The sexual assault medical forensic exam gives victims an opportunity to receive medical care for injuries, sexually transmitted infections, and pregnancy prevention. It also connects victims to counseling and timely evidence collection. However, not every victim who may want an exam receives one. What prevents victims from accessing exams?

For many, it’s not the cost. Last week, we released findings from a new national study of the 2005 Violence Against Women Act, which requires states or another entity to bear the full cost for exams, regardless of whether a victim reports the assault to the police. In the 19 jurisdictions we studied, victims generally received free exams without having to report their assault.

But while the focus of our study was on how states were implementing payment practices for exams, we learned that even gaining access to the exam can be an issue, particularly for victims who do not speak English or are from immigrant communities.

Here’s what we found:

• Victims who don’t speak English have a harder time accessing the exam than English-speaking victims. About 3 of every 4 state sexual assault coalitions and over half of local sexual assault agencies reported that non-English-speaking victims had a harder time obtaining exams. Some attributed this to challenges associated with understanding the exam process, the criminal justice process, and their rights as victims. For others, it’s as simple as a lack of access to interpreters or bilingual Sexual Assault Nurse Examiners, medical personnel, and social workers. Sometimes providers rely on family members or law enforcement to translate for victims, which raises serious concerns surrounding confidentiality and privacy.
• Non-English-speaking and immigrant communities can face a lack of sensitive and culturally relevant services. These groups might experience discrimination, hostility, and lack of patience from some direct services providers. Sometimes, immigrant victims—particularly those who are undocumented—fear the criminal justice system, which in turn can make them afraid to seek help.
• Immigrant communities may lack awareness of exams and other services. There seems to be minimal outreach to immigrant communities to educate them about the availability of local sexual assault service providers and how to contact them, and a lack of information in multiple languages.
• Cultural barriers get in the way.  We also learned that in some communities, shame, stigma, and the lack of acknowledgement of rape and sexual assault create significant challenges for victims to come forward and report. And in the event they might make a report, they may not be supported by their families or their community.

These barriers prevent victims from accessing important medical care and other services, and limit the criminal justice system’s ability to hold perpetrators accountable. That is why it is critical to continue to train first responders, such as nurses, advocates, and law enforcement, to appropriately respond to historically marginalized groups and raise awareness about available services through proactive, culturally sensitive outreach.

ER sign photo from Shutterstock