PubMed · 16043580
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Jody Raphael, Deborah L Shapiro. 2005. Reply to Weitzer.. https://doi.org/10.1177/1077801205277041
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Thirty publications that evaluated health care-based interventions for women who experienced sexual violence were reviewed. The findings highlight that clinicians often need training in the provision sexual assault care, and that not all emergency departments have sexual assault care protocols. Studies examining effectiveness found that Sexual Assault Nurse Examiner programs are very helpful, that health care-based sexual assault treatment settings attract more women than do forensic-based settings, that sexual assault survivors often prefer a combination of medication and counseling treatment, and that preexam administration of a video explaining the collection of forensic evidence may reduce women's stress during the procedure. Studies on postexposure HIV prophylaxis found that many women did not complete the treatment regimen, often because of side effects. Emergency contraception to prevent postrape pregnancy is not consistently offered to women. Only one study reported on abortion as part of the range of sexual assault services.
Although there are psychometric evaluations of the Revised Conflict Tactics Scales (CTS2) when applied to heterosexual relationships, none has used item response theory (IRT). To address this gap, the present paper assesses the instrument's physical violence subscale. The CTS2 was applied to 764 women who also responded for their partners. Single dimensionality assumption was corroborated. A 2-parameter logistic IRT model was used for estimating location and discriminating power of each item. Differential item functioning and item information pattern along the violence continuum were assessed. Gender differences were detected in 3 out of 12 items. Item coverage of the latent trait spectrum indicated little information at the lower ends, while plenty in the middle and upper ranges. Still, depending on gender, some item overlaps and regions with gaps could be detected. Despite some unresolved problems, the analysis shows that the items form a theoretically coherent information set across the continuum. Provided the user is aware of possible drawbacks, using the physical violence subscale of the CTS2 in heterosexual couples is still a sensible option.
This forum focuses on the health sector's response to sexual violence against women, analyzing the policies formulated by the Brazilian Ministry of Health and the protocol in two academic health centers. The premise is that an approach to sexual violence requires the discussion of women's autonomy in relation to their bodies and thus their right to abortion. This intrinsic link between sexual violence and morally and politically loaded issues has contributed to the relatively slow response by the public health sector in Brazil. However, the pioneering experience of two academic health centers in treating rape victims demonstrates the importance of these issues in the training of health professionals and the need to guarantee women's expanded and ongoing access to these services.