Care-seeking behavior by survivors of sexual assault in the Democratic Republic of the Congo

In February 2008, trained female interviewers collected data on sexual violence and use of medical services following sexual assault from 607 women in the Democratic Republic of the Congo (DRC). Exposure to sexual violence during the DRC's civil war was reported by 17.8% of the women; 4.8% of the women reported exposure to sexual violence after the war. Few sexual-assault survivors accessed timely medical care. Facility assessments showed that this care was rarely available. Clinical care for sexual-assault survivors must be integrated into primary health care for DRC women.     

Comprehensive medical care for victims of sexual assault: a survey of Illinois hospital emergency departments

BACKGROUND: Sexual assault is a major public health problem affecting 17 million women in the United States. Hospital emergency departments (EDs) are often the primary point of care for these women. We propose the concept of "comprehensive medical care management" (CMCM) at the primary point of care for victims of sexual assault. The objectives of this study were (a) to describe medical care services provided to sexual assault victims presenting at the EDs in Illinois hospitals, and (b) to identify the percentage of hospitals that always provide all 10 elements of CMCM. STUDY DESIGN: This is a cross-sectional prevalence study. A 14-item phone survey was administered to 187 eligible EDs in Illinois from July to September 2004. Outcome measures were the percentages of EDs that provide the elements of CMCM: (a) acute medical care; (b) history and physical exam; (c and d) acute and long-term rape crisis counseling; (e and f) prophylactic and therapeutic sexually transmitted infection (STI) management; (g and h) prophylactic and therapeutic HIV management; and (i and j) counseling and provision of emergency contraception. RESULTS: An 83% response rate of eligible emergency rooms provided the following data: while 100% of emergency rooms provide acute medical care upon presentation, two thirds provide rape crises counseling, two thirds provide STI management, 4 of 10 report counseling and provision of emergency contraceptives, and only 28.2% provide HIV management. About 1 in 10 (9.6%) provides all elements of CMCM. CONCLUSION: Although there are recommendations from various medical organizations for all 10 elements of CMCM for victims of sexual assault, very few hospitals provide CMCM. Improvements must be made to provide quality comprehensive care for victims of sexual assault.     

Rape attitudes amongst British medical students

OBJECTIVES: To examine the rape attitudes of a sample of 252 British medical students. DESIGN: A 20-item questionnaire was used. SETTING: A London medical school. SUBJECTS: Fourth-year medical students. RESULTS: In general, students were well informed on legal and factual issues regarding rape and sexual assault. However, significant differences were found in the attitudes to rape between males and females. Female students were significantly more positive in their responses to victims. CONCLUSIONS: These results support findings from previous studies of rape attitudes in other professional groups. Better knowledge and enlightened attitudes amongst health care staff can have a significant impact on the management of sexual assault and influence the likelihood of victims presenting for treatment. In conclusion, this study emphasizes the importance of teaching about sexual violence in British medical schools.     

Asking patients about violence: a survey of 510 women attending social and health services in Trieste,Italy

Violence against women is frequent, and has serious consequences for their physical and mental health. Until now, a common response of health services and professionals to victims has been the denial of the violence. The aims of this study were to estimate the prevalence of present and past violence among women attending social and health services in Trieste (Italy) for any reasons, and to evaluate the feasibility of asking them about violence. Five public health care facilities were involved: a hospital-based Emergency Department, two "Consultorio Familiare", and two community-based Social service centers. The final sample consisted of 510 women; the response rate among eligible women was 76% across all facilities. The study revealed a high prevalence of different kinds of violence, mostly perpetrated by men well known to the victim. Among the women interviewed, 10.2% had experienced physical/sexual violence in the last 12 months, regardless of perpetrator. Violence by a male partner or former partner, occurred in 6.4% of women; by other relatives, 1.6% of women; and by "other" persons 3.3% of women. The results demonstrated the feasibility of "asking about violence" in all cases; moreover, those women who had been abused were often eager to talk about it. A systematic approach to the issue of violence is a necessary condition for responding appropriately to the needs of women who have experienced or are experiencing violence. Nevertheless, to avoid the replication of a common bias against victims of violence, health and social personnel should be appropriately trained before "asking all cases" becomes a policy within health and social services.     

Comprehensive care program for sexual violence victims in Escuintla, Guatemala

We implemented a comprehensive care program for sexual violence victims in six municipalities of Escuintla. Sexual violence victims received both medical and psychological care. Clinical and epidemiological information relevant to the sexual violence event was collected. Samples were taken for sexually transmitted infections (STIs), HIV, and pregnancy testing. In two years, 164 sexual violence victims were attended: 111 (67.6%) were under 18 years old, 91 (64.5%) were females and 20 (86.9%) were males, and the mean age was 12 and 8.3 years, respectively. The most frequently reported type of sexual violence was vaginal and/or anal penetration in 69.9% of cases. In 30.5% of cases the assailant was a stranger. We identified 11 cases of STIs. The project was able to influence national policy through active participation in the development of a national protocol for the care of sexual violence victims. Activities to promote gender equity and child protection should be intensified.     

Partner violence and medical encounters: African-American women's perspectives

OBJECTIVE: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Community-based, primary care center. PATIENTS: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter. MEASUREMENTS: Patients' perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV "in the past year." RESULTS: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers. CONCLUSIONS: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Partner violence and medical encounters: African-American women’s perspectives

Objective: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population.Design: Cross-sectional, self-administered, anonymous survey.Setting: Community-based, primary care center.Patients: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter.Measurements: Patients’ perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV “in the past year.”Results: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers.Conclusions: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Gender and physical violence

This study examines incidents of physical violence in relation to the sex of both assault victim and attacker. A survey of all assault victims attending an urban accident and emergency department (AED) in Norway during a 2-year period was carried out. All the assault victims were interviewed using a structured questionnaire administered by the attending physician as part of the initial consultation at the AED. During this interview, information about the victims, the attackers and the assaults was collected from the victims. Information on the sex, age, alcohol state of victims, and any referral to hospitals and specialists, was collected from the victim's medical notes at the AED. The severity of the victim's injuries was rated retrospectively using Abbreviated Injury Scale (AIS) and Shepherd's Injury Severity Scale for rating of injuries of assault. A total of 1234 men (74%) were attacked by other men, 354 women (21%) were attacked by men, 33 men (2%) by women, and 59 women (4%) by other women. The characteristics of the assaults carried out amongst female victim-female attacker and male victim-male attacker groups had many similarities. The same was found for the female victim-male attacker and male victim-female attacker groups. We conclude that changes in the traditional behaviour associated with women and men in relation to physical violence may be taking place.     

Repeated sexual victimization and trauma change during the acute phase of the sexual assault trauma syndrome

Victimization studies indicate that the risk of sexual assault is significant for women in America today and that sizable numbers of women are sexually assaulted more than once during their lives. This study proposed and tested alternative hypotheses about repeated sexual victimization and trauma change during the acute phase of the sexual assault trauma syndrome. Panel interview data were collected during a two-year period on 184 female victims (14 years and older) admitted to a sexual assault treatment center for initial and follow-up services. Controlling for initial trauma level and time between assessments, prior assault victims were more traumatized than first assault victims at follow-up. Prior and first assault victims had different patterns in short-term trauma change, with only the first assault victims decreasing in trauma. Prior mental health or substance abuse problems partially explained the observed effect of prior sexual assault on trauma change. Prior sexual assault, however, continued to affect trauma significantly in the condition where the repeated assault victim also had prior mental health or substance abuse problems at the time of the current assault.     

Domestic violence and sexually transmitted diseases: the experience of prenatal care patients.

OBJECTIVES: The authors analyzed interview responses of patients at a prenatal care clinic to explore whether women who had been victims of sexual and physical abuse were more likely than non-victimized women to have experienced a sexually transmitted disease (STD). METHODS: A consecutive sample of 774 prenatal patients of a large health department in North Carolina were interviewed concerning a variety of health issues, including violence and STDs. Logistic regression analysis was used to model the women's STD status as a function of their experiences of sexual and physical abuse, controlling for several potentially confounding factors. RESULTS: Thirty percent of the women reported having experienced at least one STD, with the most common infections being chlamydia and gonorrhea. Twenty-eight percent of the women reported having been victims of abuse; 16% reported physical abuse only, while 12% reported both physical and sexual abuse. The majority of violence was domestic in nature, perpetrated by the victims' husbands, boyfriends, male friends, and relatives. After controlling for confounding variables, the authors found that women who reported both physical and sexual abuse were significantly more likely to have experienced STDs than non-victims (odds ratio [OR] = 2.25; 95% confidence interval [CI] 1.37, 3.69). The logistic regression analysis also showed a relationship of borderline statistical significance between non-sexual physical abuse and STDs. CONCLUSIONS: Health care providers should routinely screen patients for both abuse and STDs, and they should assist identified women in accessing appropriate health, social, and legal services.     

Sexual assault in Virginia: A population-based study.

PURPOSE: Sexual assault is a serious social problem that affects the lives of many women, men, and children. Most sexual assaults are not reported to authorities and most victims do not seek services. As a result, accurate statistics on the prevalence and incidence of this problem are difficult to obtain. As in many states, the magnitude of sexual assault in Virginia is not known. This study was conducted to estimate the prevalence and determine the correlates of sexual assault among women in Virginia. METHODS: A cross-sectional telephone survey was conducted among adult female residents of Virginia between November 2002 and February 2003. A total of 1,769 women aged 18 and older were interviewed using a random digit dialing method. RESULTS: The lifetime prevalence of sexual assault in Virginia was 27.6%. The majority (65%) were rape victims with a prevalence of 17.8%. Approximately 78% of the victims reported that the sexual assault occurred for the first time when they were children or adolescents. Women who reported sexual assault were more likely to be between 35 and 44 years old (OR = 3.57; 95% CI = 2.06-6.15), divorced/separated/widowed (OR = 1.61; 95% CI = 1.13-2.30), consume alcohol four or more times a week (OR = 1.80; 95% CI = 1.01-3.21), ideate suicide (OR = 4.48; 95% CI = 3.23-6.23), and perceive their health status to be poorer (OR = 2.74; 95% CI = 1.30-5.83). CONCLUSION: Sexual assault is a major public health problem in the Commonwealth of Virginia and children are disproportionately affected by the problem. Interventions and prevention programs should focus on children and adolescents.     

Sexual assault among North Carolina women: prevalence and health risk factors

STUDY OBJECTIVE: Sexual assault is traumatic at the time it occurs, but it also may have longlasting negative effects on physical health. Much of the research linking specific health problems to sexual assault victimization has used samples from special populations. The goals of this study are to estimate the prevalence of sexual assault in a representative sample of women in North Carolina and examine sexual assault in relation to specific health risk factors for leading causes of morbidity and mortality in women. DESIGN: The North Carolina Behavioral Risk Factor Surveillance System (BRFSS) is a household telephone survey of non-institutionalised adults, 18 years of age and older, conducted by random digit dialling. SETTING: This investigation focuses on the study participants in the 1997 survey. PARTICIPANTS: The sample includes 2109 women who responded to the sexual assault questions in the 1997 North Carolina BRFSS interview. MAIN RESULTS: The lifetime prevalence of sexual assault was 19% (95% CI 17% to 20%), of which 73% of victims experienced or were threatened with forced sexual intercourse. Sexual assault victims, particularly victims of forced intercourse or the threat thereof, were more likely to perceive their general health as being fair or poor (OR=2.3, 95% CI 1.5 to 3.4) and were more likely to have suffered poor physical and mental health in the past month (poor physical health, OR=2.1, 95% CI 1.6 to 2.8; poor mental health, OR= 2.6, 95% CI 1.9 to 3.5). After controlling for sociodemographic factors and health care coverage, victims of forced intercourse or the threat thereof were more likely to smoke cigarettes (OR=2.0, 95% CI 1.4 to 2.8), to have hypertension (OR=1.5, 95% CI 1.1 to 2.2), to have high cholesterol (OR=1.7, 95% CI 1.2 to 2.5), and to be obese (OR=1.7, 95% CI 1.3 to 2.4). CONCLUSIONS: This study shows associations between sexual victimization and health risk factors in a non-clinical statewide population of women. Future research should determine whether clinically screening for and identifying a history of sexual victimization among women seen in a variety of health care settings leads to the initiation of effective interventions that help women successfully cope with these violent experiences. There is also a need for further research to investigate the temporal sequence of assaults and subsequent health outcomes by assessing physical health status before and after victimization.     

Violence against Canadian Women

HEALTH ISSUE: Exposure to violence as children or as adults places a woman at higher risk of poor health outcomes, both physical and psychological. Abused women use more health care services and have poorer social functioning than non-abused women. Knowledge of the prevalence of violence against women, and of which women are at risk, should assist in the planning of services for abuse prevention and treatment of the health consequences of abuse. KEY FINDINGS: The highest rates of any partner violence were in Alberta (25.5%) and British Columbia (23%). The lowest rates were in Ontario (18.8%). Women aged 15-24 had the highest rates in all regions in Canada, compared with older women. Aboriginal women in Manitoba/Saskatchewan and Alberta had higher rates of violence (57.2% and 56.6% respectively) than non-Aboriginal women (20.6%). Lower rates of partner-related violence were reported among women not born in Canada (18.4%) than among Canadian-born women (21.7%). Visible minority women reported lower rates of lifetime sexual assault (5.7%) than non-visible minority women (12.3%). Perceptions of violence may vary by ethnicity. DATA GAPS AND RECOMMENDATIONS: More information is required concerning the prevalence of violence among Aboriginal women, immigrant and refugee women, women with disabilities, lesbian women and pregnant women. Future national population-based surveys need better questions on the health consequences of violence and related resource utilization. Further research is needed to identify the health care system's role in prevention, management and rehabilitation as they relate to violence against women. Future programs and policies must be based on valid, reliable and comprehensive empirical data.     

广州市两所医院工作场所暴力现象调查

目的 了解医院工作场所暴力的发生现况并分析其原因,为维护医院正常工作秩序提供依据。方法 调查广州市2所三级甲等医院的卫生工作人员2001年10月至2002年10月中遭受工作场所暴力的情况。工作场所暴力事件的判断标准是,卫生工作人员本人在上述调查时间的1年中,在医院场所遭遇到心理暴力和(或)身体暴力。结果 1043名被调查者在1年中有678人遭受过工作场所暴力,以个人为单位,发生率为65．0％,以心理暴力为主。医生比护士更容易受到暴力威胁,发生率分别为70．3％和67．7％。30～39岁年龄段、工龄为11～20年的医院工作人员发生率最高。男性(11．7％)比女性(5．3％)更容易遭受身体暴力,但心理暴力和性暴力在性别上均差异无显著性。护士和护士助理最容易遭受性暴力。患者家属(64．2％)与患者本人(50．0％)是主要的肇事者,以患者家属为主。没有满足肇事者要求、患者病情无好转或患者自认无好转是发生工作场所暴力的主要原因。结论广州市医院工作场所暴力多发,必须引起重视,实施以法律与教育为主导的综合干预措施,以维护医院的正常工作秩序。     

Violence and HIV Sexual Risk Behaviors Among Female Sex Partners of Male Drug Users

SUMMARY

Objective: Violence and HIV are emerging as interconnected public health hazards among drug users and their families. The purposes of this study are to (1) determine the prevalence of sexual and physical abuse of non-drug-using female sex partners of male drug users, and (2) ascertain the association between such violence and HIV-related risk behaviors. Methods: From 11/93 to 11/95, 208 female sex partners of injection drug or crack users in Collier County, FL, Tucson, AZ, and Portland, OR, were interviewed as part of a NIDA-funded HIV risk reduction project. Their mean age was 30 years (range 18–54); 21% were White, 6% African American, 7% Native American, and 63% Hispanic. Results: Of the 208 women, 28% reported being sexually molested and 20% raped before age 13; 41% reported being raped at least once in their lifetime. Forty-two percent of the women were physically assaulted by their sex partners; 36% had been threatened with assault by their sex partners. Those who were raped or threatened with assault were more likely to have multiple sex partners and engage in unprotected anal sex; there was a trend for women who had been physically assaulted to be more likely to engage in unprotected anal sex. Discussion: Rape, assault and the threat of assault are commonplace in the histories of female sex partners of male drug users. Experiences of violence and threats of violence are associated with heightened risk for the sexual transmission of HIV. Providers of HIV prevention need to understand the sequelae of violence, and design interventions which empower women to protect themselves from sexual transmission of HIV.     

Prevalence of violence and its implications for women's health.

This study estimates the lifetime prevalence of violent experiences and their relationship to health and the use of health services in U.S. women aged 18-64 years. The Commonwealth Fund's 1998 Survey of Women's Health provides a nationally representative sample. Use of weighted data allows projections to be made to the U.S. population. Over four of ten women in the U.S. are likely to have experienced one or more forms of violence, including child abuse (17.8%), physical assault (19.1%), rape (20.4%), and intimate partner violence (34.6%). In multivariate logistic regression models that control for sociodemographic characteristics, violence-particularly intimate sexual violence-is significantly related to poorer physical and mental health and increased problems with access to medical care. Only one-third of women who experience violence have discussed it with a physician. Health care professionals need to initiate the conversation about violence and offer referrals for needed services.     

大学校园暴力发生情况及危险因素分析

目的探讨大学校园暴力的发生情况及相关危险因素。方法以某省两所高校大学生为调查对象，对一年来校园暴力发生情况及相关因素进行匿名问卷调查。分析各类型暴力的发生率，并用多因素logistic回归分析暴力发生的危险因素。结果（1）共发放问卷5300份，得到有效问卷3910份，应答率73．77％。3910人中最近一年内发生校园暴力者703人，发生率为17．98％。其中，男生发生率为29．60％，女生发生率为7．27％。男生发生率高于女生（x^2=329．89，P=0．000）。（2）一年来男生受暴力发生率为28．00％，女生为7．27％。各受暴力类型中，威胁、勒索、情感虐待、躯体攻击、语言的性骚扰、躯体的性骚扰发生率，男生分别为18．03％、13．97％、10．77％、085％、0．48％；女生分别为3．64％、5．84％、1．38％、1．33％、1．13％。暴力来源主要为校内同学。（3）一年来男生施暴他人发生率为10．40％，女生为1．47％。施暴对象主要为校内同学。（4）多因素logistic回归分析结果表明，吸烟、饮酒、经常上网是遭受暴力（OR值分别为1．48、2．96、1．66）和施暴他人（OR值分别为2．92、1．88、2．09）的危险因素。结论大学校园暴力的发生率很高，一些危险因素也不容忽视，应积极采取干预措施预防校园暴力的发生。