"Gender-based Violence (GBV) and HIV, they are like sister and brother": barriers and facilitators to GBV screening and referral in public HIV treatment settings in Uganda

BACKGROUND

People living with HIV are vulnerable to gender-based violence (GBV), which can negatively impact HIV treatment outcomes. National guidelines in Uganda recommend GBV screening alongside HIV treatment services. We explored barriers and facilitators to providers implementing GBV screening and referral in public antiretroviral therapy (ART) clinics in Uganda.

METHODS

We conducted qualitative in-depth interviews. Providers were purposively sampled from 12 ART clinics to represent variation in clinical specialty and gender. We used the Theoretical Domains Framework to structure our deductive analysis.

RESULTS

We conducted 30 in-depth interviews with providers implementing GBV screening and/or referral. Respondents had a median age of 36 (IQR: 30, 43) years and had been offering post-GBV care to clients for a median duration of 5 (4, 7) years. 67% of respondents identified as female and 57% were counselors. Facilitators of GBV screening and referral included providers having access to post-GBV standard operating procedures and screening tools, trainings offered by the Ministry of Health, facility-sponsored continuing medical education units and support from colleagues. Respondents indicated that referrals were uncommon, citing the following barriers: negative expectations regarding the quality and quantity of referral services; lack of financial resources to support clients, facilities, and referral partners throughout the referral process; and sociocultural factors that threatened client willingness to pursue post-GBV support services.

CONCLUSIONS

Findings from this evaluation support the refinement of GBV screening and referral implementation strategies that leverage facilitators and address barriers to better support individuals living with HIV and who may have heightened vulnerability to GBV.

Beyond a deficit-based approach: Characterizing typologies of assets for cisgender and transgender female sex workers and their relationship with syndemic health outcomes

Female sex workers (FSWs) live and work at the intersection of multiple marginalized identities that place them at greater risk for various negative health outcomes. Resilience theory asserts that an individual or community needs assets from which they can draw in response to stressors, such as chronic discrimination and abuse. This study characterizes and compares patterns of assets among cisgender and transgender FSWs living with HIV in the Dominican Republic and their relations with syndemic health outcomes. With Latent Class Analysis, we used companion cross-sectional datasets comprised of cisgender and transgender FSWs (N = 211 and 100, respectively) to estimate typologies of interpersonal, community, and institutional assets. We used multivariate logistic regression to model the relationship between class membership and HIV care and treatment, mental health, violence exposure, and substance use outcomes, respectively. Among cisgender FSWs, we identified three classes: Internal and External Multilevel Assets (Class 1); External Institutional Assets (Class 2); and Low Reported Assets (Class 3). Compared to Class 3, Class 1 membership among cisgender FSWs was significantly associated with ART adherence and marginally associated with viral suppression, and Class 2 membership was marginally associated with currently taking ART. We identified two classes in the transgender sample: Internal and External Multilevel Assets (Class 1) and External Institutional Assets (Class 2). Class 1 membership among transgender FSWs was significantly associated with ART adherence and marginally associated with current ART use and physical or sexual violence, compared to Class 2. Having a variety of assets may explain the ability of some FSWs to more effectively engage with healthcare and maintain their HIV medication regimen. Future interventions should seek to expand FSWs' interpersonal and community assets, both from within and outside of the sex worker community, to bolster their ability to care for themselves and their community.

Reacting to Non-Prototypical Victims: Blame, Empathy, and Willingness to Label Sexual Assaults of Men and Sexual Minority Victims

Sexual assault is prevalent in the U.S. society, with an estimated 16% of women and 8% of men experiencing some form of sexual violence during their lifetime (Breiding, 2014). Sexual violence crosses all identity lines; however, legislation, cultural representation, and academic scholarship on sexual violence has historically been limited to assaults against women perpetrated by men. This dominant analysis of sexual assault focuses on the impact of sexism on sexual violence, neglecting the impact off other forms of oppression and attitudes related to sexuality and gender. This dominant representation leaves non-prototypical victims, such as men, people of other genders, and sexual minorities of all genders, less visible and less understood. This underrepresentation may lead to negative reactions toward these victims including blame, exoneration of the perpetrator, and reluctance to acknowledge assaults. In the current study, I explored the impact of both victim gender and sexual orientation on reactions to a hypothetical intimate partner sexual assault victim. Results indicated that perpetrators who assaulted a man were blamed less than those who assaulted a woman. Furthermore, study participants had more empathy for women who were assaulted than they did for men. There were no differences in participants' negative reactions to victims by sexual orientation. Results suggest that, while some advances have been made in public support for sexual assault victims, these advances may not extend yet to men as victims.

Perpetuating Victimization with Efforts to Reduce Human Trafficking: a Call to Action for Massage Therapist Protection

Human trafficking guised as massage therapy businesses is a highly successful business model that creates independent but related victims beyond the women and girls forced into sex work. Massage clinicians and the massage therapy profession are also negatively impacted by the trafficking massage business model with over 9,000 established illicit massage businesses marketing services alongside professional therapeutic massage businesses. Credential regulation efforts advocated for by various massage-related professional organizations and regulating agencies have fallen short in their purported intentions to protect massage therapists and trafficking victims. Massage industry advocates continue endorsing massage therapy as a branch of health care although health-care workers are not generally considered or treated as sex workers. Sexual harassment research in direct patient care disciplines, such as physical therapy and nursing, points to a high patient initiated incident rate and transdisciplinary, detrimental mental health outcomes for clinicians. Reporting and debriefing instances of sexual harassment inside of health-care organizations, covered by The Civil Rights Act of 1964, promotes a victim-centered perspective to support the well-being of past, current, and pending victims. The massage therapy workforce is comprised of mainly female sole proprietors, creating a double vulnerability in their potential to experience sexual harassment. This threat is compounded by little-to-no protective or supporting systems or networks for massage clinicians. The priorities of professional massage organizations to depend on credentialing and licensing as their primary efforts to fight human trafficking, seems more to perpetuate the current system/expectations, leaving individual massage therapists responsible for fighting or reeducation deviant sexualized behaviors. This critical commentary closes with a call to action aimed at professional massage organizations, regulators, and corporations to protect massage therapists through a unified position, supported in word, policy, and action, against sexual harassment, and unequivocally condemns professional massage devaluation and sexualization in all forms.

Top 10 priorities for Sexual Violence and Abuse Research: indings of the James Lind Alliance Sexual Violence Priority Setting Partnership

OBJECTIVES

To establish a James Lind Alliance (JLA) Priority Setting Partnership (PSP) to identify research priorities relevant to the health and social care needs of adults with lived experience of recent and/or historical sexual violence/abuse.

PARTICIPANTS

Adults (aged 18+ years) with lived experience of sexual violence/abuse (ie, 'survivors') were consulted for this PSP, alongside healthcare and social care professionals who support survivors across the public, voluntary, community, independent practice and social enterprise sectors.

METHODS

In line with standard JLA PSP methodology, participants completed an initial online survey to propose research questions relevant to the health and social care needs of survivors. Research questions unanswered by current evidence were identified, and a second online survey was deployed to identify respondents' priorities from this list. Questions prioritised through the second survey were presented at a consensus meeting with key stakeholders to agree the top 10 research priorities using a modified nominal group technique approach.

RESULTS

223 participants (54% survivors) provided 484 suggested questions. Seventy-five unique questions unanswered by research were identified and subsequently ranked by 343 participants (60% survivors). A consensus meeting with 31 stakeholders (42% survivors) examined the top-ranking priorities from the second survey and agreed the top 10 research priorities. These included research into forms of support and recovery outcomes valued by survivors, how to best support people of colour/black, Asian and minority ethnic and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) survivors, improving access to high-quality psychological therapies, reducing public misconceptions/stigma, the impact of involvement in the criminal justice system on well-being, and how physical and mental health services can become more 'trauma informed'.

CONCLUSIONS

These research priorities identify crucial gaps in the existing evidence to better support adult survivors of sexual violence and abuse. Researchers and funders should prioritise further work in these priority areas identified by survivors and the professionals who support them.

Who do They Tell? College Students' Formal and Informal Disclosure of Sexual Violence, Sexual Harassment, Stalking, and Dating Violence by Gender, Sexual Identity, and Race

Disclosure of interpersonal violence (i.e., sexual violence, sexual harassment, dating violence, and stalking) is often the first step toward receiving social and systemic support. Research demonstrates that sexual assault and dating violence survivors on college campuses are more likely to disclosure to informal sources (i.e., friends and family) than formal sources (e.g., police, Title IX, counseling centers). However, there is limited research examining disclosure rates after other forms of violence (i.e., stalking, sexual harassment), and little is known about the impact of the survivors' identities on disclosure. Utilizing four academic years (2016-2019) of aggregated campus climate data from a large Southeastern university, the current study examined rates of disclosure across experiences of sexual violence, sexual harassment, dating violence, and stalking while identifying whether the prevalence and type of disclosure (formal versus informal-only) differed by gender, sexual orientation, and/or race/ethnicity. Of 8,017 participants, 4.6% reported sexual violence, 18.9% reported sexual harassment, 12.3% reported dating violence, and 11.3% reported stalking in the past academic year. Results of multinomial logistic regression indicated that, across all four types of violence, men (as compared to women) had lower odds of disclosing both informally-only and formally. Bisexual as compared to heterosexual students had higher odds of formal disclosure of sexual harassment and stalking while gay/lesbian students had higher odds of formally disclosing sexual harassment. Individuals of another race/ethnicity (compared to White students) had lower odds of informal-only disclosure of dating violence. Findings underscore the need to implement programs to improve the social reactions of friends and family members receiving disclosures, and to increase culturally-tailored service provision.

Public Opinion About #MeToo Victims and Offenders: A Nationwide Experiment

During the #MeToo movement, many sexual assault survivors are discredited because of their delay in disclosure or failure to report to the police. The current study investigates which factors influence public opinion towards sexual assault victims and offenders by analyzing data from a national factorial survey. Results show disclosing the offense immediately to the public, reporting to the police, and having a witness are positively related to punitive attitudes towards the offender, via increased perceived credibility of the victim. The results highlight the importance of understanding extralegal factors in shaping stereotypic views about sexual assault in the #MeToo era.

A Review of Undergraduate Student Disclosures of Sexual Violence

INTRODUCTION

Sexual violence (SV) has been a prevalent issue on college campuses for decades. Researchers, universities, and legislators have tried to understand and prevent it. Despite these efforts, 25% of female and 6% of male undergraduate students will experience a nonconsensual sexual experience (NSE) as a student. An immense amount of research has been conducted on the prevalence, effects, resources for, and outcomes of SV over the last few decades.

OBJECTIVES

The current paper aims to compile and summarize the extant literature on undergraduate student disclosures of sexual violence. The objective is to provide a comprehensive review of the research.

METHODS

A literature search was performed using the terms sexual violence, NSE, undergraduate students, informal and formal reporting, and disclosure.

RESULTS

Disclosure patterns and outcomes for survivors vary widely based on individual factors including type of disclosure source (ie, informal or formal reporting), disclosure recipient response, previous history of NSEs, and personal identity (ie, gender identity, sexual orientation, race/ethnicity). Though there are many formal resources (ie, police, Title IX), the majority of survivors report to informal sources (ie, family or friends). In addition to researching survivors' experiences and rates of disclosures, research also evaluates how disclosure recipients perceive their response to a survivor's disclosure, their likelihood of receiving a disclosure based on their own individual identities, and how the disclosure impacts the recipient and their relationship with the survivor.

CONCLUSION

The individualized response and decision to report SV has made prevention and the creation of effective resources difficult. As there are so many individual factors to consider when evaluating how or whether a NSE will be disclosed, future research should consider these individual differences and use them to create more effective reporting sources and resources. Sears-Greer MA, Friehart BK, Meston CM. A Review of Undergraduate Student Disclosures of Sexual Violence. Sex Med Rev 2022;XX:XXX-XXX.

Explaining the Why in #WhyIDidntReport: An Examination of Common Barriers to Formal Disclosure of Sexual Assault in College Students

Within the current study, we examined themes of college students' reasons for choosing not to formally disclose (report) sexual assault. To complete this objective, we examined tweets (n = 1,297) that used the WhyIDidntReport hashtag in which a user also made reference (within the same thread) to being enrolled at a college or university during the time (and aftermath) of the assault. We deemed Twitter a particularly valuable platform, offering insight into the hidden figure of crime, as users described events, feelings, and perceptions after the event that led to them not formally disclosing. Further, it provides a large sample of cases of women and men who recognize their assault as an assault (at least in hindsight), while also providing open-ended, unstructured explanations of their rationales and motivations. Using an inductive approach, we established broad themes that were then refocused into common barriers of formal disclosure or the continuation of formal disclosure. Subthemes included anticipated social reactions (stemming from vicarious and direct experiences), internalized emotions, often stemming from social reactions (normalization, shame, and blame), victim and offender status, and victim-offender relationship. Three overarching premises were developed from the analysis including (a) victims' internalizations of experiences and observations, (b) the interaction of social factors of the victim, offender, and the victim-offender relationship, and (c) the continual and compounded decision-making process of formal disclosure. These conclusions were then examined within theoretical models, including Black's Behavior of Law Theory (specifically morphology and stratification), Overstreet and Quinn's intimate partner violence stigmatization model, and Chaudoir and Fisher's disclosure process model. Lastly, we provide programmatic recommendations, which includes retailoring current bystander intervention curricula to include more focus on social reactions and social support in anticipation of college students being recipients of sexual assault disclosures by friends and acquaintances.

Factors Promoting Posttraumatic Growth in Sexual Minority Adults Following Adolescent Bullying Experiences

The minority stress model posits that stigmatized identities expose sexual minority individuals to chronic stressors that contribute to health disparities, but that individual-level resources may mitigate psychological distress. Sexual minority adolescents experience one such stressor, bullying victimization, at higher rates than heterosexual peers. Whereas negative consequences of sexual identity-based bullying are well documented, potential positive outcomes are not well understood. The present work examined hypothesized pathways to posttraumatic growth (PTG)-positive psychological changes stemming from trauma-in sexual minority adults following adolescent bullying experiences. We predicted that attributing bullying to one's sexual identity, as opposed to other factors (e.g., weight/appearance, personality), would exacerbate perceived bullying severity but, in turn, enhance PTG. We also predicted that outness about sexual identity would enhance social support and, in turn, facilitate PTG. The hypothesized conceptual model was tested in two samples of sexual minority adults who had experienced bullying during adolescence (Sample 1: Community Sample [N = 139]; Sample 2: National Online Sample [N = 298]), using structural equation modeling with Bayesian estimation. Mediation hypotheses were tested using the PROCESS v3.4 macro. Participants reported their adolescent experiences with bullying, attributions for bullying, outness, social support, and PTG as a result of adolescent bullying experiences, in addition to demographics. Supporting the hypothesized model, in both samples, attributions to sexual identity-based bullying directly and indirectly (via bullying severity) predicted greater PTG, and outness predicted greater PTG through proximal impact on social support. This research underscores the importance of supportive responses to individuals who disclose sexual minority identities and of (re)framing attributions about bullying to facilitate growth.

Does Group Size Matter? Group Size and Symptom Reduction Among Incarcerated Women Receiving Psychotherapy Following Sexual Violence Victimization

Survivors Healing from Abuse: Recovery through Exposure (SHARE) is an eight-week therapy group for incarcerated women who have experienced sexual violence victimization. SHARE requires each member to complete an imaginal exposure and to listen when others share their experiences of victimization. While trauma-focused group interventions including SHARE are associated with reductions in internalizing symptoms, little work has examined how group characteristics predict symptom decreases. The purpose of this study was to examine whether group size was associated with symptom changes pre- to post-treatment. Participants (n=140 across 29 groups) completed self-report measures of posttraumatic stress symptoms before and after completing SHARE. Multilevel modeling revealed the majority of the variance in post-treatment symptoms was attributed to individual factors rather than group factors. Symptom change was comparable for groups of two to eight women; declines in symptom improvement were observed at a group size of ten participants.

Sexual Victimization Disclosure: A Cluster Analysis Approach to Understanding Victimization Experiences in Disclosers and Non-Disclosers

Research has used cluster analysis to identify clusters, or groups, of sexual victimization survivors who share similar assault experiences. However, researchers have not investigated whether disclosure status is a key component of the survivors' experience. The current study identified two clusters among 174 disclosing and non-disclosing sexual victimization survivors. Cluster One (n = 74) included an incapacitated assault by a lesser-known perpetrator and disclosure of the event. Cluster Two (n = 100) included a verbally instigated assault by a well-known perpetrator and nondisclosure of the event. Follow up independent t-tests revealed that women in Cluster One had significantly higher depression and posttraumatic stress disorder (PTSD) symptoms than women in Cluster Two. Results support prior research identifying clusters of victimization based on assault characteristics and suggest that disclosure status is a key variable in the recovery process. Specific implications for clinicians, policy makers, and the community are discussed.

Sexual Assault Among Women in College: Immediate and Long-Term Associations With Mental Health, Psychosocial Functioning, and Romantic Relationships

The current study sought to examine immediate and long-term consequences of college sexual assault (C-SA) among women with no prior sexual assault history. While much is known regarding the short-term negative impact of C-SA, the current study examines whether C-SA is associated with immediate academic and psychosocial consequences as well as long-term poorer mental health (depression, posttraumatic stress [PTS], anxiety) and interpersonal functioning (relationship quality, sexual and emotional intimacy). In addition, the current study explores potential moderators of these associations, including race, the nature of the assault, resulting injury, relation to perpetrator, and whether the assault was reported. A stratified design was used comparing women who experienced C-SA (n = 201) to women with no C-SA history (n = 203) controlling for age, education, race, and ethnicity. Results from a series of repeated-measures analyses of variance (ANOVAs) demonstrated that across race and ethnicity, women with a history of C-SA reported lower grade-point averages, more missed classes, and fewer serious romantic relationships in college following the assault. Furthermore, results from a series of linear and logistic regression revealed that approximately 9 years later, women who experienced C-SA reported greater symptoms of depression, anxiety, and PTS as well as lower emotional and sexual intimacy. These associations differed by a number of assault variables (assault type, relation to perpetrator, amount of fear reported, physical injuries sustained, whether the assault was reported, whether medical treatment was sought). The current study further confirms the significant and pervasive impact of C-SA associated with women's health and functioning, warranting further intervention to both reduce the incidence of C-SA and expand the reach of existing mental health interventions to survivors.

The Unintended Consequences of Rape Disclosure: The Effects of Disclosure Content, Listener Gender, and Year in College on Listener's Reactions

Rape is prevalent on American college campuses. Rape survivors often disclose their experience to their peers in hope of receiving support and obtaining justice (i.e., the intended consequences of disclosure). Yet, rape disclosures may also lead to unintended consequences, such as stigma. How peers react to survivors' disclosures of rape greatly influences survivors' recovery and their decision to press charges against their perpetrators. In this article, we explore gender differences in responses to rape disclosures. Using an experimental design (N = 391), we investigate reactions to stigmatizing (versus nonstigmatizing) rape disclosures. We find that, when controlling for the experimental condition, college men stigmatize the rape survivor more than college women. However, in response to a stigmatizing (versus nonstigmatizing) rape disclosure, college women who have been in college longer, compared with college men, have more stigmatizing reactions toward the person disclosing that information. Their reactions then predict increased social distance between the recipient of the disclosure and rape survivors.

Who Helps the Helpers? Social Support for Rape Crisis Advocates

Secondary exposure to trauma may have negative effects on rape victim advocates' well-being. Self-care can help to mitigate these negative effects on advocates' well-being, and prior research suggests that social support is an especially important aspect of advocates' self-care. However, there is a lack of research on how rape crisis advocates access and receive social support in relationship to their advocacy work. Therefore, semistructured qualitative interviews were conducted with 15 rape crisis advocates who volunteered for a rape crisis center in Chicago to understand how they accessed social support from informal and formal support providers, and when they did receive support, what was helpful versus unhelpful. Data were analyzed using thematic content analysis. Results revealed that many advocates were able to seek out and receive positive instrumental and emotional social support that nurtured them and their work. However, advocates also experienced a variety of barriers to obtaining positive support from informal support providers, including fear of burdening providers and a reluctance or lack of preparedness of their support providers to speak about the issue. Advocates emphasized the need for rape crisis centers to provide resources for their informal social support systems in order to encourage helpful responses. In addition, advocates praised the rape crisis center for its built-in formal support structures, but also encouraged the organization to seek broader representation of persons from minority backgrounds among their advocates and mentors. Implications and future directions for research and rape crisis centers are also discussed. The present study highlights the importance of social support systems for advocates and potential barriers that may be addressed to reduce service provider burnout and vicarious trauma.

Reasons for and Experiences of Sexual Assault Nondisclosure in a Diverse Community Sample

PURPOSE

After a sexual assault (SA), victims often disclose their SA to an informal support provider (SP) to receive social support; however, many survivors do not disclose or wait months or years to tell anyone. While research exists on disclosure, social reactions of informal SPs to disclosure, and how those reactions affect the victim both positively and negatively, little research exists on reasons for and impact of adult SA survivors' nondisclosure to informal social network members.

METHOD

This qualitative interview study examined 42 ethnically diverse women who had disclosed SA to an informal SP (e.g., friend, family, significant other). For this study, nondisclosure of SA mentioned by survivors was examined.

RESULTS

Various reasons for not telling people in their lives and/or delaying doing so were uncovered including fear of negative social reactions, lack of perceived available support and fear of burdening others, family and social norms expectations, and anticipated problematic gendered responses by both men (e.g., violence) and women (e.g., overwhelmed) SPs.

CONCLUSIONS

Implications for future SA disclosure research and supporting survivors in their choice to selectively/not disclose are discussed.

United States Air Force Academy Cadets' Perceived Costs of Concussion Disclosure

INTRODUCTION

Concussion is unique among sport-related injuries as effective clinical diagnosis and treatment often rely on symptom-report for clinician diagnosis and treatment. However, at-risk populations such as collegiate athletes and military academy cadets often have been shown to under-report concussions and symptoms, complicating diagnosis, treatment, and policy-based interventions. The purpose of this study was to explore factors influencing concussion reporting in United States Air Force Academy (USAFA) cadets.

MATERIALS AND METHODS

Semi-structured interviews were conducted on 34 cadets (18 with concussion history; 16 without concussion history). This study was approved by the USAFA Institutional Review Board. Analysis included a five-cycle process of clarifying the topic at hand through an introduction, conducting a literature review, data collection and summarization, relating current findings to current literature, and making final interpretations. Data were summarized by creation of a codebook after reading five transcripts and identifying meaningful units. A four-person research team read and identified meaningful units individually, then met to discuss common meaningful units and codebook creation. Once the codebook was created, the lead researcher used the codebook to code all transcripts.

RESULTS

Eight themes were generated from interview transcripts. This manuscript focuses on the perceived costs following a concussion theme and the following subthemes: perceived costs to physical fitness, military career aspirations, pilot qualifications, sport, reputation, academics, and lack of time.

CONCLUSIONS

Cadet interviews described a complex environment where concussions were often viewed as costly to future career ambitions and provided potential reasons for non-disclosure largely including disruption in daily life. Reduction in perceived and actual harms due to concussion disclosure will require not only improving clinical care, but also addressing barriers to self-disclosure. Additionally, research suggests the sooner one reports a concussion, the sooner they return to physical or military activity. Educational interventions should be designed to address the perceived costs identified from our study and educate cadets that while some costs may be reality, others may not. Secondly, it should also be stressed to cadets that the sooner one seeks medical attention following a concussion, the sooner they may return to activity. Messaging around these themes may decrease the costs associated with time removed from academics, athletics, or military activities therefore minimizing attempts at concussion self-management. Lastly, if efforts are made to improve the overall concussion disclosure stigma, cadets may increase seeking care after injury because their reputation may not be as impacted.

Why Women Are Not Talking About It: Reasons for Nondisclosure of Sexual Victimization and Associated Symptoms of Posttraumatic Stress Disorder and Depression

Disclosure of traumatic experiences is typically encouraged and associated with positive outcomes. However, there is limited research on nondisclosure of sexual trauma and consequent symptomology. This online study of undergraduate females examines reasons for nondisclosure and associated symptoms of posttraumatic stress disorder (PTSD) and depression. Of 221 participants who reported sexual victimization, 25% had not previously disclosed it. Four reasons for nondisclosure were identified: shame, minimization of experience, fear of consequences, and privacy. Nondisclosers who minimized the experience and nondisclosers low on shame reported fewer PTSD symptoms than disclosers. These findings suggest that reasons for nondisclosure are associated with symptomology.

Posttraumatic Growth as a Mediator of Self-Blame and Happiness in the Context of Interpersonal Violence

Sexual assault (SA) and intimate partner violence (IPV) occur at alarming rates in the United States. Prior research indicates that victims of traumatic events frequently experience both positive and negative changes as part of their recovery process. The present study aimed to further existing research by examining the relationship between self-blame, posttraumatic growth (PTG), and happiness when controlling for posttraumatic stress and time since victimization. The current study analyzed 357 women who had experienced at least one incident of SA or IPV. We found that PTG partially mediated the relationship between self-blame and happiness, suggesting that PTG only somewhat explains the impact of self-blame on victim happiness. Implications of these findings and directions for future research are discussed.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

Crowdsourcing Trauma: Psychopathology in a Trauma-Exposed Sample Recruited via Mechanical Turk

Although crowdsourcing websites like Amazon's Mechanical Turk (MTurk) allow researchers to conduct research efficiently, it is unclear if MTurk and traditionally recruited samples are comparable when assessing the sequela of traumatic events. We compared the responses to validated self-report measures of posttraumatic stress disorder (PTSD) and related constructs that were given by 822 participants recruited via MTurk and had experienced a DSM-5 Criterion A traumatic event to responses obtained in recent samples of participants recruited via traditional methods. Results suggested that the rate of PTSD in the present sample (19.8%) was statistically higher than that found in a recent systematic review of studies that used only traditional recruitment methods. The severity of PTSD reported in the MTurk sample was significantly greater than that reported in a college sample, d = 0.24, and significantly less than that reported in a veteran sample, d = 0.90. The factor structure of PTSD found in the MTurk sample was consistent with prevailing models of PTSD. Findings indicate that crowdsourcing may improve access to this hard-to-reach population.

Internalized Stigma and Stigma-Related Isolation Predict Women’s Psychological Distress and Physical Health Symptoms Post-Abortion

Researchers have provided evidence that accessing abortion relates to anticipated, experienced, and internalized stigma. These aspects of stigma have previously been associated with increased psychological distress and physical health symptoms. However, there has been no research on how anticipation, perception, internalization, and stigma-related isolation are related to psychological distress and somatic (physical) symptoms. We examined this question in an online volunteer sample of women in Ireland ( N = 155) who have had an abortion. Internalized stigma and stigma-related isolation significantly predicted higher levels of psychological distress, and internalized stigma also significantly predicted somatic symptoms. The direct effect of each type of stigma on somatic symptoms was mediated by psychological distress. Thus, to the extent that women had internalized greater stigma and isolated themselves, they also reported increased psychological distress, and this psychological distress predicted increased somatic symptoms. The relation between internalized stigma and somatic symptoms was also moderated by stigma-related isolation. Our findings complement and extend the existing literature on the relations between stigmatized identities, psychological distress, and physical health problems, particularly regarding women who have accessed abortion. They also indicate that those involved in policy-making and activism around reproductive rights should avoid inadvertently increasing the stigma surrounding abortion.

Sexual violence in the college population: a systematic review of disclosure and campus resources and services

AIMS AND OBJECTIVES

To synthesise research examining college student sexual violence disclosure and campus sexual violence resources and services.

BACKGROUND

Recently, the issue of sexual violence within the college population has garnered attention worldwide. The prevalence of sexual violence within college students is alarmingly high. Survivors often experience negative outcomes (e.g. health-related consequences, impact on education). Efforts have been made to address this significant public health concern.

DESIGN

Systematic review of published literature.

METHODS

Studies were identified through systematic searches of PubMed, CINAHL and PsycInfo of articles published between January 2010-February 2015. A total of 672 articles were identified. After screening, 16 articles were included in this review.

RESULTS

A lack of consistency in how sexual violence was referred to and measured was identified. Research on college student sexual violence disclosure has primarily been conducted in six areas: (1) informal disclosure, (2) formal disclosure, (3) friends' perceptions of disclosure, (4) process/effects of disclosure on the survivor, (5) barriers to disclosure and (6) social support in the disclosure process. Research related to campus sexual violence resources and services has primarily focused on: (1) students' knowledge, (2) students' utilization and (3) students' suggestions. Synthesised findings are presented.

CONCLUSIONS

Sexual violence impacts college student survivors and the campus community as a whole. To appropriately assist/address sexual violence, a thorough understanding of college student sexual violence disclosure and campus sexual violence resources/services is necessary. Suggestions for researchers, colleges and nurses are provided.

RELEVANCE TO CLINICAL PRACTICE

Nurses who serve students, especially those at on-campus student health centres, are opportunely placed to address sexual violence. Findings highlight the need for nurses to use consistent definitions of sexual violence when identifying survivors. Nurses should take measures to increase disclosure and promote sexual violence resources/services provided by their facility. Additional suggestions for nurses are provided.

Seeing How Far I've Come: The Impact of the Digital Sexual Life History Calendar on Young Adult Research Participants

The Digital Sexual Life History Calendar (d/SLHC) is a Web-based platform for collecting young adults' sexual histories. In addition to collecting diverse data, the d/SLHC was designed to benefit participants by enabling reflection on their sexual and relationship experiences in the context of other life events and circumstances. In a pilot study of the d/SLHC, survey data were collected to test whether creating a d/SLHC timeline had any impact on sexual well-being. A sample of 18- to 25-year-old participants recruited through Amazon Mechanical Turk (MTurk) completed an online survey about sexuality and relationships. Of those, 113 also completed d/SLHC timelines and 262 served as a comparison group. Six months later, participants from both groups were invited to complete a follow-up survey (total N = 249). Repeated-measures analysis of variance (ANOVA) results indicated that participants who completed d/SLHC timelines exhibited higher sexual esteem immediately following d/SLHC completion and at follow-up. No changes in sexual esteem were observed in the comparison group, and there were no differences between the groups with regard to sexual health behaviors and outcomes. These findings suggest that sexuality studies may have the potential to yield not only rich data for researchers but also rich experiences for participants.

Predicting Sexual Assault Revictimization in a Longitudinal Sample of Women Survivors: Variation by Type of Assault

This study used a large community sample of women sexual assault survivors to prospectively assess 17 theorized predictors across four types of sexual assault revictimization: unwanted contact, coercion, substance-involved assault (SIA), and force. Results indicated that predictors varied across types of revictimization: Unwanted contact and coercion appeared more common in social contexts more hostile toward survivors, whereas forcible assaults and SIAs occurred in circumstances where survivors were vulnerable to being targeted by perpetrators. Overall, the strongest predictors were social environments hostile to survivors, race, childhood sexual abuse, decreased refusal assertiveness, and having more sexual partners. We discuss implications for intervention and research.

Through the Looking Glass: Exploring How College Students' Perceptions of the Police Influence Sexual Assault Victimization Reporting

Despite increased attention, education, and prevention programs, sexual assault of college students and underreporting of this victimization remain a pervasive problem. Previous research has examined factors influencing the reporting of crimes by the public to the police, the extent of sexual victimization on college campuses, sexual assault victimization reporting and/or disclosure (for both university victims and non-university victims), and perceptions of police by university students. However, there remains a dearth of research examining whether students' perceptions of police influence their decision to report victimization, in particular sexual assault victimization. The present study examined whether students' perceptions of police influence their decision to report victimization. Using data obtained from a survey of students attending a public university in Southwestern Pennsylvania, the current study examines factors that impact victimization reporting and whether perceptions of police influence victims' decision to report or not. The results of the analyses indicated that victimization reporting and satisfaction with the police were impacted by gender, and support was found for the proposition that perceptions of the police influence the likelihood to report victimization.

Silenced suffering: the need for a better understanding of partner sexual violence

This article has two overall goals. First, to examine the current state of sexual violence research to highlight several shortcomings in the knowledge on partner sexual violence. Second, to describe several factors to consider in future research to facilitate a more in-depth understanding of partner sexual violence. Shortcomings of the research on partner sexual violence include (1) overreliance on dichotomous yes/no representations of sexual violence experiences; (2) lack of, or inadequate documentation of the scope and nature of partner sexual violence; (3) inadequate ways to account for impairment of consent under different circumstances; (4) difficulties in discriminating unwanted from nonconsensual sexual activities; and (5) limited information about the role sexual violence plays in the larger context of coercive control. In order to facilitate a more in-depth understanding of partner sexual assault, there is a need (1) to better understand the scope and nature of partner sexual assault and (2) to better understand the role partner sexual violence plays in coercive control. By improving the measurement of this phenomenon, victims, researchers, practitioners, and those involved in the justice system might be better equipped to respond to sexual violence among intimate partners.

Perceptions of Similarity and Responsibility Attributions to an Acquaintance Sexual Assault Victim

Individuals view similar rape victims as less responsible for the rape than victims perceived as dissimilar. However, it is unclear if individuals hold victims they perceive as similar less responsible for the assault, or if individuals view themselves as more similar to victims they do not view as responsible for the assault. The current study, therefore, examined the temporal relationship between these constructs. A total of 167 college women listened to a date narrative that ended in sexual assault, consensual sex, or no sexual activity (these last two served as controls). Results supported that participants viewed themselves as less similar to the woman in the narrative when the date ended in sexual assault. Only similarity ratings made following learning that the woman was sexually assaulted predicted responsibility attributions suggesting that viewing a victim as responsible for the assault results in decreased perceptions of similarity toward her. Implications and suggestions for future research are discussed.

Does Encouragement by Others Increase Rape Reporting? Findings from a National Sample of Women

Our study explores the role of victims' consultation with others about whether or not to report their rape to police. Three groups were observed within this sample of 435 rape victims from a national telephone household probability sample of women: those who did not consult with anyone about reporting (n = 364), those who consulted with someone and were encouraged to report to police (n = 40), and those who consulted with someone and were not encouraged to report (n = 31). Descriptive analyses indicated that the encouraged group was more likely to report to police than either of the other two groups (which did not differ from each other). Because there were no differences between the two consulting groups on demographic or rape-related variables, they were combined in subsequent analyses. Consulting with others about whether to report, peri-traumatic fear of injury or death, assault perpetration by a stranger, and concerns about contracting a sexually transmitted disease were significant predictors of reporting to police after controlling for other significant predictors in a multivariate regression analysis. Implications of these findings are discussed, including the benefits and consequences of formal rape reporting for victims, and the role that disclosure recipients may have in assisting victims post-rape (e.g., encouragement of reporting, emotional support).

Acknowledged versus unacknowledged sexual assault among college women

Research suggests that many sexually victimized women do not acknowledge their unwanted sexual experiences as assaults. The majority of the research on this topic has focused on rape acknowledgment; however, this pattern holds true for other forms of sexual assault as well. The present study examined differences among university women with acknowledged, unacknowledged, and no histories of sexual assault. Relevant groups were compared in terms of current psychological distress, the situational factors of the assault, and the labeling of the assault. Similar to studies examining only rape, acknowledged victims of sexual assault reported clearer refusal, the experience of a more forceful assault, and more intense resistance against the perpetrator. Unacknowledged victims were more likely to endorse a prior romantic relationship with their assailant and a more recent assault. The great majority of women who endorsed an unwanted sexual experience also reported they were intoxicated at the time.

The invisible suffering: sexual coercion, interpersonal violence, and mental health--a cross-sectional study among university students in south-western Uganda

Background

Despite a history of conflicts and widespread human rights violation in sub-Saharan Africa, little is known about the prevalence of interpersonal violence among the population in this region. Evidence from high-income countries suggests that exposure to violence has mental health consequences and violence also has associations with experiences of sexual coercion.

Aims

This study sought to investigate the prevalence of physical and perceived threats of violence among university students in Uganda and to assess the possible relationship between such violence, sexual coercion, and symptoms of anxiety, depression, and psychoticism, respectively.

Method

In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic factors, social capital, importance of religion, mental health, experience of violence and sexual coercion, and sexual behaviour factors. Logistic regression analysis was applied as the main analytical tool.

Results

Of those who responded, 28% reported perceived threats/threats of violence and 10% exposure to actual physical violence over the previous 12 months, with no significant gender differences in exposure history. Exposure to violence was significantly associated with the experience of sexual coercion among both males and females. Sexual coercion and threats/threats of violence were both significantly associated with poor mental health in males and females, but only males showed a strong association between exposure to physical violence and poor mental health.

Conclusion

The current study suggests that in terms of general exposure, both males and females in the study population are equally exposed to sexual coercion and interpersonal violence, and both male and female students show generally similar mental health effects of exposure to such violence. The prevalence of interpersonal violence found in our study population may have long-term negative health implications. Our findings may serve as a baseline for interventions and continuing research aimed at preventing interpersonal violence.

Expressed sexual assault legal context and victim culpability attributions

Legal scholars have argued that laws have an expressive function, specifically that sexual assault laws may convey social-level messages that victims are culpable for crimes against them. In a university sample, we conducted the first experimental test of legal scholars' proposal, hypothesizing that legal messages-specifically their clarity and effectiveness in conveying that sexual assault is a crime-affect victim culpability attributions. Results demonstrated that greater culpability was attributed to a victim of sexual assault within a context expressing unclear and ineffective sexual assault law than within a context clearly and effectively expressing that sexual assault is a crime. We also garnered empirical support for a mediation model, that is, negative affective reactions to a victim statistically accounted for the relationship between expressed legal context and victim culpability attributions. Implications for future psycholegal research and potential legal reforms are discussed.

A Match-and-Motivation Model of How Women Label Their Nonconsensual Sexual Experiences

Many rape victims are unacknowledged rape victims—they report an experience meeting researchers’ operational definitions of rape but do not label their experience as rape. The purpose of this study was to investigate women’s decisions about whether to label their experiences as rape. Participants were 77 college women (predominantly White; mean age = 19.23) who had experienced rape according to the study’s operational definition. The researchers used open-ended questionnaires and interviews to explore participants’ explanations for labeling or not labeling their experience as rape. Explanations were related to match—whether the incident matched their rape script (e.g., whether the man fit their image of a rapist; whether they fought back)—and to motivation—the perceived consequences of using the label (e.g., discomfort with thinking of the perpetrator as a rapist; feeling less self-blame vs. feeling less control or more traumatized). Over time, participants were more likely to label their experience as rape. Results suggested that individuals differ in the meanings that they ascribe to the label rape. For some individuals, labeling their experience as rape may be adaptive; for others, it may be unhelpful or even harmful. Researchers, clinicians, and advocates should use caution in imposing their own preferred labels on other women’s experiences.

Silent Survivors

Prior research suggests that rape victims who do not disclose or report to the police give reasons including self-blame and fear of judgment; however, this research has not been conducted with incarcerated women. Female offenders are a unique population because they experience high rates of sexual assault prior to incarceration. This study recruited 74 women at a U.S. state prison, who experienced sexual assault prior to incarceration to explore the associations among rape myth acceptance (RMA), disclosure, and reporting of sexual assaults to the authorities. Participants were asked open-ended questions regarding why they chose to disclose their sexual assaults to others, to report to the police, or to remain silent. Narratives were audiotaped, transcribed, and coded for thematic content. Women’s narratives, particularly those of women who indicated that they remained silent, frequently included a variety of rape myths that involved blaming themselves for the rape, fearing not being believed, believing that familiar perpetrators cannot be rapists, and questioning whether the event was really a rape. Women often described such rape myth beliefs with greater frequency than discussing situational characteristics of the rape as reasons for nonreporting. Implications for these findings in clinical, research, and social justice contexts are discussed.

Emancipatory Sexuality Education and Sexual Assault Resistance

The current study examined whether adding emancipatory sexuality education, which encourages the exploration of women’s own sexual values and desires, to a sexual assault resistance program would improve women’s resistance to sexual assault by known men. The participants were 214 first-year university students. A randomized experimental design evaluated the effectiveness of a basic and sexuality enhanced version of a sexual assault resistance program against a no-program control. Both programs, compared to the control group, increased women’s perception of their own risk, their confidence that they could defend themselves if attacked, and their use of more effective methods of self-defense in hypothetical situations of acquaintance sexual assault. Effects were maintained from 3 to 6 months after program completion. No significant reductions in completed sexual assault were found. The sexuality enhanced program was superior in several areas, particularly risk detection and initiation of sexual activity, which may be important to women’s integration of the program’s content to their lives. Future research will need to strengthen and continue to evaluate the promising programs for women which now exist. Until effective programming for men on campus is developed and implemented widely, our best hope to improve the health and safety of female students lays in comprehensive women-only multi-unit sexual assault resistance education.