Girls as young as 10 are being forced to have sex by their teachers to pass exams, and threatened with poor grades if they refuse, according to a report on school violence published by aid agency Plan.

The report says sexual violence is institutionalised in many schools throughout Africa but also happens in Latin America and Asia.

In the worst cases abuse can spell death, says Plan's head of global advocacy, Nadya Kassam. Girls may contract HIV/AIDS or become pregnant and die in childbirth because their bodies are not developed enough.

Most victims of sexual violence are too scared, ashamed or traumatised to speak out and school authorities are often unwilling to investigate accusations, Plan says.

The report comes as Plan launches a three-year campaign called Learn Without Fear aimed at ending all forms of violence against children in schools, including bullying and torture.

The World Health Organisation has previously estimated that 150 million girls and 73 million boys have been raped or suffered other forms of sexual violence. It's impossible to say how much of this abuse takes place in or around schools but here are some figures from studies quoted in Plan's report:

• In Uganda, researchers found 8 percent of 16 and 17 year-old boys and girls questioned had had sex with their teachers and 12 percent with ancillary staff
• In South Africa, teachers were found guilty of one-third of chid rapes
• In Ecuador, a study of female adolescent victims of sexual violence found that 37 percent named teachers as perpetrators
• In Zambia, one-third of students aged 13 to 15 said they had been physically forced to have sex in the previous month

The Plan report says studies in Africa and Latin America show some male teachers offer girls good grades in exchange for sexual acts and threaten poor grades if they refuse. But Plan says the abuse is often seen as an inevitable part of school life. (See Rosemary's story below.)

Plan's chief executive Tom Miller says the agency's campaign aims to challenge the complacency surrounding all forms of violence at school.

"We often hear from parents, 'There's nothing we can do.' They know that their daughter is having to have sex with the teacher but they say, 'If she doesn't, she can't go to school. I'm too poor to send her to school.'

"In some ways, that is the worst, when they know that it is wrong, but say they can't do anything about it."

Plan says the problem is often compounded by cultural attitudes towards women. Girls in societies where women have a lower status are more likely to suffer sexual violence at school. In Latin America, South Asia and Islamic South East Asia, sexual violence against girls tends to remain a silent crime because of the importance attached to girls' sexual purity. In some parts of South Asia, rape is seen as an offence against the honour of male members of the family.

In some African countries, there is a belief that a man can cure himself of AIDS by having sex with a virgin, which has led to the abuse of students with disabilities who are seen as easy targets.

Aside from the risk of injury and disease, victims of sexual violence suffer psychological trauma and stigmatisation. Many are forced to leave school.

Plan says sexual violence forms a major barrier to girls' access to education. Abuse, or the fear of abuse, may cause girls to avoid class or stop parents sending them to school in the first place.

Sexual abuse of children in schools is outlawed in all but one of the 66 countries where Plan operates, the exception being Pakistan. But even where there are laws, few perpetrators are held accountable.

However, Plan has been encouraged by a recent landmark ruling in Zambia where the High Court awarded a 15-year-old rape victim $13,000 and ordered criminal proceedings against her teacher.

Initiatives under the Plan campaign include encouraging anti-violence regulations; systematic reporting of offences and holding perpetrators accountable; training teachers to prevent and respond to sexual violence; empowering children to stand up to and report violence; training healthcare personnel to recognise warning signs of abuse and training police officers to deal with crimes of sexual violence.

"This is really a grassroots up campaign which is what's going to make it so powerful and practical," Kassam said.

Rosemary's story

Rosemary, a head girl at a school in Tanzania, says she was repeatedly abused by her teacher. She fled to her aunt's home in fear but was kicked out when it became apparent she was pregnant. The case was reported to local authorities but the teacher continues to work at the school, which has washed its hands of the problem.

Rosemary says the abuse started when the teacher asked her to his office. "He asked me to read something that was written on his cell phone. It was written I want you to be my lover. I refused," she says.

Meanwhile another teacher had punished Rosemary for not attending extra classes that she could not afford. She says the teacher who abused her coerced her into sex after sending money to pay for her tuition.

"She has been completely traumatised and has missed school for a year," Kassam says. "If she goes back she still has a child to support. The chances are she may not go back and the impact on her education and future potential is absolutely diminished."

Rosemary should have taken her final exams last month. Instead, she spent the morning at home in tears. "I cannot see my future, life is so difficult," she says.

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