"The unheard adversity": the lived experiences of socially isolated survivors of wartime sexual assault.

BackgroundSexual abuse and sexual assault are complex phenomena that involve many factors (or correlates) and have many health and financial implications for individuals, families, and society. Every correlate needs to be studied in detail, individually and in relation to other correlates. Only with a thorough understanding of these correlates can more efficient and targeted prevention and intervention programs be designed.ObjectiveThe purpose of this study was to examine the differences between male and female survivors of sexual abuse and sexual assault regarding the correlates of the survivors’ age of onset of assault, age at the last assault, and age at which they entered therapy.MethodsTherapists at eight sexual assault centers in the province of Alberta, Canada, completed a questionnaire on each of their clients over a period of 7 years. A total of 3302 participants, of whom 2901 (87.86%) were female and 401 (12.1%) were male survivors of sexual abuse and assault, were included in this study. Mostly descriptive analyses were carried out on the 4 variables of concern in this study.ResultsRegarding the number of survivors who sought therapy, female survivors outnumbered male survivors by a ratio of 7:1, with different ratios for different age groups. As children age, their risk of being sexually assaulted for the first time decreases. Male children are more likely to be sexually abused at a younger age, whereas female children are more vulnerable to being assaulted at all ages, particularly in adolescence. The mean age of onset of sexual abuse was found to be 6.71 (SD 2.86) years, and the odds of experiencing the first sexual assault during childhood, as opposed to adolescence, were 4:1 for females and 9:1 for males. Male survivors were two times more likely than female survivors to experience their first sexual assault in childhood. The vast majority of survivors sought help many years after being sexually assaulted, and male survivors waited an average of 3 years longer from the last sexual assault before seeking therapy.ConclusionsThe majority of survivors of sexual abuse and sexual assault live with the consequences for many years before they seek help, and a large proportion of male survivors are not likely to seek help.

Evaluation of documentation practices of sexual assault nurse examiners

This study employed a mixed-methods design to examine victim service barriers on local and state levels for Black/African-American (AA) sexual assault (SA) survivors. Victim-serving organizations (VO, n = 22) across a state-wide SA coalition were surveyed along with non-victim organizations (NVO, n = 26) that serve Black/AA clients/individuals (e.g., public service agencies/churches) in a local urban area. Survey findings highlight the most critical barrier was fear and mistrust of the legal system. Other significant barriers included: fear of perpetrator retaliation, cultural disclosure norms, lack of service awareness and transportation, mismatch between survivor-provider demographic characteristics, and survivor shame/stigma. In addition, a focus group (n = 8) of Black/AA SA survivors, VOs, and NVOs was conducted in response to the survey findings. Thematic analysis indicated a multi-system approach across individual, organizational, and system levels was necessary to effectively impact barriers and improve access for Black/AA SA survivors. Lessons learned include the importance of cultural context and relevance in offering organizational services for victimized marginalized populations. Such knowledge may be translated into prevention and intervention efforts to improve services. Recommendations for future inquiry include replicating this study by using larger sample sizes that include Black/AA SA survivors and evaluating the effectiveness of the recommendations offered in this study.

Author: Mary Simmerling, University of Chicago, mcs@uchicago.edu Goal. To determine the incidence of sexual assault (SA) within the community and to do a needs assessment for SA survivors in the community. The study will use random digit dialing (RDD) to households in the community. The research assistants working on the project will ask the person who answers the phone if she may speak to any females in the home over the age of 18. If there are any qualifying subjects in the home, they will be invited to participate in a 45 minute survey about their experience(s) of violence in the community. The survey will include demographic questions, specific questions about SA experience(s), and the subjects’ help-seeking behavior and post-assault needs. Study methods include completing a survey questionnaire about the survivor participant’s sexual assault experience(s), and participating in an in-depth interview that focuses on general life history as well as specific information about the sexual assault(s). Ethical and scientific justification. There is alleged to be a high incidence of SA that is never reported to the police or others. Consequently, it is difficult to gauge the actual incidence of SA within a community. This study would gauge the incidence of SA in the community, and assess the needs of SA survivors. RDD permits representative sampling that will help to inform estimates of actual incidence as well as the needs of non-reporting and reporting SA survivors. SA survivors who do not come forward to report their assault may also be less likely to self-select to participate in research in this topic. The use of RDD may help to identify and include those survivors in this type of research. The use of RDD may also allow for increased privacy protection for participants who may not be comfortable participating in face-to-face interviews on this topic. Ethical objections or barriers. Asking survivors to recall their assault experiences may be re-traumatizing for them, cause emotional distress, and leave them worse off in terms of their recovery (e.g., may exacerbate PTSD). This may be particularly pronounced in research that utilizes RDD in which subjects are not self-selecting as they would be in the case of advertisements for participants in such a study. Although the use of RDD allows for the inclusion of non-reporting SA survivors who may not otherwise come forward to participate, it may be experienced as an invasion of privacy by these individuals. The use of RDD to reach out to non-reporting SA survivors may result in their first disclosures being to the researchassistant interviewers. This may be very distressing to subjects whose first disclosure might better be to a trained counselor. As “vulnerable subjects” survivors need to be protected from risks such as shame, stigma, and emotional distress. Also, they may have “limited autonomy” and so not be positioned to choose freely whether to participate and if so to what extent. Suggested empirical questions:

Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.

BackgroundRecent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment.ObjectiveThis study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both.MethodsPhase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance).ResultsSix themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant’s favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations.ConclusionsOverall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.

Confronting Sexual Assault: Transformative Justice on the Ground in Philadelphia

Cross-sectional studies have shown that chronic musculoskeletal pain and somatic symptoms are frequently reported by sexual assault (SA) survivors; however, prospective studies examining pain and somatic symptoms in the months after SA have not been performed. Women SA survivors 18 years of age or older who presented for care within 48 h of SA were recruited. Pain in eight body regions (head and face, neck, breast, arms, abdomen, back, genital and pelvic, and legs) and 21 common somatic symptoms (e.g., headache, nausea, insomnia, persistent fatigue) were assessed (0-10 numeric rating scale in each body region) at the time of presentation, 1-week, 6-week and 3-month interview. Post-traumatic stress disorder (PTSD) symptoms were assessed at the 6-week and 3-month interview. Clinically significant new or worsening pain (CSNWP) symptoms were common among study participants 6 weeks after SA [43/74, 58% (95% CI, 47-69%)] and 3 months after SA [40/67, 60% (95% CI, 48-71%)] and generally occurred in regions not experiencing trauma. Women SA survivors also experienced an increased burden of many common somatic symptoms: 8/21 (38%) and 11/21 (52%) common somatic symptoms showed a significant increase in severity 6 weeks and 3 months after SA, respectively. Correlations between PTSD, CSNWP and somatic symptoms were only low to moderate, suggesting that these outcomes are distinct. New and/or clinically worsening pain and somatic symptoms, lasting at least 3 months, are sequelae of SA. Further studies investigating pain and somatic symptoms after SA are needed.

(101) Using Quantitative Sensory Testing to Assess the Pain System in Sexual Assault Survivors

While tonic immobility (TI) is a phenomenon well known and documented in the animal world, far less is known about its manifestation in humans. Available literature demonstrates that TI is significantly associated with less hopeful prognoses when compared with survivors who did not experience TI (Fiszman et al., 2008; Heidt et al., 2005). If survivors who experience TI are at increased risk for "depression, anxiety, posttraumatic stress disorder (PTSD), and peritraumatic dissociation" (Heidt et al., 2005, p. 1166) and respond more poorly "to standard pharmacological treatment for PTSD" (Fiszman et al., 2008, p. 196), the implications for treatment are significant, suggesting that TI "should be routinely assessed in traumatized patients" (Fiszman et al., 2008, p. 193). Literature indicates that "TI is thought to be particularly relevant to survivors of rape and other sexual assault" and that "sexual assault is a trauma that appears to entail virtually all of the salient elements associated with the induction of TI in nonhuman animals, namely, fear, contact, and restraint" (Marx et al., 2008, p. 79). Describing the phenomenon as it is experienced by survivors is especially important because the ability to accurately understand and describe the nature of the phenomenon is the first step toward accurately identifying, diagnosing, and treating the sequelae of such a response. This study examines the experience of TI from the perspective of 7 women who survived a sexual assault accompanied by tonic immobility using qualitative phenomenological methodology, and yields a description of the core defining themes of the experience of TI.

Journal of Gynecologic SurgeryVol. 16, No. 4 Antibiotics in GynecologySexual Assault: Infection ProphylaxisNewton G. OsborneNewton G. OsborneSearch for more papers by this authorPublished Online:6 Jul 2004https://doi.org/10.1089/10424060051069697AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Sexual Assault: Infection Prophylaxis." , 16(4), pp. 169–170FiguresReferencesRelatedDetailsCited byObstetric and Gynecologic Infections Newton G. Osborne6 July 2004 | Journal of Gynecologic Surgery, Vol. 17, No. 3 Volume 16Issue 4Dec 2000 To cite this article:Newton G. Osborne.Sexual Assault: Infection Prophylaxis.Journal of Gynecologic Surgery.Dec 2000.169-170.http://doi.org/10.1089/10424060051069697Published in Volume: 16 Issue 4: July 6, 2004PDF download

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.

377 The Association Between Post-Assault Physical Appearance and Behaviors in the Emergency Department and Assault Types

Objective: College sexual assault (SA) survivors tend to underutilize university resources in favor of reporting to family or friends. The current study assessed prevalence and SA disclosure themes and patterns amongst college students. Participants: Data obtained from a campus sexual violence climate survey included 3,398 students. Method: Quantitative and qualitative data examined SA prevalence, themes of disclosure, and knowledge of university resources. Results: Although participants indicated potential utilization of university resources in the event of SA, most survivors reported disclosing to family and friends, while those who had not experienced SA indicated that they would disclose to police or campus programs. Reasons for non-disclosure to university resources among SA survivors included minimization of the SA experience and discomfort with the reporting process. Conclusions: Results demonstrate the need for universities to involve peers and families as additional sources of support for SA survivors, and the need to address barriers to reporting.

Introduction: Becoming pregnant from sexual assault is a significant concern for survivors of sexual assault and survivors of different ages, social, cultural and religious backgrounds may have varying feelings regarding acceptable treatment options (Safeta, 2019). Pregnancy resulting from sexual assault is a multidisciplinary issue which associates health care practitioners, legal services, community and societal systems. The World Health Organization, (2013) guidelines for sexual gender based violence makes provision for immediate care of rape victims within 72 hours, that is, free medical and psychological care, post exposure prophylaxis, treatment of sexually transmitted infections, contraceptive pills and legal support, but few victims seek care (Resnick,2013) resulting in unwanted pregnancies and their traumatic sequelae. This study explored lived experiences of survivors of sexual assault who became pregnant and sought care at Mutare provincial hospital to identify gaps for possible improvements in delivery of comprehensive care. Methodology: A phenomenological qualitative approach was employed for an exploration of lived experiences of survivors of sexual assault who become pregnant. Purposive sampling was used to draw a sample of ten survivors of sexual assault who became pregnant. A thematic approach was used to explicate data from the study. Findings: Five themes emerged from the study findings. The three which are unstable family environment; low socio-economic status; and low education and empowerment as risk factors to sexual assault and pregnancy as well as negative outcomes. Two themes related to decision making and outcomes implicated on existing environments as well as strengths and gaps in service provision. Conclusion: The overall discussion was occurrence of sexual assault facilitated by unfavorable victim environment, late disclosure and missing emergency medical care resulting in pregnancy and psychological distress connected to inadequate care and unresolved socio-demographic issues. Therefore, the study recommends policy level address of detected risky factors and training of multidisciplinary care teams.