The full document is at
http://new.vawnet.org/category/Documents.php?docid=1191

Screening for Sexual Violence: Gaps in Research and Recommendations for
Change by Lynne Stevens with contributions from Barbara Sheaffer (December
2007)

Data show that the majority of completed and attempted sexual assaults
against women are not reported to the police. In addition, resources that
may be thought of as refuges for survivors, such as rape crisis centers, are
often not accessed by them. In fact, most women who are victims of childhood
or adult sexual violence do not go to hospitals, do not tell their families,
and are hesitant to speak to their friends about it.

But survivors of sexual violence do make frequent visits to health care
services. Often these women go to health care providers because they are
experiencing the physical and psychological effects of sexual violence,
which can manifest as headaches, gastrointestinal distress and/or the
physical effects of the violence such as Pelvic Inflammatory Disease (PID)
and Sexually Transmitted Infections (STI's) or Human Immunodeficiency Virus
(HIV).

It is clear that health care visits are the gateway to care for many
survivors of sexual violence and that providers could be central in
improving the outcomes of survivors of violence if they screened, educated
and referred their patients. The American Medical Association, the World
Health Organization, American College of Obstetricians and Gynecologists
(ACOG), American Academy of Pediatricians, and the Ameri- can Nurses
Association are amongst the health care groups who recommend that providers
screen their women patients for violence. ACOG specifically recommends that
obstetricians/gynecologists screen women at each visit and include inquiry
about sexual violence.

Yet often when providers do screen their female patients for violence,
the focus of the screening is on assessing women for domestic violence. This
type of screen usually covers physical, emotional/psychological and possibly
financial abuse of a woman by her partner, but not sexual violence. But
research shows an overlap between types of violence, so that women who are
beaten by their partners are often also the victims of sexual violence as
well (and visa versa).

There is a critical gap in the level of knowledge we have about sexual
violence in this context. The existing domestic violence research gives us
the opportunity to learn from the research and to develop a research agenda
that asks important questions specifically related to sexual violence. This
future agenda includes questions about: inclusive and effective screening
tools; types of referrals survivors need; the development and testing of
health care outcome measures; development and implementation of program
models that work within the health care system, are cost effective and are
adaptable to different types of sites; and how screening for sexual violence
affects health care usage, the quality of survivors' lives and health care
savings.

We need to focus on identifying and assisting survivors of sexual
violence, and help them to let go of the shame of silence and isolation
related to their experiences of sexual violence. One way to do this is to no
longer weigh them with the burden of finding a person to tell or a place to
get help. We need to offer comprehensive care and services where women
already go, and make sexual violence screening a clear and integrated part
of women's health care.