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Could Emergency Department Care of Sexual Assault Victims Be Improved?

May 13, 2008

A new study published in the journal Contraception attempts to partially answer this question through a survey of emergency departments in Illinois, conducted in summer of 2004. The authors describe 10 elements of comprehensive care for sexual assault victims presenting to the ED, including acute medical care, history and physical exam, acute and long-term rape crisis counseling, prevention and treatment of sexually transmitted infections, prevention and treatment of HIV, and emergency contraception counseling and provision.

As expected, 100% of the 156 surveyed emergency departments provide acute medical care to victims of sexual assault. However, the authors note that 92% of the surveyed EDs are missing at least one of their elements of comprehensive care, and that in many cases a written protocol guiding care was not in place.

Among the other results: (respondents described services as always, sometimes, or never being offered, or indicated that they did not know)

  • 88.4% always offered same-day rape counseling; 3.2% “never” did.
  • 89.7% report “always” testing for STIs; 2.6% reported never testing.
  • 71.8% “always” tested for HIV, while 10.2% never tested.
  • Prophylaxis for STIs was offered more frequently than for HIV, with 81.4% and 31.4% respectively “always” providing this service. The authors note that routine HIV prophylaxis after sexual assault is controversial and not endorsed by the CDC.
  • 74% “always” provided counseling on emergency contraception.
  • 59.6% always provided emergency contraception, 31.4% sometimes provided it, 5.1% never provided it (and some didn’t know).

It’s too bad that the authors didn’t provide additional detail on the geography, affiliation, or other factors that may affect a hospital’s decisions with regards to EC and other services. For example, 5.1% reported never providing counseling or access to emergency contraception, but we don’t know if those are religiously affiliated hospitals or if other barriers were in place. A few hospitals elected not to participate, and their characteristics are not described, so we don’t know if their inclusion would have affected the outcome.

Finally, the authors note that state law (under the Sexual Assault Survivors Emergency Treatment Act, already in place at the time of the survey) mandates “counseling on EC to victims of sexual assault…This study demonstrates that, in spite of the Illinois law, counseling on EC occurs only 70% of the time. Counseling with on-site provision of EC occurs in only 39% of EDs.”

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