Significant obstacles prevent women seeking help following sexual violence, pointing to the need to protect anonymity and preventive strategies. Multiple-component interventions and sensitive community engagement appeared to contribute to positive outcomes. Apparent increases to risk resulted from lack of protection, stigma and retaliation associated with interventions. No studies prospectively measured incidence of sexual violence, although three studies provided some evidence of reductions in association with firewood distribution to reduce women's exposure, as did one program to prevent sexual exploitation and abuse by peacekeeping forces. Actual implementation of initiatives appeared to be limited as was the quality of outcome studies. Only one study specifically addressed the disaster setting. Despite the extensive literature on sexual violence by combatants, most interventions addressed opportunistic forms of sexual violence committed in post-conflict settings. Conducted in 26 countries, the majority of interventions were offered in African countries. The 40 included studies reported on seven strategy types: i) survivor care ii) livelihood initiatives iii) community mobilisation iv) personnel initiatives v) systems and security responses vi) legal interventions and vii) multiple component interventions. Twenty three bibliographic databases and 26 websites were searched, covering publications from 1990 to September 2011 using database-specific keywords for sexual violence and conflict or humanitarian crisis. This systematic review aimed to canvas the extent and impact of initiatives to reduce incidence, risk and harm from sexual violence in conflict, post-conflict and other humanitarian crises, in low and middle income countries. Sexual violence is highly prevalent in armed conflict and other humanitarian crises and attracting increasing policy and practice attention.
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