Overview of Populations at High Risk for Sexual Assault
Sexual Assault in Tribal Nations. Native Americans experience far more SA than other racial-ethnic groups, as well as having a history of sexualized violence such as forced sterilization and forced abortions. These rates of assault exist within a context of violence and coercion against Native Americans. Moreover, the relationship of Native American Nations to law enforcement, the criminal justice system, and health care has been fraught with barriers, injustice and brutality (Robin, 1996; Tjaden, 2000). There have been significant efforts by Native American women to redress this history, coupled with renewed efforts on the part of Indian Health Services (IHS) to ensure uniform and consistent responses to Native American victims. TeleNursing consultation provided by trauma informed, expert SANEs can play a crucial role in this effort.
Sexual Assault in Correctional Institutions. Inmates come disproportionately from populations subject to high rates of sexual violence (e.g., individuals with mental health and substance abuse challenges; survivors of childhood sexual abuse) and may have a history of perpetrating sexual violence. Because of these and other factors, rates of sexual violence in detention centers are staggering. Zweig and Blackmore’s (2008) NIJ report recommended the development of policies for the investigation, prosecution, and provision of victim services, as well as accurate documentation of sexual violence. The use of telemedicine can significantly improve inmate access to high-quality forensic medical care while simultaneously ensuring the safety of correctional and medical staff, thereby eliminating the need to transfer inmates out of prison for examinations. This will potentially benefit the public at large while simultaneously improving the care provided to victims/survivors of sexual assault.
Sexual Assault in Rural Populations. Sexual and domestic violence are among the leading health problems in rural areas throughout the country, with rates comparable or higher than urban areas. Geographic and/or social isolation, lack of public transportation/infrastructure, and difficulty accessing health and human services only exacerbate these problems. (Lewis, 2003).Underreporting in rural communities may be much higher than in other areas due to the lack of anonymity, high percentage of acquaintance SAs and an insular rural culture. The close connection of law enforcement personnel to rural social networks in particular, can result in victims feeling that reporting is neither safe nor confidential (Weisheit, Wells & Falcome, 1995). Telemedicine has been effective in extending urban medical resources to rural areas, and could be valuable for forensic SA examinations as rural practitioners see comparatively fewer victims each year.
Sexual Assault in the Military. Sexual assault in the military poses unique challenges for reporting, identification and response. Many servicewomen and men are at risk. In FY’ 11, there were 3,192 reports of SA in the military (DOD, 2012). However, it is understood that only a small percentage are reported. Former Defense Secretary Panetta estimates the real number is closer to 19,000 (Panetta, 2012). The power and structure of the military and a strong ethic of loyalty present obstacles to reporting and responding (Turchik & Wilson, 2010). The DOD established the Sexual Assault Prevention Office (SAPRO) (DOD, 2005) to enhance prevention, improve treatment and support of victims, and increase accountability. Many military treatment facilities have limited resources to provide expert forensic examinations for SA victims. Furthermore, maintaining competency in the SA forensic examination is challenging in facilities that perform only a few examinations a year (Ferguson & Faugno, 2009). A telemedicine resource center that offers 24/7 capability to guide clinicians through the acute care of SA victims could complement the military’s initiative and expedite improved care for service members.