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    More Common Than Not: Sexual Violence Among LGBTQ Persons

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    Photo Credit: Buzzfeed

    In a first-of-its-kind national report, the Centers for Disease Control and Prevention released a comprehensive set of data on intimate partner violence, titled “The National Intimate Partner and Sexual Violence Survey.” This data provides insight into the prevalence of sexual violence, categorized by factors such as gender, sexual orientation, frequency and age at first victimization. The intent of such a report is to serve as a benchmark for prevention, education, and social service efforts at reducing sexual violence.

    While reviewing the data, I was struck by the astronomical rates of sexual violence against individuals identifying as lesbian, gay, or bisexual. According to the report, 46.4% of lesbian women, 74.9% of bisexual women, 40.2% of gay men and 47.4% of bisexual men report being victims of sexual violence, respectively. These numbers highlight the frightening reality of sexual violence facing individuals identifying as LGBT.

    To help shine some light on what factors may be driving this data, I sat down with Alicia Allen, of Spectrum Recovery Solutions. Allen, a relationship counselor and sex researcher, answered some of the questions I had and offered her unique perspective on this staggering problem.

    1. According to the study, the rates of sexual violence among individuals within the LGBT community are significantly higher than in the heterosexual community. What are your thoughts when you see these statistics?

    I find it incredibly tragic when I hear about sexual violence against any individual, but especially against those who are marginalized by society because they don’t fit the mold. For me, these statistics show how we, as a society, have not done our part to protect all our members. While the Violence Against Women Act of 2013 was extended to include the LGBTQ community in helping those affected by domestic and sexual violence access resources, this is not enough. We have failed to create a safe space for those who have been assaulted and to provide adequate outreach and education to those who are at risk. We need to have these programs starting in the schools and going into the communities. Bottom line is that we are not providing protective factors or practicing harm reduction.

    2. It is interesting to note that the rates of sexual violence among bisexual men and women are much higher than in gay men and lesbian women. What might be a reason for this?

    This is a very important question that needs to be addressed. As for why this is, I have to say that we need further research before we can start speculating on causation. As the study shows, almost half of the bisexual women who responded experienced their first rape between 11 and 17 years old, as opposed to only 17.4% of the heterosexual women surveyed. Not only that, but both bisexual and heterosexual women reported that their perpetrators were exclusively male. So, people are taking those two statistics to try to say that women become bisexual because they were raped by a man. This simply is not true. Unfortunately, we as a society do not accept the natural fluidity of female sexuality over the lifespan. Regardless, we have no concrete answers as to why bisexuals are at the greatest risk for abuse. However, we do know what is needed is prevention and education. We need to be proactive to help combat intimate partner violence and sexual assault.

    3. What role, if any, do factors such as discrimination, social norms, and policy play on the rates of violence against members of the LGBT community?

    This is a really good question. As I stated before, society plays a large role. It’s a dialectical role. The LBGTQ community has gained momentous rights in the past couple of years through advocacy, education, and rallying of the public. However, there are still big pockets of our society that hold onto antiquated and inaccurate notions about sex, sexuality, and gender. We are still struggling with the “blame the victim” mentality. “She was dressed like a slut.” “What was he doing out that late at night in that guy’s apartment?” Things like that. Then there’s policy. In the same year where the US Supreme Court upheld marriage equality, they also shot down The Student Non-Discrimination Act that was created to protect LBGTQ children from bullies. The wonderful organization dedicated to advocating for the LGTBQ, Give A Damn Campaign, has reported that almost 90% of LGBTQ youth have experienced verbal and physical abuse AT SCHOOL. What message are we sending when we do not protect the most vulnerable among us, our children?

    4. How can social workers and mental health professionals be more sensitive to the needs of LGBT clients who may have a history of sexual or physical violence?

    With this study, we as clinicians know that the possibility of a trauma history is increased when working with our LGBTQ clients. The first thing we have to do as clinicians is understand our own value system. Do we hold even the most benign of prejudices? Then we need to use a systems perspective to look at how well informed we are of the environment of our clients. Do we know what our clients face on a day-to-day basis in their homes, workplaces, school, etc… And finally, and I cannot stress this enough, we need to have a trauma-informed practice. When we use the trauma informed approach to therapy, we appreciate how intrusive the trauma is on our clients’ lives and how it can be an obstacle to both physical and mental wellbeing. Having a trauma informed practice means integrating this knowledge into our policies and procedures. With this approach, we are saying that from first contact we will create a safe place for growth and healing for our clients.

    5. Is there anything social workers and mental health professionals could be doing better to help reduce the rates of sexual violence among members of the LGBT community?

    There are three things that we can start with:First, know the community. That means be aware of what the LGBTQ community experiences from both a macro and a micro level. Keep yourself educated on laws, practices, and policies that are discriminatory in nature. Know what resources are out there to help combat this. If there aren’t any or they are not enough…then get involved.

    Second, educate the community on what bulling, intimate partner violence, and the bystander effect looks like in our everyday lives and strategies to combat these.

    Finally, advocate. Advocate for equal protection. Advocate for effective and accessible resources. Advocate for change.

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    Paul C. Milford, MSW is a social worker specializing in the assessment and treatment of children, adolescents, and families. Milford has a passion for helping others find the keys to their own success and draws from a variety of therapeutic modalities to help them do so. Milford received his Master of Social Work degree from the University of South Florida. Milford's clinical areas of interest include behavior management, depression, chronic disease management, relationship issues, school performance, and anxiety within the individual and family systems.

    Justice

    Partnering with Clergy to Prevent Domestic Violence

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    Domestic violence remains a serious and widespread problem in the U.S., particularly for women from racial or ethnic minorities, who experience higher rates of abuse than the national average. Now, a team of researchers from the University of Georgia have developed an online training that leverages the influence of religion to prevent intimate partner violence in Korean American communities.

    The CDC defines intimate partner violence as physical or sexual violence, stalking, or psychological harm caused by a current or former partner or spouse.

    “For many immigrant communities, the commonality that I witnessed, and that research bears out, is that religious organizations and religious leaders are a very important piece of the puzzle to prevent partner violence because they have so much power in the immigrant communities,” said project lead Y. Joon Choi, an associate professor in UGA’s School of Social Work.

    While some religious traditions have at times reinforced gender inequity and norms that discourage women from seeking help, religious leaders have the power to shape attitudes and behaviors within their communities and promote new norms that support healthy relationships and reject partner violence.

    Aware of this critical influence of religious leaders, Choi wanted to not only educate clergy on the problem, but empower them to speak out against violence and support parishioners who come to them for help.

    Choi collaborated with Pamela Orpinas, professor of health promotion and behavior in UGA’s College of Public Health who also studies intimate partner violence, and instructional designer ChanMin Kim with Penn State University, to build a program comprised of four interactive case simulations that guide clergy through real-world scenarios. The program is called Religious Leaders for Healthy Families.

    The researchers worked with domestic violence prevention groups and gathered feedback from Korean American faith leaders to present cases that were culturally appropriate and supported the clergy’s ability to be domestic violence prevention advocates.

    “What we wanted to see was behavior change,” said Orpinas. “After this training, are faith leaders going to be able to help victims when they suspect abuse? Are they going to be involved in the prevention of partner violence within their congregation?”

    The key, say the researchers, is to build confidence within faith leaders that they could take action to promote healthy relationships and connect domestic violence service providers to parishioners who need their support. The interactive case simulations allow clergy to practice responding to victims who are experiencing different types and degrees of partner violence in a safe space.

    “We wanted to make sure that through this medium, they were able to practice how they are going to interact,” said Choi, “and also they are going to learn what are good responses versus dangerous, unsafe responses for the victims. We are hoping to increase their self-efficacy through this intervention.

    Though this project is focused on Korean American clergy, the team designed the modules to be easily translated to other communities.

    “Much of what they need is there,” said Orpinas, “in terms of asking open-ended questions and supporting and believing the survivor. The case simulation helps clergy practice how to talk about those things.”

    The team is eager to see the program be adopted more broadly by immigrant communities or any community where faith leaders are trusted and influential resources.

    The full development of the online program, including theoretical underpinnings, community feedback, and performance objectives, is described in a paper published in Health Promotion International. It is available here.

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    Health

    How Investing in Young Black Women During Sexual & Reproductive Health Care Can Address Inequities

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    Dina took to Google after feeling some discomfort in her pubic area. Although she was in graduate school several hundred miles away, she waited to see a healthcare provider until she could return home. During her visit with her gynecologist, she learned that her intrauterine device had become dislodged and was moving around—this was the cause of the pain. After talking with her healthcare provider, she decided to get a new device inserted within two days. This outcome was relieving, because what she had found online had scared her and created additional uncertainty around the symptoms she was experiencing. While Dina was able to find the support she needed from her provider, she also experienced a delay in care because she was unsure that she could expect the same level of support from a different provider closer to her school. Dina’s story is not unique: due to previous mistreatment in healthcare settings, some young Black women fear contraceptive care visits will be harmful—or, if they have had favorable experiences, that a worse healthcare encounter is likely.

    Aja approached her visit with worry and some optimism. She had been experiencing pain during sexual activity that was becoming increasingly bothersome. She reluctantly shared this information during her annual visit with her gynecologist. Despite having seen more than five different providers over the years for this issue, this provider was the first to empathize with her and acknowledge that sex should not be painful. Although Aja already understood this, hearing it from her healthcare provider and coming up with a plan to find a solution were healing for her. This provider explained the various tests she would order and the reasons why, and solicited Aja’s opinion. Aja described feeling included and informed throughout the visit, and left feeling more at ease and confident that her provider took her seriously. Other providers had not taken the time to listen to her, and often prescribed new methods of birth control without acknowledging her pain or frustration with having to deal with the condition.

    While technical aspects of contraceptive care provision can be improved to save patients’ time and money, social and emotional aspects of care provision should not be overlooked. Interviews with cisgender Black women ages 18-29 about their experiences receiving contraceptive care highlighted how important it was to feel heard, understood, and included during provider visits. Women appreciated when providers took the time to empathize, especially if they presented to visits with uncertainty, unexplained pain, and other health issues. These findings demonstrate a need for health systems to “put the care back into health care” and focus on sexual and reproductive health and well-being as a primary goal of healthcare encounters. Health systems can equip providers to engage patients in ways that are adequate, affirming, and responsive to their health needs, especially for those who have historically experienced neglect and mistreatment by health care providers.

    Although health care systems would likely believe that their providers offer care that is person-centered and high-quality, women’s narratives do not align with these perspectives.

    How to Invest in Contraceptive Care Services for Young Black Women

    Before engaging with patients in the clinic, providers should:

    • Learn about and acknowledge the role structural oppressions have on people’s access to contraception and health care in general, and
    • Engage in training and education related to cultural humility and person-centered contraceptive care.

    During visits, providers should:

    • Greet patients warmly and consider sitting, rather than standing next to a seated patient
    • Ask the patient about what they want to discuss during the visit
    • Inform them of care procedures and processes before performing them
    • Engage individuals in a dialogue around their health, providing appropriate and relevant education as needed
    • Engage in active listening, asking questions for clarification and repeating back pertinent information
    • Take the patients’ concerns seriously, demonstrate empathy
    • Gain their permission before placing orders
    • If patients experience physical or emotional discomfort during visits or examination, try to reduce discomfort, stop performing the procedure, and ask what could mitigate discomfort
    • Acknowledge when they do not have the answers
    • Demonstrate an overall commitment to helping them achieve their goals and sexual and reproductive health and well-being

    A small investment in person-centered care approaches may significantly change the perceptions and experiences of young Black women who use contraceptive care services. As this group has borne the brunt of poor contraceptive care encounters, changing a person’s care experience early in the reproductive health care trajectory may help to address inequities in reproductive healthcare settings. Collectively, contraceptive care service users, healthcare providers, and healthcare systems can work together to achieve sexual and reproductive health and well-being. Health systems can incentivize providers to engage in person-centered contraceptive care approaches by offering training and monitoring person-centered care outcomes. Third party payers focused on ensuring quality provision of healthcare services, including a focus on health equity, could incentivize health systems to implement such measures through pay-for-performance structures. At the provider level, clinicians should partner with service users during visits to establish relationships and foster the trust needed to learn of people’s needs before helping to find solutions. Although the focus here is young cisgender Black women, person-centered and equity-oriented approaches to sexual and reproductive health care can be applied to any service user population—by investing in people, we can help them attain better sexual and reproductive health and better well-being overall.

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    Justice

    The Future of Criminal Prosecution for Self-Induced Abortion & Pregnancy Endangerment

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    The intensifying avalanche of restrictive U.S. abortion laws since 2012 has made it more difficult for many people to terminate their pregnancies. These restrictions have also had the effect of increasing what are considered illegal abortions. But the face of illegal abortion has shifted since the 1973 Roe v. Wade decision by the Supreme Court. Today’s procedures rarely resemble the back-alley abortions of the past, given the availability of medications that can effectively induce abortions and the rise of the internet as a tool women can use to procure such medications and to learn how to use them. Some things, however, have not changed. Just as pregnant women were sometimes prosecuted after aborting or attempting to abort pregnancies in the pre-Roe era, pregnant women today are still sometimes prosecuted for similar acts, even if the exact methods are different.

    In the United States, pregnancy occupies a contradictory socio-legal space. For many, pregnancy and resultant parenthood are much desired (and encouraged) conditions. But being pregnant can also result in the loss of important constitutional rights, including rights to privacy, liberty, and free religious expression, along with rights to due process, freedom from cruel and unusual punishment, and equal protection. Because of the potential for such lost rights, my research argues that pregnancy legally creates a lower class of person – a situation I call “pregnancy exceptionalism.” Pregnant women hold a tenuous position under the law if they go outside legally recognized methods of abortion, either by choice or because are otherwise unable to access those methods. An examination of recent instances in which pregnant women have been prosecuted offers possible clues as to future directions of the law, insofar as reductions in pregnancy prevention services continue along with erosion of legal options for ending pregnancies.

    Prosecuting Pregnant Women

    Three states – Alabama, South Carolina, and Tennessee – have expanded criminal law through legislatures or courts to include what they define as “unborn children.” My research on these three states has identified nearly 900 cases of arrest of pregnant or formerly pregnant people for terminating, attempting to terminate, or otherwise causing harm to their pregnancies between 1973 and 2016. In all three states, arrests of pregnant women for these offenses occurred before formal definitions were entered into the code of law.

    Other states have taken similar steps. To date, every state but Vermont and Delaware has participated in the arrest and prosecution of pregnant women, allegedly in defense of their embryos and fetuses. Most of these arrests have involved pregnant women or newborns who tested positive for drugs, but cases involving attempted suicide have also been documented. One woman who attempted to evade the police was additionally charged with reckless endangerment of a minor because she was running while pregnant. Mysteriously, two women were charged with crimes against their “unborn children” but were later released when they were found not to have been pregnant in the first place. Other arrests occurred when pregnant women attempted to abort their pregnancies illegally, or were accused of doing so.

    Prosecutions of pregnant women have gotten little public attention, with some exceptions in cases where medical providers reported women who were later prosecuted:

    • In Indiana in 2013, a woman named Purvi Patel was hiding a pregnancy from her conservative Hindu parents. She expressed some ambivalence about the pregnancy and texted a friend about procuring abortion pills online. After having a miscarriage at her family’s restaurant, Patel placed the fetus in the dumpster. She eventually went to the hospital, where policy interrogated her. Later, she was arrested for causing the fetus’s death, convicted and sentenced to two concurrent 20-year sentences. An appeals court later vacated the feticide charge and reduced her sentence to 18 months.

    • In Tennessee in 2015, Anna Yocca allegedly attempted to perform a self-induced abortion using a wire clothes hanger. At 24 weeks pregnant, Yocca would have needed to travel to Washington, New York, Maryland, or Colorado to obtain a legal abortion. When she began to bleed heavily, her boyfriend drove her to the emergency room. She received medical care and her baby survived, although the baby was born prematurely and likely to have lifelong disabilities. After Yocca’s healthcare providers notified police that Yocca made “disturbing” statements about wanting to end the pregnancy, she was charged and arrested for attempted murder.

    Key Questions for Continued Research

    As nascent research proceeds on prosecutions of pregnant women dealing with new legal restrictions, many important questions remain to be investigated:

    • How and why are people pursuing illegal abortion in the United States?

    • How has illegal abortion changed since Roe v. Wade, both legally and practically?

    • How are state legislatures and courts addressing illegal abortion?

    • What are the characteristics of criminal cases brought against women who have sought or procured illegal abortion?

    • What are the legal arguments used in making these criminal prosecutions?

    No matter the answers to these questions, it is already clear that as legal abortion becomes harder to access, women will likely seek extra-legal means of terminating undesired pregnancies, even if such efforts may result in their prosecution and imprisonment. As researchers examine the safety of newer medications and technologies for self-induced abortions, they must also explore the legal risks and treatment facing people who make use of those methods. The possibility that a new Supreme Court majority may overturn Roe v. Wade or further eviscerate legal abortion rights warrants a thorough examination of the precedents that will go into adjudicating cases like those of Puri Patel and Anna Yocca that, while rare in the past, may appear more frequently in the future. More research now can help all concerned be better prepared for the new legal as well as medical world that may arrive as legal abortions become more circumscribed in the United States.

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