Amey, A. L., & Bishai, D. (2002). Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey. Annals of Emergency Medicine, 39, 631-638.

According to CDC guidelines, victims of rape should be offered emergency contraception (EC) as well as screening and treatment for sexually transmitted diseases (STDs). The extent to which these treatments have been provided has not been assessed at a national level. This study offers a descriptive epidemiology of female rape victims receiving these particular services at emergency departments (ED) by drawing upon a nationally representative sample. These findings were then compared with CDC guidelines. Data was collected from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years spanning 1992 to 1998. Cases were deemed as receiving EC if women were administered or prescribed drugs from the national drug class 1040 (contraceptives). Women were considered to have obtained screening for STDs if they received urinalysis tests or specific CPT procedures. Furthermore, women were considered to have received treatment if they were given prophylaxis. Findings revealed 204 sexual assault cases from a total of 182,107 ED records available. Results indicated that 20% of women received EC, 36% were screened for STDs, and 23% were screened for HIV. Of those screened, only 34% received STD treatment. Women over 18 were twice as likely to receive STD screening and treatment than those younger than 18 years. Black women were significantly more likely to be screened for STDs and more likely to receive prophylaxis than White women were. The authors conclude that a significant number of victims of sexual assault are not receiving ED medical care as recommended by CDC guidelines and may be better served by hospitals with specialized programs for sexual trauma.

Topics: Effects; medical response; racial/ethnic differences

Azikiwe, N., Wright, J., Cheng, T., & D’Angelo, L. J. (2005). Management of rape victims (regarding STD treatment and pregnancy prevention): Do academic emergency departments practice what they preach? Journal of Adolescent Health, 36, 446-448.

This study examined the difference between institutional policy and practice concerning the role of emergency contraception (EC) and STD-screening for sexual assault cases in 85 emergency departments. Results showed that 60% of emergency departments screen for STDs. Additionally, 85.9% provide EC counseling, 87.7% administer the first dose in the emergency department, and 64.7% offer HIV postexposure prophylaxis (PEP). Interestingly, only 67.9% of emergency departments have an EC policy and only 55.3% have a nonoccupational HIV PEP policy. As such, the majority of academic emergency departments are apparently offering EC counseling, EC treatment, and HIV PEP to victims of sexual assault, despite the absence of institutional policies.

Topics: Medical response; treatment; victim services

Brecklin, L. R., & Ullman, S. E. (2002). The roles of victim and offender alcohol use in sexual assaults: Results from the National Violence against Women Survey. Journal of Studies on Alcohol, 63, 57-63.

This study drew upon information collected from the National Violence Against Women Survey (NVAWS) where 8,000 women were interviewed via telephone and screened for sexual assault experiences. Variables addressed included: the role of alcohol use by offender and/or victim, assault outcomes (i.e., rape completion, physical injury, and medical care), victim demographics (e.g., age, marital status and drinking in the past year), and assault characteristics (e.g., offender’s substance use and victim-offender relationship). Analyses focused on 859 incidents of sexual assault, given specific study criteria. As such, logistic regression analyses revealed that offender behavior predicted rape completion as well as victim injury and medical care outcomes. Specifically, the probability of a completed rape was twice as high when the offender had been drinking and the probability of victim injury was greatly affected by offender aggression. The authors conclude by outlining some of the limitations of their study and emphasize that rape prevention programs should focus on the problems of alcohol-related expectancies as well as situational factors inherent in sexual assault outcomes when alcohol was involved.

Topics: Alcohol; injury; medical response

Fitzgerald, M.M., Danielson, C.K., Saunders, B., & Kilpatrick, D.G. (2007).Youth victimization: Implications for prevention, intervention, and public policy. The Prevention Researcher, 14, 3-7. [Posted August 2007]

Key Points: Policies and practices are needed to minimize the harm of youth victimization by encouraging assessment, targeted prevention, and treatment interventions.  

Abstract: The authors review national prevalence rates of youth victimization, including: sexual, emotional or physical abuse; witnessing domestic or community violence; property crime; and excessive punishment. They note gender and race/ethnicity differences in prevalence rates as well as mental health effects. Specific recommendations for assessing risk and resiliency factors as well as screening for victimization in clinical settings are given. The authors discuss the importance of targeted interventions for specific groups, and urge adoption of an ecological model. Finally, the authors discuss how public and organizational policies can help decrease the impact of victimization and increase the availability of supportive services for youth and their families.

Topics: Adolescent/high school; effects; medical response; prevalence; prevention; racial/ethnic differences

 Heise, L., Ellsberg, M., & Gottemoeller, M. (1999). Ending violence against women. Population Reports, Series L, Number 11, 1-43.

This report provides an admirably thorough review of the various dimensions concerning violence against women across the globe. The authors begin by addressing the concept of gender-based violence, how health care providers can help, and what societal responses should entail in curbing the problem. The report discusses in detail the prevalence and ramifications of intimate partner abuse, sexual coercion, impact of violence on women’s reproductive health, threats to health and development, the role of health providers in recognizing and treating the effects of violence, and finally, an agenda for change. The report includes numerous charts presenting, for example, cross-cultural data on issues related to rates of approval of wife-beating and prevalence of forced first intercourse in various countries. The report also includes examples of posters used to educate women and increase awareness of the issues in different countries as well as several useful charts with instructions and guidelines for health care providers. This is an invaluable resource for anyone interested in understanding violence against women on a global level.

Topics: Community attitudes/responses; disclosure; effects; injury; male-female relations; marital rape; medical response; myths/stereotypes; perpetration; prevalence; prevention; racial/ethnic differences; risk; statistics; underserved populations; vulnerability

Jordan, J. (2001). Worlds apart? Women, rape, and the police reporting process. British Journal of Criminology, 41, 679-706.

In this study, 48 New Zealand women were interviewed about their experiences of reporting rape/sexual assault to the police. The reporting process was separated into four main areas of research; (a) initial contact and reporting, (b) medical examination, (c) statement-taking and interviewing, and (d) the case progress. The women interviewed reported an overall desire for the initial contact and reporting process to be more victim-centered. The medical examination process was reportedly satisfactory due to the caring and sensitive nature of the examiners. Dissatisfaction in the statement-taking and interviewing process was associated with the interviewing police officers’ lack of professional caring and respect for the individual victims. It was also associated with case outcome. Higher dissatisfaction with the process was associated with cases in which the offender was not detected or detected but not prosecuted. The women reported an overall desire to be informed about the realities of court proceedings in rape cases.

Topics: Disclosure; legal responses; medical response

Magid, D. J., Houry, D., Koepsell, T. D., Ziller, A., Soules, M. R., & Jenny, C. (2004). The epidemiology of female rape victims who seek immediate medical care: Temporal trends in the incidence of sexual assault and acquaintance rape. Journal of Interpersonal Violence, 19, 3-12.

The emergency department is an important source of information about sexual assault occurrence since victims of sexual assault usually go to the emergency department for medical assistance after being assaulted. This is a study comparing the number of female sexual assault victims treated in a Colorado county’s emergency department between July and November of 1974 and 1991. It was hypothesized that there would be a significant increase in the incidence of sexual assault between 1974 and 1991. As predicted, there was a 60% increase in sexual assault incidence with this increase primarily caused by an increase in sexual assaults involving known assailants. Moreover, victims in the emergency department reported more physical force and physical injury in 1991 when compared to 1974. Additional differences between study years (e.g., incidence of oral/anal intercourse during assaults as well as administration of pregnancy prophylaxis and antibiotics) are also presented. Implications of these findings concerning rates of acquaintance rape, reporting rates, and changes in treatment practices are discussed.

Topics: Injury; medical response; statistics

Resnick, H., Monnier, J., Seals, B., Holmes, M., Nayak, M., Walsh, J., et al. (2002). Rape-related HIV risk concerns among recent rape victims. Journal of Interpersonal Violence, 17, 746-759.

This article assesses the degree of fear and concern over contracting HIV during and after a rape assault. The study was conducted from July 1994 to September 1996. During this time researchers recruited 62 participants (ages 18 to 48 years) from postrape medical clinics. The initial interview was completed an average of 37 days after the incident and participants were paid $30 for their time and cooperation. Results of the study showed that 69.4% of those interviewed were raped by someone they did not know, 71% reported instances of verbal threats, and 82.3% feared being killed or injured during the attack. The study also revealed that 91.9% of those raped included vaginal penetration, 21.3% included oral penetration, and 9.8% included anal penetration. When participants were questioned about their fear of HIV, 69% reported being fearful during the rape that the assailant might have HIV and 92% were concerned about contracting the disease after the rape occurred. The most common reason for their concern (75.4%) over contracting HIV was that the assailant may have raped others. In addition, 64.9% reported that the assailant was a stranger. The results of this study and many others similar to it have shown us that women who are raped by a stranger are more likely to report concern about HIV than women who were raped by someone familiar to them. Of these victims, 82% reported interest in receiving more information about HIV during their postrape exam.

Topics: Effects; medical response; survivors

Schei, B., Sidenius, K., Lundvall, L., & Ottesen, G. L. (2003). Adult victims of sexual assault: Acute medical response and police reporting among women consulting a center for victims of sexual assault. Acta Obstetricia et Gynecologica Scandinavica, 82, 750-755.

The purpose of this study was to determine whether sexual assault victims who report to the police can be differentiated from those who do not report. One hypothesis holds that victims who suffer the most severe sexual assaults are more likely to report the assault to police. Through this reporting process, these victims are able to achieve access to needed medical care. The clinical records of 156 women who used a hospital-based sexual assault center during a 9-month period served as the data source. These standardized records included nurses’ intake forms, gynecologists’ medical records, and documentation from social workers and a psychologist. From these records, the following information was abstracted: demographics, sexual assault type, coercion type, place of the assault, the victim-perpetrator relationship, type of injuries (separate for genital area vs. other areas), alcohol or drug use by the victim and/or the perpetrator, and preventive medical treatment received by the victim. Results revealed that approximately 60% of the victims came to the center within 24 hours of the assault and these victims were much more likely to have reported to the police. While the type of sexual assault (e.g., attempt/genital contact and penetration offenses) did not influence police reporting, victims who were coerced through severe violence or restraint were more likely to report, as were victims who sustained extra-genital injuries. Reporting was also more likely if the perpetrator was a stranger whereas reporting was least likely if the perpetrator was a friend. In fact, this latter relationship was the only one to remain substantially associated to reporting after the other characteristics were controlled for. Finally, the rate of police reporting did not differ according to whether or not victims had received the preventive medical services of antibiotic prophylaxis or emergency contraception.

Topics: Disclosure; medical response; rape crisis centers

Sievers, V., Murphy, S., & Miller, J. J. (2003). Sexual assault evidence collection more accurate when completed by sexual assault nurse examiners: Colorado’s experience. Journal of Emergency Nursing, 29, 511-514.

Very few studies exist regarding the efficacy of evidence collection by sexual assault nurse examiners (SANEs). This study compared rape kits completed by SANEs and non-SANE personnel in the state of Colorado. The goal of this study was to determine if the kits collected by the SANEs were more complete and effective than those of their non-SANE trained counterparts. An audit process consisting of 10 questions used to evaluate the rape kits was developed by the Colorado Bureau of Investigation (CBI) and the Colorado Coalition Against Sexual Assault (CCASA), with the audit program implemented between October 1999 and April 2002. A total of 515 kits were audited, with 279 collected by SANEs and 236 collected by non-SANE personnel. As was expected, the SANE kits were more likely to have: completed the chain of custody, properly sealed individual specimen envelopes, labeled individual envelopes, collected the correct amount of pubic hair and head hair, included the appropriate number of blood tubes, collected the correct number of swabs, and collected a vaginal fluid slide. This study presents quantitative evidence that the specialized training and experience of SANEs enhance forensic evidence collection necessary for the prosecution of sexual assault cases.

Topics: Medical response; victim services

Updated 08/01/07