face an epidemiological study, I believe since this is a retrospective analysis there might be additional contextual factors that we failed to adjust for. But we can say that the key message here that sexual violence can affect male as well and male were minority in all the settings that were under the study. And we really had different uptakes according to the difference in the setup of the program. And if we want to improve the barriers we have to put in mind how we are setting our program. And maybe we should also start thinking about developing more sensitive screening tools that are able to identify male victims attending other services because as we can see like general care had the better success rates because they offer multiple opportunities for male victims to disclose because they can be like doing physio treatment or seeing a mental health consultation. So they have several opportunities through which they can disclose the incident of SV. So thank you for your attention.