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S e x u a l V i o l e n c e
Materials about various types of sexual violence:
Find these materials online at http://www.nsvrc.org/resources/index.html
Specific materials about the health care response to sexual violence: Mental Health Services for Rape Survivors: Current Issues in Therapeutic Practice, by Dr. Rebecca Campbell
http://www.vaw.umn.edu/documents/commissioned/campbell/campbell.pdf
A SAFE or SANE is a registered nurse or physician who provides comprehensive care, timely collection of forensic evidence and testimony in sexual assault cases. This individual has completed a specialized training course. http://www.nsvrc.org/resources/strategies/sane.html
More information at http://www.nsvrc.org/resources/strategies/ec.html
Including policy statements by the American Academy of Pediatrics, and sample protocols. http://www.nsvrc.org/resources/strategies/children.html
It is understandable for a health care provider to feel the need to ’fix’ the problem when a woman discloses that she is a victim of violence. After all, health care providers have been taught to help people and make them feel better. However, a situation of violence can be very complex and an easy solution may not always be available. Women living in situations of violence, or those who have experienced violence at some point in their lives, may have been stripped of their autonomy and may have experienced a lack of control over what happens to them. Therefore, it is particularly important for providers to help them make their own decisions and to respect their autonomy. For instance, it is possible for a client to disclose that she is living in an abusive situation but decide not to leave the relationship at that moment. Understand that simply asking questions and addressing the issue of violence in a sensitive manner can be an important step in a woman’s life. Just because the woman decides not to leave the relationship immediately does not mean that she has not benefited from your intervention.
Many women still do not know about emergency contraception (EC). Displaying information about EC in your office will help educate women should they ever be in a situation in which they need this contraceptive method, whether as a result of violence, contraceptive failure or any other reason.
If a woman is currently living in an abusive relationship, she is unlikely to have much autonomy as to when and how she has sexual intercourse, and what contraceptive method she and her partner decide to use. Asking about a client’s relationship and about how her partner feels regarding contraception might help you to assist her in deciding what may be the most suitable contraceptive method for her at this time.
When promoting
prevention strategies for sexually transmitted infections (STIs) such as HIV, it
is important to help a client think through whether she could safely propose
condom use with her partner. In many contexts, condom use is still associated
with multiple partners and unfaithfulness. Proposing condom use in the context
of a long-term and (supposedly) monogamous relationship can therefore be
particularly problematic. Research has shown, for instance, that attempts to
adopt condom use and access STI treatment services by disadvantaged women are
likely to lead to abuse. Research has also linked condom promotion with
increased risk of violence for vulnerable women who may already be victims of
sexual or physical abuse. Clearly this does not mean that condoms should not be
promoted, but rather that you should help a woman think through other issues
that may be associated with proposing condom use. Additionally, making the
female condom available may increase the options a woman has to protect herself
from STI/HIV infection. All these measures can help women make informed
decisions as to how best to protect themselves. Providers should also consider
the issue of violence when counseling women both prior to and post HIV testing.
Research has shown that women may be at increased risk of violence when they
choose to disclose their HIV status and the needs for partner notification must
therefore be carefully balanced against the risk of violence. |
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