A comparison of intimate partner and other sexual assault survivors' use of different types of specialized hospital-based violence services

Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review

Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.

Frequency, Types, and Manifestations of Partner Sexual Violence, Non-Partner Sexual Violence and Sexual Harassment: A Population Study in Spain

Background: This study analyzes the frequency and sociodemographic characteristics associated with sexual violence by a partner/ex-partner (PSV), someone other than a partner or ex-partner (NPSV), or sexual harassment (SH). Methods: The study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality among a sample of 9568 women age 16 or more years. Odds Ratios were calculated and multinomial logistic regression analyses were performed. Results: Forty-four women had suffered some kind of sexual violence over their lifetime, 9.2% had experienced PSV, 6.5% NPSV and 40.4% SH. More than 7% of women had been raped by a partner and 2.2% by another man. In the three groups, violence was associated with lower age and having a certified disability. NPSV and SH were significantly associated with a higher education and internet use. In NPSV, 9.2% of cases were reported to the police and 3.9% were reported to the courts. In SH, 91.7% of women told a family member or a close friend and 4.2% reported it to the police or the courts. Conclusions: A greater emphasis needs to be placed on reporting sexual violence in its various forms. Rape within intimate partnerships ought to be investigated and studied in greater depth.

Domestic Violence and Immigrant Women: A Glimpse Behind a Veiled Door

Domestic violence (DV) experienced by immigrant women is a public health concern. In collaboration with a community agency, researchers undertook a retrospective review of 1,763 client files from 2006-2014. The three aims were to document the incidence of DV, service needs associated with DV, and identification of risk factors associated with DV in the extracted file data. About 41% reported DV and required multiple services. Separated and divorced women, and women on visitor/temporary visas showed the highest risk. The results underscore the value of research partnerships with community-based service agencies in increasing our understanding of DV among immigrant women.

Implementation of Sexual Assault Services in a Clinic Setting

Sexual assault services cost Americans more than $420,000,000 annually for medical and mental health services. Personal costs include lost wages, lost quality of life, and victim assistance. Public costs include police work, legal adjudication, and sanctioning (penalties). In 2014, an estimated 284,350 adult women were sexually assaulted in the United States. Sexual assault is significantly underreported by those who are assaulted. Upon determination that sexual assault services in a clinic setting were nonexistent, services for sexual assault were developed and implemented in a clinic setting in a Midwestern state. The purpose of clinic services was to provide support, assessment, and forensic examinations for adult women and to evaluate the number of women receiving services. A quality improvement approach was used to determine how and when sexually assault victims received sexual assault services. Persons who have been sexually assaulted vary in gender and age; however, for the purpose of the pilot project, implementation initially included services to women over 18 years of age. Although the number of female patients receiving care was low in the inaugural clinic during the implementation and evaluation period, the services provision remains a viable option for women who experienced sexual assault in a community that previously had no access to clinic services.

The case for "investigate all": Assessing the cost-effectiveness of investigating no CODIS hit cases in a sexual assault kit initiative

An increasing number of US jurisdictions have begun to submit their previously untested sexual assault kits (SAKs) for DNA testing. However, best practices for what should happen after testing are not well established. Should all cases be investigated regardless of the testing outcome or only those that returned a DNA hit? We examine an early-adopter jurisdiction that has completed testing and investigating all 5165 previously never tested kits. We explore and compare the criminal justice outcomes and cost-effectiveness of investigating: all cases, those with CODIS hits, and those without CODIS hits. Findings indicate the SAK initiative produced a cost savings to the community: $26.48 million ($5127 p/kit) after the inclusion of tangible and intangible costs of future sexual assaults averted through convictions, of which $9.99 million ($1934 p/kit) was from also investigating no CODIS hit cases. When considering only the costs to law enforcement, investigating all cases cost $12,000 p/additional conviction. Findings also illustrate the cost-effectiveness of investigating no CODIS hits cases and support an "investigate all" approach. This study enhances our understanding of the economic value of what comes after testing kits and investigating cases and provides a framework for jurisdictions for prioritizing resources and maximizing outcomes from testing.

How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review

INTRODUCTION

Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services.

METHODS AND ANALYSIS

To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories.

DATA ANALYSIS

A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies.

PROSPERO REGISTRATION DETAILS

CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.

Misperceptions and stereotypes in nursing care for sexually transmitted infections and domestic violence: a qualitative exploratory study

Background: Sexually transmitted infections (STI) and domestic violence (DV) are common healthcare issues experienced worldwide with DV increasing the risk of acquiring STI/s. Although nurses are well-placed to provide care for both issues, little is known about how and whether nurses perceive STI risk within the context of DV and whether this informs nursing care.Aim: To explore nurses' perceptions of STI acquisition within the context of DV and whether this informs nursing care.Design: Qualitative exploratory descriptive design.Methods: Eight participant narratives were collected from Australian Registered Nurses (RNs), with 1-17 years of clinical practice in varied settings. Participants were required to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) and converse in English. Semi-structured interviews were undertaken via face-to-face, telephone and computer-mediated communication (CMC). Thematic analysis was guided by Braun and Clarke (2006).Results: Three themes emerged from the data: 'Perceptions: They don't talk about it, 'Stereotypes: Just that stigma and 'Provision of Care for STIs/DV: Physical and emotional. Participants held various perceptions associated with STIs and DV including the covert nature of both issues, the care of STIs within the context of DV, and how the nature of nursing care differed between STIs and DV.Conclusions: Nurses need to recognise the impact that nurse perceptions and stereotyping have on disclosures and provision of care for STIs, particularly in the context of DV. Consideration is also needed in relation to sexual and reproductive autonomy, the impact on disclosure and provision of care.

[Domestic Violence at the University Emergency Department Bern: A Retrospective Analysis from 2006 to 2016]

Domestic Violence at the University Emergency Department Bern: A Retrospective Analysis from 2006 to 2016 Abstract. Domestic Violence (DV) is considered as one of the largest medical risks worldwide. In Switzerland, DV is defined as offence requiring public prosecution since 2004. The present retrospective cohort study aims to investigate cases of DV in one of the largest Swiss emergency departments. The aggressors are predominantly male and either (ex-)partner or (ex-)husband of the victim. The head and the extremities are most often injured. Strangulation was documented in 16 % of the cases. Prevalence in our ED is very low with 0.07 % in 2016 (overall 0.09 % 2006-2016) and much lower compared with international data. We assume that we face many unreported cases and that victims are reluctant to seek medical help. Healthcare professionals should receive regular education in domestic violence, standards of care must be defined, and a sensitive and open-minded communication style is essential.

Exploring Receipt of HIV PEP Counseling Among Women Sexually Assaulted by an Intimate Partner

Among 136 women sexually assaulted by a current or former male intimate partner presenting to hospital-based violence treatment centers, 58 (42.6%) received HIV post-exposure prophylaxis (HIV PEP) counseling by a specially trained sexual assault nurse. We identified factors that were associated with receipt of HIV PEP counseling. Those who received counseling were more likely to have been younger than 25 years of age, single, a student, vaginally penetrated, and have received various other services (e.g., STI prophylaxis). They were less likely to have been unemployed. Hospital-based violence treatment centers need to be aware that not all women sexually assaulted by an intimate partner will have the same risk of acquisition of HIV and care needs.