A Mediation Model of Sexual Assault among Latter-Day Saints

Socialization that occurs within some conservative Christian contexts might facilitate development of attitudes and beliefs that increase women’s risk for sexual assault. Patriarchal community structure and rigid gender role adherence place women in subordinate roles and maintain gender inequality. Within conservative, dogmatic contexts, comprehensive sex education and education about assault might be minimal, and rape myths are hypothesized to be more prevalent. This study assessed sexual assault experiences (victimization and perpetration) in a sample of 208 male and female college students affiliated with the Church of Jesus Christ of Latter-Day Saints (LDS). Women reported victimization of all forms of sexual coercion at higher rates than men reported perpetration. In addition, traditional gender role adherence mediated the link between dogmatic, religiously fundamentalist beliefs and acceptance of rape mythology for both men and women. Traditional gender role adherence also mediated the link between religious fundamentalism and sexual assault behaviors for men.     

Treating an HIV/AIDS Patient’s PTSD and Medication Nonadherence With Cognitive-Behavioral Therapy: A Principle-Based Approach

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a patient with HIV/AIDS who was unable to adhere to his antiretroviral medication regimen primarily because of PTSD and depressive symptoms resulting from a sexual assault that had caused his seroconversion. Exposure-based cognitive-behavioral therapy was instrumental in helping the patient overcome his PTSD and depressive symptoms so that he could tolerate his HIV medications. The patient’s symptom relief was evidenced by improved scores on the Impact of Event Scale and Beck Depression Inventory. The article discusses the importance of accurate assessment, therapist flexibility, and principle-based treatment versus strict adherence to manual-based protocols.     

Understanding Intimate Partner Sexual Assaults: Findings from Sexual Assault Kits

ABSTRACT

In 2013, Cuyahoga County, Ohio, began DNA testing and investigating nearly 5000 previously unsubmitted sexual assault kits (SAKs) from 1993 through 2009. We examined case files from a sample of SAKs that were tested but not previously adjudicated (n = 429). More than 10% (n = 45) involved victims who reported to police that a former or current intimate partner sexually assaulted them. This article integrates the available data on the offenders, the victims, the initial investigation, and the specifics of the assaults to provide a more complete understanding of intimate partner sexual assault (IPSA). More than one-third of the IPSA offenders were serial sex offenders; that is, the offenders sexually assaulted an intimate partner and another person(s). Comparing IPSAs to all other sexual assaults, IPSAs more frequently involved bodily force, less frequently involved a weapon, and IPSA investigations were more frequently closed because (1) the victims stated they lied or the police doubted the victims and (2) the victims declined to prosecute. The most common sequencing of events was a demand for sex by the offender followed by a verbal refusal by the victim and the use of bodily force in the sexual assault. The findings, however, indicate a great deal of variation in the sequencing of events surrounding the sexual assault, with over 25% involving no physical confrontation before or after the sexual assault and no demands for sex. Unsubmitted SAK data provide a unique window into understanding the understudied and underreported issue of IPSA.     

Sexual Assault Training in the Military: Evaluating Efforts to End the “Invisible War”

Sexual assault is an insidious problem in the United States military. In 2005 the Department of Defense (DoD) created the Sexual Assault Prevention and Response Office, which centralizes responsibility for sexual assault training. However, this training initiative has undergone little evaluation by outside researchers. Addressing this need, we analyzed responses from over 24,000 active duty personnel who completed the 2010 DoD Workplace and Gender Relations Survey. We assessed whether sexual assault training exposure (None, Minimal, Partial, or Comprehensive) predicted accurate knowledge of sexual assault resources and protocols. Using a social-ecological framework, we investigated whether institutional and individual factors influenced Service members’ training exposure and judgment of training effectiveness. According to our results, exposure to comprehensive training predicted lower sexual assault incidence and superior knowledge. However, comprehensive training differed as a function of military branch, rank, gender, and sexual assault history. Judgments of training effectiveness also varied across these dimensions. Our results highlight the importance of considering context, gender, and victimization history when evaluating institutional efforts to end sexual violence. The DoD’s 2010 annual report on military sexual assault concluded that “most Active Duty members receive effective training on sexual assault” (p. 104). Our results cast doubt on that assertion.     

Asian American Women Sexual Assault Survivors’ Choice of Coping Strategies: The Role of Post-Assault Cognitive Responses

ABSTRACT

Even though approximately one in three Asian American (AA) and Pacific Islander women experience sexual assault victimization, there is a dearth of literature examining how AA women sexual assault survivors cope with this traumatic experience. This study examined AA female sexual assault survivors’ choice of coping strategies post-assault and how their cognitive responses toward sexual assault victimization (e.g., attributions of self-blame, perceived control over the recovery process) relate to their use of coping strategies. Using the AA subsets of two large community studies, a total of 64 AA women ages 18 to 58 with unwanted sexual experiences after the age of 14 years were included in the analyses. Results indicated that AA survivors used Acceptance and Self-Distraction the most to cope with sexual assault. In addition, those who perceived they had less control over their recovery process tended to use more maladaptive coping strategies, such as substance abuse and behavioral disengagement (e.g., giving up). The discussion includes clinical implications and recommendations for using language, modalities, and foci of interventions that are consistent with clients’ and their families’ worldviews (e.g., indirect inquiries, solution-focused).     

The Impact of Sexual Assault on College Students’ Daily Occupations: A Phenomenological Approach

Abstract

Sexual assault is associated with a high degree of Posttraumatic Stress Disorder (PTSD) severity. Three in ten survivors of campus sexual assault develop PTSD over their lifetime. Occupational therapists treat veterans with PTSD, but limited research exists addressing college student survivors of sexual assault and occupational therapy. A phenomenological approach was used to understand meanings of sexual assault for college student survivors. Semi-structured interviews yielded rich data and themes of disruption and reduced quality of life. The author concludes there is potential for occupational therapists to play a collaborative role on college campuses.     

Correlates of Serious Suicidal Ideation and Attempts in Female Adult Sexual Assault Survivors

Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post‐assault outcomes, and psy‐chosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self‐blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for research and treatment are discussed.     

If “Boys Will Be Boys,” Then Girls Will Be Victims? A Meta-Analytic Review of the Research That Relates Masculine Ideology to Sexual Aggression

In feminist sociocultural models of rape, extreme adherence to the masculine gender role is implicated in the perpetuation of sexual assault against women in that it encourages men to be dominant and aggressive, and it teaches that women are inferior to men and are sometimes worthy of victimization. Many researchers have linked components of masculine ideology to self-reports of past sexual aggression or future likelihood to rape. Thirty-nine effect sizes were examined in this meta-analysis across 11 different measures of masculine ideology to determine how strongly each index of masculine ideology was associated with sexual aggression. Although 10 of the 11 effect sizes were statistically significant, the 2 largest effects were for Malamuth's construct of “hostile masculinity” (e.g., Malamuth, Sockloskie, Koss, & Tanaka, 1991) and Mosher's construct of “hypermasculinity” (e.g., Mosher & Sirkin, 1984), both of which measure multiple components of masculine ideology including acceptance of aggression against women and negative, hostile beliefs about women. The next strongest relationships concerned measures of agreement that men are dominant over women and measures of hostility toward women. Scores on general measures of gender-role adherence, such as the Bem Sex Role Inventory (Bem, 1974), were not strong predictors of sexual aggression. Sociocultural models that link patriarchal masculine id eology and situational factors to sexual aggression should prove most predictive in future research.     

Correlates of Postassault Self-Defense/Assertiveness Training Participation for Sexual Assault Survivors

Past research has shown that self-defense/assertiveness training may have positive implications for sexual assault survivors. However, little is known about the correlates of self-defense/assertiveness training participation for sexually victimized women. In this study we examined the assault characteristics and experiences that relate to women's enrollment in postassault training using data from 1,623 female college sexual assault survivors. It appears that more violent attacks may lead survivors to enroll in postassault training, especially when their resistance was less effective. Postassault training participants were marginally more likely to have told someone about their assault, experienced less supportive reactions from others, exhibited marginally less current anxiety, and reported more postassault suicidal ideation than nonparticipants. These survivors may enroll in training to exercise control over future assaults occurring and as a way of healing from sexual assault. Suggestions for future research and the development of self-defense training programs for sexual assault survivors are presented.     

Adaptation of an HIV Medication Adherence Intervention for Adolescents and Young Adults

Rising rates of human immunodeficiency virus (HIV) infection among adolescents and young adults underscore the importance of interventions for this population. While the morbidity and mortality of HIV has greatly decreased over the years, maintaining high rates of adherence is necessary to receive optimal medication effects. Few studies have developed interventions for adolescents and young adults and none have specifically been developed for sexual minority (lesbian, gay, and bisexual; LGB) youth. Guided by an evidence-based adult intervention and adolescent qualitative interviews, we developed a multicomponent, technology-enhanced, customizable adherence intervention for adolescents and young adults for use in a clinical setting. The two cases presented in this paper illustrate the use of the five-session positive strategies to enhance problem solving (Positive STEPS) intervention, based on cognitive-behavioral techniques and motivational interviewing. We present a perinatally infected heterosexual woman and a behaviorally infected gay man to demonstrate the unique challenges faced by these youth and showcase how the intervention can be customized. Future directions include varying the number of intervention sessions based on mode of HIV infection and incorporating booster sessions.     

Challenges to Doing Sexual Violence Work

Sexual assault victims experience a number of effects as a result of their victimization. Sexual assault crisis workers are assigned the responsibility of trying to minimize the negative consequences of sexual assault. In their efforts to serve sexual assault victims, it is likely that certain problems make it difficult to adequately help victims. This study considers how 43 sexual assault crisis workers (27 directors of sexual assault crisis centers and 16 workers) define the challenges of serving sexual assault victims. Major challenges reported included a lack of awareness about sexual assault, victim blaming, and a lack of resources. Implications are provided.     

Language Impairment and Sexual Assault of Girls and Women: Findings from a Community Sample

Both children and adults with disabilities face increased prevalence of abuse and assault, including sexual assault. Women and girls are disproportionately the victims of sexual assault in both disabled and nondisabled populations. Communication difficulties have been identified as a factor that may increase the vulnerability of individuals with disabilities to sexual assault. However, few studies have examined whether language impairment increases risk for sexual assault. This study reports on a community sample of children with speech or language impairment, followed to age 25. Sexual assault history was assessed based on two questions from the Composite International Diagnostic Interview Posttraumatic Stress Disorder module. Women with language impairment (n = 33) were more likely than women with unimpaired language (n = 59) to report sexual abuse/assault, controlled for socioeconomic status. Sexual assault was associated with higher rates of psychiatric disorders and poorer functioning. Women with neither language impairment nor a history of sexual assault had fewer psychiatric disorders and higher functioning than women with language impairment and/or a history of sexual assault.     

Sexual victimization in relation to perceptions of risk: mediation, generalization, and temporal stability

There is evidence that personal experience with trauma is associated with increases in both personal and comparative risk perception. This study investigates this relation in terms of sexual victimization among women, focusing on three potential mediators: perceived control over sexual assault, perceived similarity to a typical sexual assault victim, and psychological distress. Mediational analyses were investigated using structural equation modeling. Although victimization experience was not related to comparative risk perception, it was associated with greater personal risk perception. This relation was mediated by perceived similarity to a typical sexual assault victim. Prospective analyses indicated that personal risk perception does change in response to sexual victimization but also indicated that heightened risk perception may be an accurate assessment of risk that actually precedes victimization experience. Implications for the meaning of perceived similarity and perceptions of risk for sexual assault victims are discussed.     

Exploring Perceived Social Support from Peer Facilitators in an HIV Treatment Adherence Intervention for African American Patients: A Content Analysis of Participant Perspectives

HIV treatment adherence interventions increasingly rely on peer facilitators to promote treatment adherence and improve patient retention, yet little is known about how participants perceive the role performed by peer facilitators. The present study examined participant perceptions in terms of the social support from peer facilitators in a hospital‐based intervention in Chicago. Content analysis was conducted with reference to four types of social support (instrumental, informational, emotional and affiliational) on exit interviews with 11 participants enrolled in the intervention that targeted African‐American patients living with HIV/AIDS. We examined how the type of social support perceived by participants was related to their self‐reported behaviours in three domains: adherence, sexual safety and general coping. Our analysis revealed that most participants perceived informational and emotional support from their peer facilitators, followed by instrumental support. Affiliational support was the least frequently perceived type of social support. We found that perceived informational support from peer facilitators with regard to adherence had greater impact and credibility amongst participants than the same type of support from medical providers. Informational support was cited most frequently with regard to influencing adherence and sexual safety behaviours, whereas perceived emotional support was cited primarily with helping participants cope with HIV. Copyright © 2015 John Wiley & Sons, Ltd.     

Experiences of transgender prisoners and their knowledge,attitudes, and practices regarding sexual behaviors and HIV/STIs: A systematic review

Background: Despite transgender people being more visible in prison systems, research suggests they are at higher risk of experiencing sexual violence compared to other prisoners. Research also suggests that transgender prisoners experience harassment, and physical and sexual assault by fellow prisoners, and prison officers who lack transgender-specific health knowledge. There exist no systematic reviews on the experiences of transgender people in prisons. This review aims to fill this research gap. The following question developed in consultation with transgender, sexual health/HIV and corrective services stakeholders has guided the systematic review: What are transgender and gender-diverse prisoners’ experiences in various prison settings and what are their knowledge, attitudes and practices regarding sexual behaviors and HIV/STIs?

Methods: The review followed the PRISMA guidelines and searches were conducted in four databases for the period of January 2007 to August 2017. Studies were assessed against predetermined inclusion and exclusion criteria. Included studies were peer-reviewed, written in English with online full-text availability and reported data on transgender and gender-diverse prisoner experiences relevant to the research question.

Results: Eleven studies (nine qualitative, one quantitative, one mixed-methods; nine in USA, two in Australia) met the criteria for review. Four studies were of high quality, six were of good/acceptable quality, and one study was of modest quality. Transgender and gender-diverse prisoners reported a range of challenges which included sexual assault, discrimination, stigma, harassment, and mistreatment. Information on their sexual health and HIV/STIs knowledge, attitudes, practices is in short supply. Also, their lack of access to gender-affirming, sexual health/STIs and mental health services is commonplace.

Conclusions: The experiences of transgender prisoners as reported in this review are almost uniformly more difficult than other prisoners. Their “otherness” is used as a weapon against them by fellow prisoners through intimidation and violence (including sexual) and by prison officers through neglect and ignorance.     

Toward a More Complete Understanding of Bystander Willingness to Help: What Role Does Critical Consciousness Play?

Sexual assault is a common phenomenon on university campuses with about one in five women victimized while in college. Consequently, bystander intervention programs have been gaining momentum. To improve such programs, research has begun to identify factors that may facilitate or impede individuals’ willingness to help a potential victim of sexual assault. The current study adds to this literature by: (a) examining potential differences in rape myth acceptance, critical consciousness, and willingness to help based on types of self-reported exposure to sexual assault; (b) exploring the previously unexamined mediating role of critical consciousness in the relationship between exposure to sexual assault and willingness to help; and (c) clarifying how the extent of rape myth acceptance impacts the relationship between exposure to sexual assault and willingness to help. Using a sample of 511 U.S. undergraduate students, results generally demonstrated that those with multiple types of exposure to sexual assault victimization demonstrated the highest levels of critical consciousness and greater willingness to help. Additionally, there was both a significant indirect effect of exposure to sexual assault on willingness to help via critical consciousness and a conditional effect of exposure to sexual assault on willingness to help that was stronger at lower levels of rape myth acceptance. Results highlight the importance of programming targeted at increasing critical consciousness.

     

A COMPARISON OF GROUP AND INDIVIDUAL SEXUAL ASSAULT VICTIMS

The experiences of 44 group sexual assault victims (multiple offenders, one victim) were compared with 44 individual sexual assault victims (one offender, one victim). Sexual assaults included various degrees of sexual victimization ranging from verbal coercion to rape. Participants were located from among a national sample of 3,187 college women. Group sexual assaults, compared to individual sexual assaults, were in general more violent, involved greater resistance from the victims, and were more likely to be perpetrated by strangers or relatives and to involve an experience which met the legal definition of rape. Group sexual assaults were less likely to involve multiple episodes by the same offender(s). Group sexual assault victims were more likely than individual sexual assault victims to seek police and crisis services, to have contemplated suicide, and to have sought therapy postassault. Despite these differences, the two groups were similar in the amount of drinking and drug use during the assault and their scores on standardized measures of psychological symptoms.     

Sexual Assault,Overweight, and Suicide Attempts in U.S. Adolescents

Associations between overweight, sexual assault history, and suicide attempts were examined among 31,540 adolescents from the combined 2009 and 2011 nationally representative Youth Risk Behavior Surveys samples. These variables have not previously been studied concurrently. It was hypothesized that overweight and sexual assault, together, would interact and result in increased suicide attempts. Findings across analyses included (a) no significant associations between sexual assault and overweight in females or males (p = .65 and p = .90, respectively), (b) statistically significant associations between female (but not male) overweight status and suicide attempts (p = .001), (c) a strong association between sexual assault and suicide risk in males (p < .001) and females (p < .001), and (d) an elevated risk for suicide in overweight males with co‐occurring sexual assault, with over 33% of males with such histories attempting suicide. Preliminary findings have powerful implications for research and secondary prevention.