The theme of the 2019 National Sexual Assault Conference—Beyond the Breakthrough—sought to inspire the collective movement to end sexual violence and build on the momentum of the #MeToo movement. Ms. was the media sponsor for the conference—and expanded the discussions happening on-site with this dedicated series. Click here to read more posts. You can also watch interviews and conference sessions from #NSAC2019 on the Ms. Facebook!
Jennifer Pierce-Weeks, RN, SANE-A, SANE-P, is the Chief Executive Officer at the International Association of Forensic Nurses. jpw@forensicnurses.org
In much the same way that Nicole Brown Simpson’s murder drew domestic violence out of the shadows two decades ago, the #MeToo movement is shining a spotlight on sexual violence. Stories and experiences that were once discussed privately in hushed tones have now become a society-wide conversation.
Amid this new collective awareness, it is critical to consider the role health care can, and must, play in recovery from sexual assault.
When thinking about sexual assault and health care, many people immediately think about “rape kits”—sexual assault evidence collection kits, or boxes. While such a kit is critical for collecting evidence, it’s one small part of a comprehensive sexual assault medical forensic exam that looks at a patient’s total, overall healthcare needs following a sexual assault. Without an equally comprehensive response on the part of law enforcement and prosecution, it serves little purpose.
In communities that have prioritized trauma-informed treatment of victims of violence, specially trained forensic nurses, referred to as Sexual Assault Nurse Examiners (SANE), perform medical forensic exams with knowledge, compassion and expertise. These nurses ensure that the exam avoids re-victimization, and that patients are fully informed. Consent for the exam and all its components is a process that involves more than a signature on a form; the patient is consulted at each step, and the exam only proceeds with the patient’s consent. The nurse also provides the patient with information about options for services, reporting and resources.
Regardless of whether patients want to have evidence collected, it is critical that they seek health care. A host of health consequences are associated with sexual assault, including physical injury, pregnancy, sexually transmitted diseases and HIV, depression, anxiety and suicidal ideation. Some patients experience strangulation during the assault, which can inflict hidden internal injuries that can cause long-term health consequences or even death.
But health care for victims of sexual assault also doesn’t stop immediately after the assault. Whether the assault occurred in 1989 or 2019, it’s never too late to seek STD testing. Some STDs are asymptomatic, and a test is the only way to identify and treat them before they cause health complications, such as infertility. Other healthcare needs may include ongoing counseling or therapy to address the short- and long-term effects of the trauma. It’s never too late to seek help from advocates with the emotional recovery that every patient deserves in the aftermath of sexual violence.
The statistics show us that sexual violence is not stopping. Survivors—women, men and children—tell us sexual violence is not on the decline. But society’s awareness and acceptance of it has changed, and a new generation of voices is ensuring the conversation about ending violence and ensuring justice for survivors remains front and center.
With this chorus of voices comes the expectation that health systems step up and acknowledge the pivotal role they play in caring for survivors. More health systems than ever before are establishing forensic nursing programs to properly care for patients who have experienced sexual and relationship violence. More healthcare providers are asking their patients about the role violence has played in their life and health, and more patients are disclosing their assault histories—in emergency rooms, pediatricians’ offices, urgent care clinics, primary care offices, maternity wards and even dental offices.
The truth remains: Anyone can experience trauma, and everyone in every community deserves a trauma-informed response. Advocates must put the emotional and physical needs of the survivor at the center of their response. The criminal justice system must prove that the system really can work to hold offenders accountable, and to minimize re-traumatizing survivors who report. And health systems must be designed to meet the healthcare needs of the survivor—whether or not evidence collection is part of the equation.
