Health care-based interventions for women who have experienced sexual violence: a review of the literature

Adult Sexual Assault Patients' Experience of the Physical Examination Component of the Medical Forensic Examination: A Scoping Review to Identify Gaps in the Research Literature

We undertook a scoping review of published research literature that reported on adult sexual assault patients' experience of the physical examination component of the medical forensic examination (MFE). Eligible papers were those reporting data about the physical examination component of the MFE from the adult patient's perspective, published in the period January 2000 to March 2022 in peer reviewed journals and reports containing original research data published from a tertiary institution. Twelve papers were identified. The review identified a gap in the literature regarding the patient's experience of the physical examination component of the MFE. The existing literature is limited but suggests that some patients find the examination empowering and reassuring, restoring a sense of bodily control; however, for others it is an intrusive, violating experience that they endure. A more patient-centered sexual assault service appears to have a therapeutic value in itself, but more research is warranted as existing research is very limited and often from a proxy. In particular, more research on patients' self-reported experience of the MFE, including specific aspects of the examination and the experience of male and gender nonconforming victim-survivors, is needed. A better understanding, from the point of view of the patient, of the benefits of attending, may encourage victim-survivors to seek a health response and, possibly, report to police. It may also be time to assess the impacts of certain aspects of the forensic examination, rethink standard evidence collection processes, and consider enabling more acceptable options for victim-survivors including self-collection of intimate samples.

Adolescent Female Victims of Sexual Violence: Analysis of Loss of Follow-up after Emergency Care and Outpatient Follow-up

OBJECTIVE

 To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors.

METHODS

 This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%.

RESULTS

 A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR =  2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up.

CONCLUSION

 Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.

Views on Interprofessional Collaboration in a Dutch Sexual Assault Center: A Qualitative Study Among Workers

Purpose

As the response to sexual assault victims proved to be shattered and substandard, sexual assault centers were set up to improve care by providing the victims with medical, psychosocial and legal care. The Dutch Centers for Sexual Assault were launched in 2012. We wished to examine the challenges in interprofessional collaboration experienced in a long-running Dutch Sexual Assault Center.

Methods

In this qualitative study, data was collected via semi-structured explorative interviews which were analyzed using thematic analysis in an iterative process. The semi-structured interviews were held with fifteen professionals from medical, psychosocial and legal disciplines. An interview guide was developed based on expert opinion and the Bronstein Index of Interprofessional Collaboration. Qualitative analyses were done using the method of thematic analysis in ATLAS.ti and were reported according to the COREQ criteria. The themes of the experienced challenges in interprofessional collaboration were further clarified using quotations.

Results

Participants mentioned three themes that challenged interprofessional collaboration: 1. discrepancies in professional involvement, 2. conflicting goals and 3. a lack of connection. Discrepancies in motivation and affinity to work with victims of sexual violence between professionals proved to be the most pivotal challenge to collaboration, leading to disturbing differences in professional involvement. A low caseload and time restraints complicated gaining expertise, affinity and motivation. Conflicting goals and confidentiality issues arose between the medical and legal disciplines due to their contrasting aims of caring for victims versus facilitating prosecution. Some professionals felt a lack of connection, particularly due to missing face-to-face personal contact, which hindered the sharing of complex or burdensome cases and gaining insight into the other discipline's competences.

Conclusion

Building collective ownership and equal professional involvement are crucial for interprofessional collaboration. Professional involvement should be increased by training courses to clarify conflicting goals and to improve reciprocal personal contact between professionals. Training courses should be facilitated with organizational financial support.

Neighborhood-Level Predictors of Sexual Violence Across Intimate Partner and Non-Intimate Partner Relationships: A Case-Control Study

Ample research explores individual factors associated with sexual violence, yet individual, dyadic, and environmental influences on intimate partner sexual violence (IPSV) occurring in the larger context of non-intimate partner violence (NIPSV) remain relatively unexplored. The current study aimed to determine the extent to which county-level indicators in combination with individual and dyadic factors are associated with sexual violence across relationship types. Reported IPSV and NIPSV cases were obtained from the Tennessee Bureau of Investigation's (TBI) online incident-based reporting system. County-level variables indicative of neighborhood physical disorder, violent crime, income inequality, firearm prevalence, and community alcohol use patterns were retrieved from the online resource County Health Rankings and Roadmaps. Using a nested case-control design, we determined significant sexual violence risk within younger cohorts and across relationship types, finding three significant county-level factors: 1) income inequality, 2) rate of firearm fatalities, and 3) percentage of female residents. Suggested prevention and intervention efforts include targeting younger age groups for IPSV and NIPSV education, developing resources for a range of relational partners, improving legal access and law enforcement training for reporting, and continued examination of the role of firearms.

Paper: violence, abuse and exploitation among trafficked women and girls: a mixed-methods study in Nigeria and Uganda

Background

Africa is the global region where modern-slavery is most prevalent, especially among women and girls. Despite the severe health consequences of human trafficking, evidence on the risks and experiences of trafficked adolescents and young women is scarce for the region. This paper addresses this gap by exploring the intersections between violence, migration and exploitation among girls and young women identified as trafficking survivors in Nigeria and Uganda.

Methods

We conducted secondary analysis of the largest routine dataset on human trafficking survivors. We used descriptive statistics to report the experiences of female survivors younger than 25 years-old from Nigeria and Uganda. We also conducted 16 semi-structured interviews with adolescents identified as trafficked in both countries. We used thematic analysis to explore participants’ perceptions and experiences before, during and after the trafficking situation.

Results

Young female survivors of human trafficking in Nigeria and Uganda are exposed to a range of experiences of violence before migration, during transit and at destination. The qualitative data revealed that children and adolescents migrated to escape family poverty, violence and neglect. They had very low levels of education and most had their studies interrupted before migrating. Family members and close social contacts were the most common intermediaries for their migration. During transit, sexual violence and hunger were common, especially among Nigerians. Participants in both the quantitative and qualitative studies reported high levels of violence, deception, coercion, withheld wages and poor working conditions at destination. The adolescents interviewed in the qualitative study reported severe mental suffering, including suicide attempts. Only one reported the prosecution of perpetrators.

Conclusions

Our findings suggest that interventions to prevent or mitigate the negative impact of adverse childhood experiences can contribute to preventing the trafficking of adolescents in Nigeria and Uganda. These interventions include social protection mechanisms, universal access to education, social service referrals and education of parents and carers. Importantly, effective prevention also needs to address the systemic conditions that makes trafficking of female adolescents invisible, profitable and inconsequential for perpetrators.

Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault

Sexual assault and rape are common forms of sexual violence/abuse. The psychological/health consequences represent significant and ongoing harm. It seems imperative that victim/survivors receive evidence-based support within first response settings. To assess what psychosocial interventions work for victim/survivors of a recent sexual assault. Twenty-seven electronic databases were systematically searched. Narrative data synthesis was used to read across studies. Reporting format follows PRISMA checklist. Ten studies were identifed including range of interventions. The evidence is sparse and scientifically weak, common flaws are reviewed. There is some weak evidence for the impact of video and cognitive behavioural therapy (CBT) based interventions, especially trauma processing. There is a gap in the evidence base on psychosocial interventions for victim/survivors of sexual assault and higher quality research is required.

Development of multidisciplinary sexual assault centres in the Netherlands

Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.

Sexual Assault Profile in Jimma University Medical Center, Southwest Ethiopia

Background

Sexual assault cases are increasingly reported in Ethiopia and worldwide. However, in Ethiopia, sexual assaults’ profile was not investigated well, regardless of its social, physical, and psychological impacts on survivors. Hence, this study assessed the survivors’ characteristics, circumstances of the victims, and treatment offered with the view of describing the management process, and service responsiveness.

Methods

A descriptive study with 3 years retrospective chart review was conducted in Jimma University Medical Center (JUMC). Samples of 187 charts/medical records were selected using a systematic random sampling technique from the medical unit. The selected survivors’ records were reviewed using a structured checklist. Data were analyzed using SPSS Version 21.0.

Results

Out of the 187 cases of sexual assaults during the study period, 67.4% were rape cases. Among these, 58.8% were below 14 years, and 85.6% knew their assailants. Above 30% of the victims were assaulted during the daytime, and 51.9% developed perennial laceration. Threat and physical force were mostly used to coerce victims during the violence. All of the survivors were not investigated for vaginal/anal swab (for sperm analysis), and 96.8% of the victims were not tested for HIV screening. Only 8% of the victims received emergency contraception.

Conclusion and Recommendation

Children and adolescents remain the most sexually assaulted group of the population, requiring protection and appropriate medical services to ensure their well-being and reduce their suffering. Appropriate and timely intervention is needed to care for such survivors. The findings have highlighted the need for closer monitoring and better follow-up of the care and support provided in the Medical Center to sexual assault victims.

Post Rape Care Provision to Minors in Kenya: An Assessment of Health Providers' Knowledge, Attitudes, and Practices

Child sexual abuse (CSA) is a major global health challenge. Extant literature in Kenya indicates an alarming rate of sexually abused minors presenting to poorly equipped health facilities with untrained health providers for post rape care. National guidelines on management of sexual violence have been in existence since 2004; however, little is known on the impact of these guidelines on post rape care provision to minors. Therefore, the study aims to assess the knowledge, attitudes, and practices of health providers with regard to post rape care provision in a Kenyan District health facility. The study used a triangulation of different qualitative methods: review of 42 health records of minors seeking post rape care, 15 in-depth interviews, and informal conversations with health providers. Findings indicate that the Kenyan national guidelines on management of sexual violence were nonexistent in the health facility. Consequently, health providers possessed limited knowledge on post rape care administration. The limited knowledge translated to poor collection and preservation of evidence, inadequate psychosocial support, and clinical care. In addition, rape myth attitudes and religious beliefs contributed to survivor blaming and provider hesitance in provision of legal abortion care, respectively. To facilitate provision of quality post rape care, policy makers and health institutions' managers need to avail protocols in line with evidence-based best practices to guide health providers in post rape care administration. In addition, there is need for rigorous training and supervision of health professionals to ensure better service provision.

Post-exposure prophylaxis for HIV infection in sexual assault victims

OBJECTIVES

Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this.

METHODS

We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion.

RESULTS

The median age of participants was 25 years [interquartile range (IQR) 21-33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6-24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120.

CONCLUSIONS

Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow-up testing and new better tolerated drug regimens must be investigated to address these issues.

Collaboration with Rural and Remote Communities to Improve Sexual Assault Services

After a recent sexual assault, clients in rural and remote communities do not typically receive comprehensive services. They experience delays with staff shortages and unfamiliarity with procedures, negative responses to disclosure such as disbelief, and may be turned away or required to travel elsewhere away from their support systems. These experiences increase their risks for mental health disorders and chronic diseases, placing a significant burden on the client's health and on the community. A participatory action approach was used in five Canadian communities to find collaborative solutions to their challenges. Mixed methods were used to collect data on the impact of community identified interventions on knowledge, service quality and comfort in providing services. Interventions included support for multidisciplinary advisory teams, resource development, and education sessions for service providers. The Enhanced Emergency Sexual Assault Services (EESAS) education selected by communities provided trauma informed knowledge of collaborative and comprehensive services in their community. Both focus group and survey data demonstrated increased collaboration and shared knowledge, enhanced communication, and improved services such as provision of increased privacy for clients. Knowledge increased in all key areas of services and service quality. Limited data suggests the changes are sustained for at least 6 months post-training. The combined findings of qualitative and quantitative data support the effectiveness of a multidisciplinary community development program. The increased knowledge, comfort and teamwork have potential to improve services clients receive and therefore the health of both the individuals and the community.

Changes in Psychiatric and Medical Conditions and Health Care Utilization Following a Diagnosis of Sexual Assault: A Retrospective Cohort Study

INTRODUCTION

Sexual assault (SA) is alarmingly common and is associated with higher prevalence of psychiatric and medical conditions. However, many prior studies are limited to cross-sectional designs. Health care systems with electronic health records provide unique longitudinal data to examine whether SA is associated with changes in health and health care utilization.

METHODS

The sample included 1350 Kaiser Permanente Northern California adult female patients with a SA diagnosis from 2009 to 2015 and 4050 adult female patients without a SA diagnosis, matched on age, medical facility, and continuous enrollment during the study period. Using a retrospective cohort design, we tested whether a SA diagnosis was associated with 12-month changes in psychiatric and medical comorbidities and health care utilization using difference-in-difference models. Analyses were conducted in 2017.

RESULTS

Patients with a SA diagnosis had a higher prevalence of psychiatric and medical comorbidities and greater health care utilization than matched patients without SA in the 12 months before the SA diagnosis, and greater increases in the prevalence of psychiatric disorders and stress-related somatic conditions, and psychiatry and obstetrics/gynecology utilization (all P<0.001), 12 months after the SA diagnosis, relative to matched non-SA patients during this time.

DISCUSSION

SA is associated with increases in psychiatric disorders and stress-related somatic conditions as well as increases in utilization of psychiatry and obstetrics/gynecology. Clinicians should be trained in how to inquire about, respond to, and refer women who have experienced SA.

Women's post-rape experiences with Guatemalan health services

We conducted a qualitative study to examine the critical pathways of 23 women survivors of sexual assault who navigated health care-based services in six states in Guatemala. We also captured the components of quality health care that were important to them, including the experience of the waiting room, being able to make active decisions, providing informed consent, and receiving emotional support. Our results from the in-depth, semi-structured interviews indicate the importance of creating and strengthening mechanisms for social support and trauma-informed, competent, and sensitive health services to accompany women as they move toward rebuilding their lives post-sexual violence.

Attitudes Toward Sexual Violence Survivors: Differences Across Professional Sectors in Kenya and the Democratic Republic of the Congo

Sexual violence survivors who decide to report their assault interact with health care, law enforcement, and legal and judicial professionals. Professionals' attitudes about sexual violence and survivors play an important role in caring for survivors and in the pursuit of justice. Despite evidence showing the relationship between service provider beliefs and survivor outcomes, relatively little is known about professionals' beliefs about sexual violence or their attitudes toward sexual violence survivors. Between June 2012 and December 2014, our study examined the beliefs and attitudes of 181 professionals from the health care, legal, and law enforcement sectors in the Eastern Democratic Republic of the Congo (DRC) and the Rift Valley region of Kenya, areas with a high prevalence of sexual violence. To determine correlates of beliefs and attitudes about sexual violence and sexual violence survivors, multiple logistic regression models were adjusted for demographic and occupational characteristics. Respondents who agreed that survivors got what they deserved (7%) or that survivors should feel ashamed (9%) were the minority, while those who would be willing to care for a family member with a history of sexual violence (94%) were the majority. Profession was significantly associated with beliefs and attitudes about sexual violence and survivors. Law enforcement professionals were more likely than health professionals and lawyers to indicate that survivors should feel ashamed. Our findings suggest a need for interventions that adequately address potentially harmful beliefs and attitudes of some professionals serving sexual violence survivors.

Awareness and Attitudes Towards Violence and Abuse among Emergency Nurses

PURPOSE

This study identifies degree of awareness and legal knowledge about overall abuse and violence, and investigates attitudes towards domestic violence in emergency nurses.

METHODS

The data collection period was between August and December 2012 for 131 nurses who worked in the emergency center of five hospitals in South Korea. This study surveyed emergency nurses about the recognition of abuse and violence, the legal knowledge of abuse and violence, and the attitudes towards domestic violence.

RESULTS

This study showed that approximately 60.0% of participants experienced incidents of suspected abuse or violence, but the reporting rates were low. Of all the participants, 70.2% knew that they must report the discovery of abuse or violent incidents, but 45.0% did not know that if someone who had duty to report but did not report that he/she had a legal responsibility. Most emergency nurses agreed that "even if the domestic violence is severe it should not be suggested to victims that they run away, leaving children at home", and "perpetrators are patients who need treatment."

CONCLUSIONS

Appropriate awareness about abuse and violence, and systematic education are required for emergency nurses so that they can provide appropriate interventions.

Sexual assault in Lagos, Nigeria: a five year retrospective review

Background

Cases of sexual assault are increasingly reported. However, Nigerian researchers have not given adequate attention to this subject despite its attendant social, physical and psychological consequences.

This study assessed survivors’ characteristics, circumstances of assault and treatment offered with a view to reducing the incidence as well as improving evaluation and management.

Methods

A retrospective review of survivors’ case records at Lagos State University Teaching Hospital, Ikeja, between January 2008 and December 2012. Data was analysed using the Epi-info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U S A.

Results

Of the 39,770 new gynaecological cases during this period, 304 were alleged sexual assault giving an incidence of 0.76% among hospital gynaecological consultations. Only 287 case notes had sufficient information for statistical analysis. Of these, 83.6% were below 19 years, 73.1% knew their assailants (majority were neighbours), most assaults (54.6%) occurred in the neighbours’ homes and over 60% of victims presented after 24 hours of assault.

Although 77.3% were assaulted at daytime, teenagers were likely to be raped during the day and non-teenagers at night (P < 0.001). Threat and physical violence were mostly used to overcome victims. Seventy three point six percent had Human Immunodeficiency Virus (HIV) screening with one positive at onset. Post Exposure Prophylaxis for HIV was given in 29.4% of those eligible and emergency contraception in 22.4% of post-menarcheal victims (n = 125).

There were neither referrals for psychotherapy nor forensic specimen collected. No record of post-assault conception or HIV infection was found during follow-up.

Conclusions

Adolescents remain the most vulnerable requiring life skills training for protection. Survivors delay in presenting for care. Therefore, public enlightenment on the benefits of early interventions and comprehensive care of survivors with the use of standardized protocols are recommended.

Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers' attitudes, knowledge, confidence, and practice in humanitarian settings

Background

Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers’ attitudes, knowledge, confidence, and practices in four countries.

Methods

Using a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers’ practice. Quantitative and qualitative data underwent statistical and thematic analysis.

Results

While negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p < .01) and 74% to 81% (p < .05) respectively. Healthcare providers’ knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p < .001) and 58% to 73% (p < .001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p < .01), HIV post-exposure prophylaxis from 42% to 92% (p < .001), and STI prophylaxis and treatment from 45% to 96% (p < .01).

Conclusions

Although beliefs about sexual assault are hard to change, training can improve healthcare providers’ respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors.

Minority women victims of recent sexual violence: disparities in incident history

AIMS

The aims of this descriptive study were to (1) describe assault and care characteristics and (2) determine differences in assault and care characteristics between black women and white women who sought emergency care following sexual violence.

METHODS

A retrospective, cross-sectional design was used to examine forensic examination data characterizing the incident history reported by women victims of sexual violence at the time of a forensic nurse examination. Examinations occurred at an urban university-affiliated hospital emergency department (ED) over a 2-year period.

RESULTS

Of the women (n = 173) seeking care in the ED, 58.4% were black and 41.6% were white. When compared with white women, black women were more likely to have weapons used in their assaults (42.6% vs. 16.7%, p < 0.00) and to be assaulted in the city rather than the suburbs (82.8% vs. 56.5%, p < 0.00). In general, substance use prior to the assault was reported to have occurred in 49.1% of the victims and 41% of the assailants; however, differences existed in the type and pattern of substance use by race/ethnicity. Black victims were more likely to report use of illicit drugs (28.7% vs. 12.5%, p = 0.01). White women were more likely than black women to report personal alcohol use prior to their assault, with significant differences for drinking by victims (47.2% vs. 23.8%, p = 0.01) or assailant use of alcohol (47.2% vs. 23.8%, p = 0.00). White women were more likely than black women to report both they and the assailant had used some type of substance (38.9 vs. 21.8, p = 0.01). Black women were more likely to arrive to the ED via EMS services (45.5% vs. 29.2%, p = 0.03). There were no reported differences in care characteristics by race.

CONCLUSIONS

Findings from this study suggest that differences exist in assault characteristics between black and white women. Use of substances, including alcohol, plays an important role in sexual violence in women and should be a focus of preventive intervention initiatives when conducting a forensic examination. Both coordinated responses and comprehensive, individualized care by specially trained providers are important in the emergency care of minority women who are victims of recent sexual violence.

Sexual Violence Victimization of Women

Sexual violence is a serious public health problem with devastating health-related consequences. In this article, the authors review the prevalence, characteristics, vulnerability factors for, and impacts of sexual violence victimization for women. Some key factors are reviewed that have been shown to increase vulnerability for victimization, including certain demographic characteristics, previous victimization, and use of drugs or alcohol. The impacts of rape and other sexual violence are described, including physical and sexual health; psychological, social, and societal impacts; as well as impact on risky health behaviors. The authors conclude with a discussion of the public health approach to sexual violence, primary prevention, the relevance of sexual violence research for health care practitioners, and recommendations for health care practice.