Gaps in Sexual Assault Health Care Among Homeless Young Adults

Abstract

Introduction: Young adults experiencing homelessness are at increased risk for sexual assault. Receiving a post−sexual assault examination has important implications for HIV and unintended pregnancy prevention; yet, utilization is not well understood. In a population at elevated risk for HIV, unintended pregnancy, and sexual violence, identifying barriers and facilitators to post− sexual assault examination is imperative. Methods: As part of a large, multisite study to assess youth experiencing homelessness across 7 cities in the U.S, a cross-sectional survey was conducted between June 2016 and July 2017. Data were analyzed in 2019 to determine the prevalence and correlates of sexual violence and examine the correlates of post−sexual assault examination utilization. Results: Respondents (n=1,405), aged 18−26 years, were mainly youth of color (38% black, 17% Latinx) and identified as cisgender male (59%) and lesbian, gay, bisexual, or queer (29%). HIV risks were high: 23% of participants had engaged in trade sex, 32% had experienced sexual assault as a minor, and 39% had experienced sexual exploitation. Young adults reported high rates of sexual assault (22%) and forced sex (24%). Yet, only 29% of participants who were forced to have sex received a post−sexual assault examination. Latinx young adults were more likely than other races/ ethnicities to receive post-assault care. Participants frequently said they did not get a post−sexual assault exam because they did not want to involve the legal system and did not think it was important. Conclusions: Interventions are needed to increase use of preventive care after experiencing sexual assault among young adults experiencing homelessness.

The promise of an intersectoral network in enhancing the response to transgender survivors of sexual assault

“…This finding is congruent with results rating a lack of service professionals who are trans-positive as the most significant barrier to collaborating across sectors to enhance care. It is also consistent with several previous studies that have identified a lack of training, limited medical knowledge, and scant access to appropriate education among healthcare and social service providers results in inadequate care and experiences of discrimination when trans persons seek supports [13,14,16,[28][29][30]. Organizational representatives indicated that a network could address these problems by supporting providers in becoming more knowledgeable about trans issues and experiences while working to improve their competence to provide trans-affirming care.…”

“…Limited access to and availability of appropriate services were identified by representatives of organizations as substantial challenges to the response to trans survivors. As in earlier studies, they associated discrimination and stigma related to being trans and a sexual assault survivor to a lack of trust in accessing healthcare services [13,14,16]. It was mentioned that these experiences intersect with other forms of oppression, including racism and poverty, which further limit access to supports; findings similar to those in research on trans persons experiencing sexual assault and homelessness [37].…”

“…However, trans persons may not have access to appropriate supports post-sexual assault, often delay in seeking needed services, or choose not to access services at all [13][14][15][16]. Obstacles to accessing services can include internal and external stigma associated with both being a sexual assault survivor and identifying as trans as well as with other intersecting marginalized identities, fear of being 'outed', fear of denial of treatment, a lack of organizational inclusive policies and practices, a lack of trust in providers, and a lack of outreach by services to trans communities [13,14,16]. FORGE found that only 9% of trans survivors had received professional medical care for their physical injuries and only 14% professional emotional support within the first week of being assaulted [9].…”

“…The problematic response to trans survivors of sexual assault is a health equity issue that urgently needs to be addressed; it is critical that trans survivors have proper access to supports that recognize, account for, and address their diverse needs [2,9,14]. As no one sector alone is positioned to provide such a response [9], networks of diverse professionals and sectors might aid in achieving this goal.…”

Formation of an intersectoral network to support trans survivors of sexual assault: A survey of health and community organizations

“…The diversity reflected in these organizations shows promise for a network that is able to function in full consideration of the implications of its actions across all types of services, sectors, and geographical regions (Emerson et al, 2012). Additionally, the organizations' diverse nature of supports offered will be critical in addressing the complex needs of trans survivors who may be experiencing multiple intersecting issues (e.g., housing instability, immigration status) that effect their vulnerability to experiencing sexual assault, as well as their interaction with supports postvictimization (James et al, 2016;Kattari & Begun, 2017;Santa Maria et al, 2020).…”