126. The IACHR has already pointed out that gender stereotypes are still endemic in the health sector and that "attitudes such as indifference, mistreatment and discrimination perpetrated by health sector employees that affects women and girls victims of violence and/or sexual abuse, as well as the lack of appropriate reproductive health services to address situations of violence, constitute barriers to access of health services."158 Therefore, the IACHR considers that States must adopt appropriate measures to eliminate all types of violence and discrimination against girls and adolescents in the health sector. This includes not only the duty to refrain from reproducing said practices but also to act with due diligence with regard to acts of violence against girls and adolescents in that sphere, which includes, for instance, implementing regulatory frameworks, including health protocols, for dealing with sexual violence against girls and adolescents, allocating heath personnel properly trained to detect and treat sexual violence against people in this age group, and providing access to effective judicial remedies for protecting the rights of young and adolescent girls with respect to acts of sexual violence. 3. Characterization of what happened to Paola Guzmán Albarracín and its causal link to her death 127. As was established in the foregoing section of this Report, in domestic proceedings relating to Paola's death there is multiple evidence of Mr. Bolívar Espín initiating an improper relationship with her, taking advantage of his position of authority and of the particular vulnerability Paola was experiencing as a result of her academic performance. This transpires from the reiterated and consistent statements by Paola's mother, the statement by her cousin-in-law, the statements of at least three pupils, and position taken by the State itself at the admissibility stage, with regard to Paola being a victim of sexual harassment and statutory rape by Bolívar Espín. It is worth mentioning that, although at the merits stage the State argued that it was a question of a relationship between private individuals for which it could not be attributed international responsibility, that defense refers essentially to the question of its international liability but does not affect nor contradict the acknowledgment of facts effected at the admissibility stage, as to the existence what the State described as sexual harassment and statutory rape. Taking the content of those crimes under domestic law into account, from the statement made by the State, together with the other elements cited, it is possible to establish the existence of the relationship and that it resulted from the position of authority held by the aggressor. 128. The Commission underscores the fact that neither the age of consent, nor the question of whether or not aggressor had sexual relations with Paola, nor the issue of whether or not she was pregnant alter the fact that Mr. Bolívar Espín misused his authority, experience, and adulthood by improperly using the power he had over Paola to achieve that relationship, Paola had neither the tools nor the autonomy to be able to reject or exit that relationship, a situation that impaired her right to study in an environment free from harassment and violence and her right to the minimum conditions needed to develop and lead a life with dignity. 129. The file on the case also contains circumstantial evidence that Paola was also sexually harassed by the school doctor, who allegedly forced her to have sexual relations with him in exchange for terminating her possible pregnancy. As will be analyzed in the corresponding section, this circumstance, brought up in several statements, was not duly investigated and no light was shed on it by the State in connection with this case. Nor did the State deny these facts. Accordingly, bearing in mind that the failure to throw light on this aspect is attributable to the State, plus the context of institutional acceptance of sexual violence by the staff, as we shall analyze in due course, the Commission considers that it is possible to infer the veracity of this additional and aggravating factor in the violence to which Paola was subjected. 130. In short, the Commission establishes that Paola was a victim for too many months of a situation of violence based on her condition as a woman and girl by the then Vice-Principal of the school, manifested at the very least in a relationship resulting from harassment of a sexual nature, which, in addition to constituting gender-based violence, should be construed as a serious instance of sexual violence. 158IACHR. Report on Access to Maternal Health Care from a Human Rights Perspective, p. 7