Category Archives: Rape and Sexual Assault

Retraumatization: The Increased Risk of HIV Transmission among Abuse and Assault Victims

While the transmission of HIV and the causes of HIV-related death are actually more complicated—and even more nuanced—than public discussion would let on, a few presumptions about it remain fairly accurate.

For women who are marginalized in their communities, who are victims of abuse or assault, and who are economically or socially dependent on a spouse, the risk of them contracting HIV or dying from multiple complications from AIDS is simply greater than that of women fortunate enough to not be subjected to these circumstances. Take these scenarios:

  • The power dynamic in an abusive relationship may prohibit women from being able to protect herself from a partner who refuses to wear a condom
  • Women in poverty and those who need to rely on a partner for financial support may have greater risk of comorbid infections than women of economic independence. They are less likely to have the health insurance and relationship with a healthcare provider that would support HIV testing and provide the essential—and expensive—HIV medications to ensure a healthy life and lower the risk of co-morbid infections
  • People without social support, living in fear of what an HIV-positive diagnosis means, or those who have reason to fear stigma around personal behavior when seeking treatment are less likely to know where to access treatment or seek it out because of that fear, stigma and lack of support

Common sense would seem to support these statements. But until recently, the pathways of infection were not always clear, and while the conclusions above seemed certainly reasonable, specific data to support them had been difficult to collect. Two recent studies led by a UCSF-researcher have changed that. One synthesized what is known about PTSD and exposure to trauma among HIV-positive women, and the other explored the root of this relationship.

The results were remarkable. HIV-positive women had between two and six times the rates of childhood and adult physical and sexual abuse, and PTSD. The snapshot of risk behaviors among HIV-positive women was sobering:

  Sample size Number (%) of participants with each characteristic
Sexual activity
Any sexual activity in the past 6 months 113 61 (54.0%)
 With a main partnerMedian number of main partners (if any) 61 43 (70.5%)1 (range 1–2)
 With casual partnersMedian number of casual partners (if any)a 61 23 (37.7%)1 (range 1–25)
Sex with any HIV negative or unknown serostatus partners (if sexually active) in the last 6 months 61 51 (83.6%)
 Disclosure of HIV status less than all of the time with these partners 51 29 (56.9%)
 Using condoms less than all of the time with these partners 51 31 (60.8%)
 Detectable viral load 51 30 (58.8%)
 Disclosure of HIV status less than all of the time, and using condoms less than all of the time, and a detectable viral load 51 16 (31.4%)
Substance use (any, recent)
Cigarettes 110 71 (64.5%)
Alcohol 111 50 (45.0%)
Marijuana 111 39 (35.1%)
Crack/cocaine, heroin, and/or methamphetamines 111 45 (40.5%)
IDUb 112 11 (9.8%)
 IDU who share needles 11 5 (45.5%)
 IDU who have a detectable viral load 11 6 (54.5%)

aOne participant had a very high number of sexual partners (N = 250) and was excluded from the analysis; b IDU injection drug use; ©2012 Machtinger, et al. (retrieved December 16, 2012.)

There were striking findings in terms of both HIV treatment failure and the impact of the above risk behavior in these women, bringing us the first real data hoping to explain this relationship. Those who suffered from recent trauma had more than four times the odds of anti-retroviral (ART) failure while on treatment than HIV-positive non-victims—and this was seemingly not due to self-reported poor adherence to the medication. One potential explanation offered by the study authors is that abuse and trauma interfere with an individual’s ability to stay on a consistent medication schedule, which is essential for control of the virus. Other studies have confirmed that abuse manifest as control, in which a male partner prevents his HIV-positive female partner from accessing services at a clinic out of fear that the stigma of HIV would be attached to him.

HIV-positive victims of recent trauma also all reported experiencing what the study calls “coerced sex,” and have over three times the odds of un-traumatized women of having sex with HIV-negative or status-unknown individuals. They had greater than four times the odds of inconsistent condom use, potentially exposing those casual partners to the virus. While high-risk sex behavior is always a factor in HIV-transmission, HIV-positive individuals who adhere consistently to HIV treatments are significantly less likely to infect HIV-negative partners during sex. So the lack of treatment adherence among traumatized HIV-positive women combined with the risky sex behavior is a great concern.

Interestingly, these figures were only significant among women who experienced recent trauma, indicating that the ongoing—not merely one occurrence—circumstances of abuse are the key to the relationship between HIV-infection and HIV-related illness and death. This can actually be seen as a snapshot of hope—if we are able to offer abuse, assault, and PTSD victims the appropriate support to heal from the experiences, we may be able to weaken the HIV/trauma relationship.

These studies draw a clear line between victims of assault and trauma and both the spread of HIV within their communities and the increased risk of HIV-related illness and death. But interestingly, the risk goes much deeper than these socioeconomic circumstances. The conversation around HIV transmission is generally split into one of two categories: social and behavioral—risky activity, injection drug use, the prejudicial judgment of sex workers; and medical and clinical—how the virus infiltrates the immune system, takes over cells, and how it is and isn’t suppressed with antiretroviral medications. What isn’t usually discussed is the possible combination of these two categories and how together they create a perfect storm for potential infection.

Recent studies have shown that those individuals suffering from PTSD had significantly higher rates of cytomegalovirus (CMV) in their body. A virus that is found in between 50%-80% of adults in the United States, CMV remains largely undetected—latent, suppressed, unproblematic—in healthy individuals. It’s also seen as a marker of immune health and function, and of the body’s ability to control potential infections. Given that 30% of American women with HIV/AIDS have PTSD (five times the national average), the potential relationship between their HIV-status and even further compromised immune function could lead to a myriad of comorbid infections and premature death. Other research has also shown that additional biological mechanisms may prevent ART-treatment from being as effective as possible, including high cortisol (stress hormone) levels. Not only do these victims have to fight against abuse and assault, they have been left without the essential social support to decrease risky behaviors that may expose others to the virus, and their own bodies are in revolt.

Collecting this kind of information is difficult. It requires consistent and positive communication between women and providers, unobstructed access to medical care and uninterrupted ART treatment, and of course, in this example, most importantly—removal from an abusive environment.

The combination of immunosuppression due to PTSD, the detectable rates of HIV in traumatized women whose viral loads are not suppressed by consistent anti-retroviral treatments, and the concurrent risk behaviors of abused HIV-positive women, all contribute to higher rates of HIV-infection in communities, as well as the potential for co-morbid infections and HIV-related death. Until these women are able to find the essential social and community support, free from abuse and trauma, and until their access to care and preventative measures are fully realized, the relationship between trauma and HIV will only deepen.

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Filed under Epidemiology and Population Health, Feminism, Health Behavior, Mental Health, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Violence Against Women, Women's Health

Ready for 2012?

I certainly am! In case you’re interested, here are some interesting stats for INTY for 2011:

Top Five Posts of the Year:

Good Riddance, Paterno

Duke Nukem – Seriously?

Beyonce – A Word

Yes, Summer’s Eve Has Bad Marketing. Oh, and the Product is Not Good for You

I Still Don’t Think Yoplait Gets It

An interesting mix, indeed! Check them out if you missed them. And for kicks, my favorite Google searches that brought people to my blog:

* “does summer’s eve cause yeast infections”

* “disney feather duster” (which brought them to the Billy Bush post)

* “self-image”

* “i think i’m a feminist” (yay!)

* “consent”

* “abortion”

* “feminism does not necessarily mean hating men”

* “equinox advertisements jealous” (which brought them here)

* “eating disorders”

* “miss usa”

* “eroticization of girls”

* “sexualization of girls”

* “sexualized advertising”

* “advertising desensitization”

* “advertising and behavior”

* “real housewives ignorant” (the RHOBH post did get a lot of comments)

* “gay stereotypes in reality television” (Zel’s guest post)

* “gender identity”

* “adolescent/human development”

* “mitch albom accept who you are and revel in it” (which took them here…showing Albom not reveling in it)

And some creepy and disturbing searches that hopefully led searchers to this blog and perhaps taught them something:

* “how to get any woman to drop her panties”

* “how do young girls get hotter”

* “funny rape jokes”

* “sexy women lying on train tracks”

* “in duke do you need to use the vibrator on the woman”

* “how to take a feminist down a peg”

* “how to take a woman down a peg”

Well, that about sums it up! Looking forward to many more conversations in the upcoming year!

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Filed under Advertising, Child Development and Child Health, Defining Gender, Education, Feminism, Gender Stereotyping, Health Education, Media, Politics, Pop Culture, Public Health, Rape and Sexual Assault, Sexism, Violence, Violence Against Women

Sebelius Caves, Girls Pay the Price

By now, I’m sure you’ve all heard that Kathleen Sebelius, the Secretary of Health and Human Services, has blocked the recommendation of the Food and Drug Administration that the over the counter (OTC) drug Plan B, commonly known as the ‘morning after pill,’ be made available without a prescription for girls of all ages. It is currently available without a prescription to girls ages 17 and up, and requires a prescription for girls ages 16 and below.

It is worth noting that this is the first time a Secretary of HHS has overruled the FDA. This is not insignificant. The purpose of HHS is to promote the health, safety, and well-being of Americans. The FDA is an obvious component of this. While the FDA is an agency of HHS, the purpose of the FDA is to promote and protect public health, through the regulation of OTC and prescription medications, vaccines, food safety, medical devices, and more. They do this through clinical trials and testing, which is how we come to know of drugs’ side effects as well as how significantly they aid in the relief of what they purport to treat. The FDA recruits researchers who understand both the purpose of and execution of this research. Attempts have been made to loosen the regulations of the FDA; for example, some terminally ill patients have petitioned the FDA to allow them to access experimental drugs after Phase I of a trial – the FDA has denied these requests due to the lack of research regarding a drug’s long-term effects post- Phase I. The FDA is not without criticisms; they have been accused of being both too hard and too lax on the pharmaceutical industry. Members of the FDA have also expressed feeling pushed to present certain results. Scientists at the FDA complained to Obama in 2009 that they felt pressured under the Bush administration to manipulate data for certain devices, and the Institute of Medicine also appealed for greater independence of the FDA from the powers of political management.

The commissioner of the FDA, who is a physician, reports to the Secretary of HHS. Sebelius’ job is not one of medicine or research, and requires a background in neither. It does require a background in politicking, which is exactly what we’re seeing here. The purpose of pointing that out, and of articulating that this is the first time a Secretary of HHS has overruled an FDA recommendation, is that Sebelius’ refute would not be based on differing scientific results, or research that opposes the FDA’s recommendations – because there is none. The override has different drivers, and the assumption floating out there – for good reason, since there is little alternate explanation – is to appease social conservatives and the anti-abortion contingents.

Plan B is not the abortion pill. It is the equivalent of an increased dose of a daily birth-control pill, and has no effect on already established pregnancies – it prevents pregnancy from occurring. Scientists within the FDA unanimously approved the access of the drug without a prescription for girls of all ages, after an expert panel put the recommendation forward. It is, to quote a USC pharmacist, one of few drugs that is so “simple, convenient, and safe.”

The conservative Family Research Council claims that requiring a prescription will protect girls from sexual exploitation and abuse – I fail to see how requiring a girl to get a prescription will protect against sexual violence, especially since girls may be attempting to get Plan B because sexual violence has already occurred. This comment is also a flagrant indication of misunderstanding of sexual violence and abuse – a young girl is not likely to disclose to an unknown physician that she is being sexually abused or assaulted and that’s why she needs a prescription for Plan B. Make no mistake, this ban is a victory for anti-abortion rights activists. If a girl cannot prevent a pregnancy from occurring, she is subsequently faced with trying to terminate an existing pregnancy (again – that could have been prevented!). Given how reproductive and abortion rights have been systematically chipped away at for the past few years, this girl who did not want the pregnancy and tried to prevent it from happening but was denied because she is shy of 17 years, will be in an even worse position. This is what anti-abortion activists are counting on – that once she is pregnant she will have to carry to term.

Plan B can prevent abortions from happening. HHS, with its mission of protecting the health and welfare of all citizens, should do everything they can to protect the health of girls’ reproductive development, which includes the prevention of unwanted pregnancy at its earliest stage. The girls under the age of 17 who need Plan B the most are the ones who also need it to be as easily accessible as possible. Much like requiring parental permission for abortions for girls under the age of 18, this ban actually can put girls at risk. Many girls will not have the family support, financial means, or healthcare to manage a pregnancy; some girls may face parental and familial abuse if they have to admit to needing to prevent a pregnancy with Plan B. What if a girl is a victim of sexual assault within her family? Should she be forced to deal not only with this trauma, but also have to determine how to prevent herself from being forced to carry a fetus to term as a result of this tragedy? Most girls under the age of 17 do not have easy access to clinicians and hospitals on their own, nor are they able to navigate our increasingly complex healthcare system on their own, which they would not only need to do to access Plan B, but would need to do within 72 hours for the pill to be effective. Girls whose bodies are not ready for pregnancy, girls who were victims of assault and rape and incest, girls whose futures will be dramatically changed and opportunities truncated – they all become casualties of this ban. Before we start sex-shaming and proclaiming that they shouldn’t have had sex if they didn’t want to deal with the consequences, let’s remember that these girls were not miraculously impregnated. Whether consensual or not, a boy was involved. This is a gendered issue – the girls are the ones who will have to deal with the lack of access to Plan B, physically, mentally, and emotionally.

Originally, advocates in 2003 successfully petitioned Plan B to be available OTC for girls 18 and up (after having been available with a prescription since 1999), but a judge overruled that decision and lowered the age to 17 after he deemed the decision had been made politically, not for scientific reasons. It appears that history is repeating itself.

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Filed under Education, Feminism, Health Education, Politics, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Sexism, Women's Health

Good Riddance, Paterno.

After watching the appalling, immature response to the rightful firing of Joe Paterno last night, I had difficulty sleeping. I could not reconcile in my mind how people were so willing to further discard these children who were victimized, further negate their trauma and reduce their suffering to something negligible and less important than the football trophies lining Penn State’s halls. I’m not introducing the main characters of this post, because by now I’m sure you all know them.

In situations like these, you don’t even have to say “I’m on Paterno’s side,” which is just what all the screaming rioters on Penn State’s campus and outside his home are doing. By bemoaning a lost season, a coach’s supposedly truncated career, a football team’s interrupted success, you are contributing your voice to the chorus of people who think this isn’t such a big deal. That the interruption of Penn State’s stellar season is actually what’s pretty sad! That a coach with such success deserves to be forgiven for some things! And they were awful things, but they happened years ago! And he reported it to the Athletic Director, so he did his job!

If you’re a rape or sexual assault victim, that chorus can sound mighty deafening. And ceaseless.

So, I’m here to tell you that this is a big deal. A really $&%/!*$ big deal. And I can’t help but cringe anytime I hear a comment on this issue that hints at anything otherwise. That Paterno didn’t have this in his control. That reporting a criminal act and the victimization of a child to an administrator with no follow-up was sufficient. That marching his ass down to the closest precinct wasn’t something he unquestionably should have done, and ensured that Sandusky didn’t get within a hundred yards of a kid ever again. We are told that we should do the best we can with what we know; Paterno and McQuery did nothing of any consequence with what they knew. They moved at a glacial pace and took actions that were of minimal requirement. They worked at a university and with students, whose well-being is ostensibly the greatest concern of any educational institution. In case anyone doubted that the cash cow athletics of some colleges is what is of greatest concern, I give you this sick and disturbing example. There is quite literally no excuse, no “explanation” of the multiple failures of multiple leaders, that doesn’t rest on the fact that compromising a winning and money-making football team was in no way an option, that this team would not be brought down by ANYthing, not even the physical, emotional, and mental sacrifice of children.

Do I sound pissed? You bet I am. You should be, too. Let’s try, for a daring second, to re-prioritize the issues of our country. Let’s move “college football” from its precious perch and consider the prevention of rape and sexual assault to be of greatest importance. The swift punishment of the criminals who perform these acts to be the first order of business, not falling behind the next desperate grasp for a game win, a series win, a university parade.

I don’t care much what happens to Paterno and the other members of a coaching or admin staff who have had blessed careers and public lives rife with success. What I care about is the little boys who suffered rapes, forced oral sex, molestation, tried to negotiate the fear, humiliation, anger, and physical ramifications of these. Who did not leave the locker rooms, living rooms, camping trips or tents with any swollen bank accounts, any buildings or stadiums named after them, any hordes of fans claiming that they supported them no matter what. Yep. I’m on their side.

And to those screaming Penn State students, knocking over news vans and co-opting an act (rioting) reserved for disenfranchised populations (of which you are not) to demonstrate their subjugation, I’m going to bring this down to as personal a level as I can. I ask of you this: You have a father. Or a brother. Or a son. Or a boyfriend. Or just a close friend. Someone you love and care deeply for. Imagine they had been anally raped in the Penn State locker room, and someone had walked in and seen it and done nothing. Walked right back out instead of saving him. And that the very man you are crowing about knew of it. And turned his head. And your father/brother/son/boyfriend/friend was ignored, his pain deemed not important or relevant, his subsequent suffering that you would have witnessed first hand dismissed and cast aside. Now picture him standing in front of this narcissistic crowd, and asking you to tell him to his face that his raping isn’t as important as your beloved football coach keeping his job. If you can easily do that, then we are in even more depraved trouble than I thought.

After the absurd riots started following his firing, Paterno said that he appreciated the outpouring of support but to please “remain calm and respect the university, its property, and all that we value.”

Respect the university! Nothing about those boys, still, who I knew were raped and assaulted, nothing about respecting them and their pain and ordeal. Respecting the university doesn’t appear to have been on Paterno or McQuery’s mind when they covered up rape, abuse and molestation cases that would ultimately be forever associated with the university and debase its reputation. They showed no respect for the little boys who lives were forever marked by the despicable actions of their buddy Sandusky. They created a chain of administrators and coaches who failed time after time to immediately stop and fix this. So, no, Paterno, despite that your plea was directed at your supporters, I’m pretty riled up and have lost respect for much of Penn State myself. Remain calm and respect the university? – that’s a mighty tall order. Don’t think I can fill it.

He followed his statements with this claim: “With the benefit of hindsight, I should have done more.”

How hollow that rings.

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Filed under Child Development and Child Health, Politics, Rape and Sexual Assault, Violence

Your Underwear = Free Drink. Fair Trade?

This story hasn’t seemed to catch on in the States yet, but a bar in Dublin is offering girls free drinks in return for their underwear.

I’ll let that new currency sit with you for a minute, and add to this that the bar in question is the very same site in which a 15 year-old reported being sexually assaulted earlier this summer.

I’m going to tackle this in two ways – both in regards to the sexual assault and in regards to the pitch that women lose their undergarments in a bar. That they aren’t asking for a jacket, or a shoe, or a sock, or a headband, or, frankly, not asking women to give up anything at all for drinks other than their cash money, is not lost on me.

The idea behind this kind of promotional event is simple. By encouraging women to drop trou under the auspices of saving them some dough and by presenting it as something of a game – if you do this, you win this – they’re trying to mask the creepiness factor with a jolly sentimentality and, it seems, a savvy sense of the economical. This not only is an attempt to cover up their hopeful possibility of granting some men a free show, but the effort to make it lighthearted is done to silence critics as prudish wet blankets. However, selling this as a game – the exchange of alcohol for valuable organ protecting clothing – sets the precedent that one’s sexuality and access to it is in fact up for sale, and also strengthens the harmful thinking that by buying a woman a drink she automatically becomes sexually accessible. The existence of this promotion, regardless of whether or not women participate in it, actually reinforces this thinking. And given the jokey presentation, those who do not participate in it are liable to be seen as ruining everyone else’s fun. Any woman who has been pressured to take a drink from a man in a bar can assure one of that. Bars have been mating and meeting grounds for years – why not just continue to let men and women buy their drinks, meet, have a chat, see where it goes – without the unnecessary orchestration of a woman removing her underwear before even being introduced?

It seems pretty callous for this bar to promote this kind of “deal” after a young girl rounded up the courage to report that she’d been raped in this club’s bathroom. Even if we were to assume that their misguided vision – one of supposed sexual prowess – was what led them to create this promotion, did no one suggest that given the recent bathroom forced sex encounter perhaps they shouldn’t encourage women to drop their underpants in an alcohol-fueled environment that is essentially paying them to strip? The bar asked for underwear because removing underwear promotes the assumption that the sex region is open for business, and willingly so. They asked for underwear because they think it’s titillating, because sex sells, because they figured a lot of men would likely show up that evening under the impression that some half-naked drunk women would be hanging out by the taps. And what comes next in this line of logic I’m sure you know. They think they might get lucky. Alcohol has long been a factor in discussions around consent and what it means. If a girl is too drunk to coherently consent to sex – something one could see happening when they are given free alcohol for an entire evening – then the sexual encounter is non-consenual. By objectifying the sexuality of these women as something that can be bargained for, I worry that certain people may consider their consent negotiable as well. Is a drunk woman up sexually up for grabs? Absolutely not. Is it a drunk woman’s fault if she is sexually assaulted? Double-no. Is presenting the exchange of goods for the stripping of clothing minimizing a woman’s sexual agency and glorifying the idea that women can be bought? Yes. Can a woman participate in this promotion and still make a decision to engage or not in consensual sex? Sure. But this is about the fact that a bar took on the role of mediator in sexuality, and the reason I can’t think of any women or girls I know taking on this bar’s “challenge” isn’t because they are prudish, and it isn’t because they don’t like to drink – many do. It’s because the foundation of this promotion reinforces the dominant gaze of men who watch while women barter their bodies for money or substances.

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Filed under Feminism, Gender Stereotyping, Rape and Sexual Assault, Sexism

Turns Out, Rape Isn’t Funny. Surprise!

Feministing posted about the opening skit of SNL’s season finale yesterday, and thank god they did because when I saw this sketch on Saturday I sat there thinking “I can’t be the only person who thinks this is totally not amusing.”

But yes, I feel like it needs to be pointed out that rape isn’t funny no matter who is getting raped or doing the raping. Joking about prison rape really negates the very real trauma people who are raped in prison experience and feel the repercussions of for the rest of their lives – like all rape victims. It delegitimizes the fight against sexual assault. When people rightfully denounce the deplorable actions of DSK and then turn around and joke about how hilarious it is to think about him being raped in prison, you lose the validity of your argument. You lose your audience who then go on to think that since it was so easy to mock the attack of someone else – however villainous he may in fact be –  it’s actually not a huge deal, and hey, if you change your perspective, it can be kind of funny. It’s not hilarious when a sex worker is raped, it’s not hilarious when a girl someone thinks is wearing “slutty” (whatever the definition of that now is) clothes is raped, it’s not hilarious when an attacker is then raped him or herself. That kind of eye for an eye retribution should be long out of style. Let’s try to truncate the cycle of hate, not add to it even by jokingly assuming that it would be funny for an assaulter to know what it feels like.

I once saw a comedian who made a rape joke and was rightfully (but very mildly) booed by part of the audience. After her performance, someone tentatively brought up the fact that she had made light of a very serious, very traumatic issue. I myself had been concerned about the possibility of rape victims being in her audience, who may have relived the trauma and felt fear, anxiety, anger, and confusion rise in their gut as they recalled an assault they may have experienced, while the comedian on the stage just laughed it off. The comedian’s response was that she felt “everything should be able to be joked about,” that everything can be funny. Well, I obviously disagree; in that response there seems to be a lack of awareness, a lack of respect, a lack of empathy. I don’t think rape jokes are funny, because I don’t want anyone to think that I don’t take their experience seriously, and I don’t want them to think at all that any part of their attack could be seen as worthy of a snicker. I don’t think AIDS jokes are funny because most of the people I have worked with as an HIV/AIDS educator don’t find their painful condition very funny, nor the circumstances (cost of medication, treatment options, co-morbidities, shortened life span, loss of friends and family) very funny. If you’re a good comedian, a good writer, a good actor – you must be able to come up with material that doesn’t cover the grounds of assault, no?

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Filed under Health Education, Media, Public Health, Rape and Sexual Assault, Violence