Our Bodies, Ourselves (150 page)

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Authors: Boston Women's Health Book Collective

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Fear of not being believed—and, for those of us who are lesbian or bi and/or trans, experiences of homophobia and transphobia—may make many of us reluctant to call a crisis line, go to an emergency room, call the police, or tell our friends. If you are not lesbian or bisexual, you may fear that people will assume you are. Everyone deserves respectful assistance. Woman-to-woman sexual assault must be acknowledged so that all women can get the support and assistance they deserve and need.

MEDICAL CONSIDERATIONS REGARDING RAPE

If you have been raped, it is critical to obtain medical attention as soon as possible, even if you have no obvious injuries. It is understandable to want to take a shower and try to forget what happened, but bathing may wash away evidence that could be crucial if charges are filed (see
sidebar on rape kits,
). Even if you do not think you want to go to the police right now it is important to gather evidence in case you change your mind. Note that statutes of limitations—laws that set the maximum amount of time that can pass after a crime is committed before legal action is taken—vary by state; check the Rape, Abuse & Incest National Network (rainn.org) for specifics in your state. Since rape perpetrators seldom rape only once, your evidence may also provide critical information that can help others.

Hospital Exam

A friend or advocate can help you through the step-by-step examination process. Trained rape
crisis advocates are available through the organizations listed in the
resources box on.

RAPE KITS AND THE GOVERNMENT BACKLOG

A rape kit (also known as a sexual assault evidence collection kit, or SAFE kit) is designed specifically for collecting physical evidence of sexual assault. A specially trained health care provider collects and stores in sterile envelopes anything the rapist might have left on or in a woman's body–including hairs, blood, and semen–as well as photographs of bruises, scratches, and injuries. The collection process can take about four hours and can be done only with consent. This medical evidence will be made available to police or others only with your written permission. DNA testing of the materials in the kit can provide forensic evidence to support the prosecution in a case against the rape suspect, if legal action is pursued.

The DNA testing is usually performed by a local law enforcement agency and can cost the agency up to $1,000. Owing to lack of funds and, in some cases, not taking sexual assault seriously enough, many municipalities have a large backlog of untested rape kits. Many choose to test only those kits for which there is an identified suspect as well as a promising legal case. An estimated 180,000 rape kits a year remain untested, leaving on the shelves potential evidence that could prove a woman's claims, identify an attacker, or exonerate a suspect.

The backlog in rape kit testing is a serious public health and safety issue. The long delay creates extra stress for sexual assault survivors, adding to feelings of isolation, helplessness, and abandonment. Advocates have testified repeatedly before Congress, pressing for legislation that would require quicker testing and provide more funds. (The federal government helps cities and states foot the bill through grants to local law enforcement agencies.) New York City has achieved dramatic success in eliminating rape kit backlog. It can be done.
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Clothing you wore during an assault may have evidence on it, so bring it with you if you changed before going to the hospital, or ask a friend to bring a change of clothing to the hospital so you can leave your clothes there if needed.

If possible, request a trained sexual assault nurse examiner in the emergency room. Some hospitals have specialized programs staffed by nurses or doctors who have received extensive training in the medical, legal, and emotional issues associated with sexual assault.
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The programs are designed to provide sensitive medical exams and collect the best evidence possible for prosecution. Under the Violence Against Women Reauthorization Act of 2005, there is no charge for a rape exam; the physical samples and information gathered are considered criminal evidence.

Rape can cause physical injuries to any part of the body. You should request a thorough examination that includes and/or results in the following.

A verbal history of the sexual assault and related medical concerns:
You will be asked to
give a detailed description of the assault, which will be written down. Although it may be difficult to talk about these details, it is important for the medical provider to know where to check for injuries and what evidence to document for possible prosecution. Do not answer irrelevant questions about your sexual history, past drug use, or mental health counseling; should you go to trial, the perpetrator's defense might try to gain access to your records.

A pelvic or rectal exam:
You will have a pelvic exam if you were raped vaginally and a rectal exam if you were raped anally. (For more information on these exams see
Chapter 2
, “Intro to Sexual Health.”) You or your advocate should check the clinician's written record for accuracy and objectivity as soon as possible after the exam. Try to do this while the clinician is still present.

Checking for external injuries:
The practitioner will examine and treat you for any external injuries and may photograph bruises or other marks to document the assault. Take pictures of any bruises that emerge after the exam and call the examiner so the information can be added to your record.

Prevention of sexually transmitted infections (STIs):
You should be offered antibiotic injections as a preventive measure against STIs that are treatable by antibiotics. Medications are available to decrease the risk of some other STIs, including HIV. (For more information, see
“Decreasing Risk
After
Exposure,”.
) If you are offered testing for HIV, be aware that immediately after the assault is too soon for HIV antibodies to show up. Also, the test results could become part of your medical and legal record. Because some STIs are not detectable until six weeks have passed, you should get tested again for STIs six weeks after the rape.

Prevention of pregnancy:
If it is possible that you will become pregnant as a result of the rape, the practitioner may offer you emergency contraception (EC), sometimes called “the morning-after pill.” Catholic hospitals may not offer EC. If you are seventeen or older, you can buy emergency contraception at pharmacies without a prescription. (For more information, see
“Emergency Contraception,”.
) A pregnancy resulting from rape cannot be detected until several weeks later.

Follow-up exam:
Although you may feel physically recovered shortly after the rape, a follow-up visit that includes tests and treatment for STIs and a pregnancy test, if indicated, is an important part of taking care of yourself.

WHAT TO DO IF SOMEONE YOU CARE ABOUT HAS BEEN SEXUALLY ASSAULTED

If a friend or family member has been sexually assaulted, you might not know what to say. Just being there and listening is helpful. If she feels ashamed or guilty, reassure her that the rape was not her fault and that her feelings are normal. Even if you feel you might have reacted differently, remember that her reactions are uniquely hers. Help her to think about what changes, if any, she would like to make that will help her feel safer, whether related to her physical surroundings or her interactions with people at home or at work. Resist pressuring her to do things she is not yet ready to do. When in doubt about what to do or say, ask what she wants or needs from you. For more ideas on how you can be supportive, see “What to Do if Someone You Care About Has Been Raped” at ourbodies ourselves.org.

LEGAL CONSIDERATIONS REGARDING RAPE

Although improvements have been made in the legal system, prosecution of a rapist can still be a drawn-out and painful process. Most communities have rape crisis centers that provide advocates to help women navigate the legal system. Many local district attorney offices offer victim/witness advocates who can provide information and support. In some states, sexual assault can be reported anonymously.

Even if you do not intend to report the assault now, write down everything you can remember so if you decide to file a criminal complaint later, your statement will be accurate. This statement can be useful should you decide to pursue a sexual assault protection order or other civil law remedies. For guidance, contact the Victim Rights Law Center (victimrights.org.), which focuses on legal services for victims of sexual assault.

PROTECTING OURSELVES AND EACH OTHER FROM SEXUAL ASSAULT

The responsibility to prevent rape should be on the people who rape–not on the potential victims. Rape is never our fault, but in a society where sexual assault is so prevalent, it is wise to try to take steps, when possible, that may reduce our risk.

Safety in social situations:
Pay attention to how you feel, and trust your instincts. If you want to end a date or leave a party, say so, even if you are afraid or embarrassed. If you have a drink, keep an eye on it, as blackout-inducing drugs can be slipped into drinks. If a friend is drinking heavily, make sure she gets home safely and is not left alone. If you see a situation in which another woman is possibly being subjected to unwanted sexual advances, you may be able to interrupt the situation safely by asking her to accompany you in finding a women's washroom. This can give her a break from the pressure and a chance to reassess the situation.

Safety in intimate relationships:
Learn to recognize potentially abusive relationships. An abusive or unhealthy relationship involves disrespect, fear, jealousy, possessiveness, and controlling behavior.

Safety at home:
Make sure entrances are well lit and windows and doors are securely locked. Identify alternative ways out of your home besides doors. Use only your last name on your mailbox. Find out who is at your door before opening it for anyone.

Safety in your neighborhood:
Arrange to walk home with people you trust. Get to know the people who live in your apartment building or on your street.

Safety on the street:
Be aware of what is going on around you. Walk at a steady pace and look as if you know where you are going. If possible, walk in the middle of the street, avoiding dark places. Carry a whistle and keep it where you can easily reach it. If you drive, always check the
backseat of your car before getting in, and keep the car doors locked while driving. When taking public transportation, try to find a seat near other people, and avoid subway cars occupied by groups of men.

Calling for help on the highway:
Dial 911 for emergency services. Some highways may indicate another number for state police; this will vary by state. If you are summoned to pull over by an unmarked vehicle, especially at night or in a secluded area, you do not have to stop immediately. Slow down, turn on your emergency flashers, and drive to a well-lit, populated place before stopping. Keep your doors locked and roll down the window only an inch. Ask to see a badge and photo ID. If you have a cell phone, use it to contact a police dispatcher to check the person's authenticity.

These tactics can help, but they are not foolproof. Practice tactics for dealing with situations that make you feel most at risk and least powerful. Try to remain calm and act as confident and strong as possible.

Many anti-violence activists focus on making the existing criminal justice system work better for those who experience sexual assault and domestic violence. Hard work by feminist activists in the late twentieth century, for example, achieved better handling of domestic violence cases, through improved federal and state laws and more informed awareness in many police departments. Some activists cite deep flaws in the criminal justice system. In the anthology
Yes Means Yes!
former rape-crisis worker Lee Jacobs Riggs writes, “I felt drained and frustrated (not to mention flat-out dirty) operating within a framework that positioned the criminal legal system as the primary remedy for sexual violence.”
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In cases when prosecution of a rapist is successful, the verdict and who gets convicted too often reflect the inequities present in the U.S. legal system, which imprisons people of color and poor people at a higher rate than white and/or middle-class perpetrators of similar crimes.

INTIMATE PARTNER VIOLENCE

Intimate partner violence and battering, also known as domestic violence, are among the most common yet least reported crimes in the world. All couples at times disagree, argue, and have feelings of anger; not all aggressive behavior between partners constitutes domestic violence.

While a single act of physical or psychological violence between intimate partners is an act of domestic violence, most domestic violence involves a pattern of behavior that causes fear and intimidation in which one person in the relationship exerts coercive control over the other person. Within that pattern, acts of physical or psychological violence may occur frequently or rarely, but the threat is always present and serves to shore up the abuser's coercive control.

I was living with my then-girlfriend, and everything was okay for a while. Then she started to … force me into doing things that I didn't want to do. She wouldn't take no for an answer to anything. If she wanted it, she would get it.

A young homeless woman who moved in with an older man says of her experience:

It started with him ensuring that all ties with friends and family were broken … he would ask me to make unreasonable demands from
them, such as borrowing money, and when they refused, he managed to convince me that they didn't care about me at all. Within a year, he had me convinced that he was the only person that cared for me. Once I got pregnant, he became very abusive. There was a lot of yelling and name-calling. He had me feeling completely worthless. I couldn't make a decision without asking him. I justified it to myself saying that he wasn't really abusive because he never hit me, which I now understand is absurd.

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