Jan Welch

Rape and sexual assault

Sexual violence is a global problem. The lifetime risk of attempted or completed rape is up to 20% for women, but men and children are also often sexually violated.1 Sequelae include unwanted pregnancies; sexually transmitted infections, including HIV; depression; and post-traumatic stress disorder. Most of the literature on rape and sexual assault is retrospective, but we aim to provide an evidence based review of their management. #### Summary points #### Sources and selection criteria We searched Medline using the term “sexual assault”. We also took account of the Cochrane review of interventions for emergency contraception and for trauma related symptoms and the prevention of post-traumatic stress disorder. Guidance from the National Institute for Health and Clinical Excellence and national and World Health Organization guidelines were also considered. We searched our personal archives of references and consulted experts. Anyone can be sexually assaulted but some people are especially vulnerable, such as adolescents and young women, people with disabilities, poor and homeless people, sex workers, and those living in institutions or areas of conflict.1 Consumption of alcohol is commonly linked with sexual assault,2 although covert administration of drugs …

Multiple Perpetrator Sexual Assault How Does It Differ From Assault by a Single Perpetrator

Research that attempts to identify characteristic features of multiple perpetrator sexual assault (MPSA) is limited. This study compared demographic and assault related characteristics of 135 cases of MPSA with 139 cases of single perpetrator sexual assault (SPSA) reported to the Haven sexual assault referral centre, Camberwell, London, over a 4-year period, and aimed to identify any unique features of MPSA victims, perpetrators and assault type. Victims of MPSA were younger, less likely to be White, more likely to report previous self-harm and more likely to sustain injuries than victims of SPSA. Multiple perpetrators were younger, less likely to be White and more likely to be strangers to the victim than single perpetrators. The nature of the assault was different in single and multiple perpetrator cases; in MPSA, there were more completed rapes and more multiple rapes, and perpetrators were more likely to meet the victim in an outside location before carrying out the assault in a place of residence that was not the victim’s. These findings add to a scant but growing evidence base.

Preferred choice of gender of staff providing care to victims of sexual assault in Sexual Assault Referral Centres (SARCs)

BACKGROUND A Sexual Assault Referral Centre (SARC) is a model of service developed in the UK to provide immediate medical care, forensic and after care services for the victims of serious sexual assault. National guidelines recommend female medical staff for victims of serious sexual assault, although there has been few studies specifically undertaken to ask victims themselves about their choice of gender of staff in a SARC. OBJECTIVE To collect feedback from victims about their preferences for staff gender within SARCs as a means of informing recruitment policy. METHODS Three SARCs participated in the study; two in London and one in Manchester. Clients over the age of 16 years (with no vulnerability) were asked to complete a questionnaire about their preference for gender of staff providing forensic examination and care. RESULTS Most victims (76.8%, male and female) preferred SARC staff to be female. Almost 100% of victims would continue with the examination if carried out by a female doctor, whereas 43.5% of victims said they would not if the doctor were male. CONCLUSION SARCs should continue to consider female staff as the primary gender of staff providing services, as part of their recruitment policy, within the realms of employment law.

Care of HIV-positive women aged 50 and over – can we do better?:

A sample of 123 HIV-positive women aged 50 years and over showed high rates of late diagnosis with CD4 count <350 (71%), significant co-morbidities (90%), high rates of premature menopause (6.8%) and early menopause (6.8%) and cervical cytological abnormalities (47%). Specific interventions to improve care in this group should include yearly cervical cytology, early counselling with regard to reproductive options, menopause management and screening for sexually transmitted infections (STIs).

Contraception and medical gynaecology for HIV-positive women in a one-stop clinic.

HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.

Medical care following multiple perpetrator sexual assault: A retrospective review

This paper describes the healthcare needs of victims of multiple perpetrator sexual assault (MPSA) and single perpetrator sexual assault (SPSA) presenting to the Haven sexual assault referral centre in south-east London, and aims to identify any characteristics that might be related to attendance at follow-up appointments. We reviewed standardised casenotes of 136 MPSA victims and 139 SPSA victims attending for forensic medical examination (FME) between 1 July 2005 and 31 July 2009. MPSA victims reported a higher rate of stranger assaults, higher rates of vaginal, anal and oral rapes, more rapes at multiple anatomical sites or multiple rapes and were more likely to sustain injuries, all of which put MPSA victims at higher risk of subsequent health problems. Rates of attendance at follow-up appointments were low for all (53.5%) as were rates of completion of post-exposure prophylaxis (PEP) for HIV (33.3%). Attendance at follow-up was associated with presence of anogenital injury at the time of FME. Those over the age of 30 years were less likely to attend.

Mental and sexual health outcomes following sexual assault in adolescents: a prospective cohort study

BACKGROUND Young people are disproportionately affected by sexual assault, yet longitudinal data are sparse. This paper examines the characteristics of adolescents presenting to sexual assault services and mental and sexual health outcomes after an assault. METHODS This was a prospective cohort study in adolescents aged 13-17 years attending the Sexual Assault Referral Centres serving Greater London, UK, over 2 years. Baseline interviews (T0) were done less than 6 weeks after an assault to collect data on sociodemographic and assault characteristics and psychological symptoms, with follow-up interviews (T1) at 4-5 months after the assault. Four psychological symptom questionnaires were used at T0 and T1: The Child Revised Impact of Events Scale, the Short Mood and Feelings Questionnaire, the Screen for Child Anxiety Related Disorders, and the Strengths and Difficulties Questionnaire. The primary outcome was prevalence of any psychiatric disorder at T1, assessed using the Development and Wellbeing Assessment. Secondary outcomes at T1 were pregnancy, sexually transmitted infections, and sexual health screening since the assault. FINDINGS Between April 15, 2013, and April 20, 2015, 141 (29%) of 491 eligible young people were recruited to the study (134 females; mean age 15·6 years [SD 1·27]), and 106 (75%) of 141 participants had T1 interviews (99 female). At T0, psychological symptom scores showed that 115 (88%) of 130 females were at risk for depressive disorder, 90 (71%) of 126 were at risk for anxiety disorders, and 116 (91%) of 128 were at risk for post-traumatic stress disorder, with symptoms largely persisting at T1. 68 (80%) of 85 females who had a diagnostic assessment at T1 had a psychiatric disorder, with multiple disorders in 47 (55%) of 85. Anxiety, post-traumatic stress, and major depressive disorders were the commonest diagnoses. Presence of a psychiatric disorder was associated with baseline psychosocial vulnerability (previous social services involvement, mental health service use, self-harm, or sexual abuse), but not assault characteristics. At T1, four (4%) of 105 females had been pregnant since the assault, 14 (12%) of 119 had a sexually transmitted infection diagnosed between T0 and T1, and nine (8%) of 107 reported re-victimisation since the assault. INTERPRETATION Vulnerable adolescents have the double disadvantage of being at risk for both sexual assault and associated psychiatric disorders, highlighting the need for comprehensive support after an assault. Feasibility and effectiveness of prevention programmes should be investigated. FUNDING National Institute for Health Research Policy Research Programme grant (115/0001).

Sexually transmitted infection in women

Sexually transmitted infections are major causes of morbidity in young women throughout the world, and are now recognized to be important co-factors in HIV transmission. This paper gives an overview of the prevention and care of sexually transmitted diseases including HIV, an update of their epidemiology, and recent advances in treatment. HIV infection in women is becoming more common, with more babies being born to infected women. The risk of vertical transmission from mother to baby can be reduced significantly by interventions such as avoidance of breastfeeding and the use of the antiviral drug zidovudine. Interventions cannot be offered unless pregnant women with HIV are identified, which highlights the need to establish voluntary named antenatal screening programmes.