Your Health

Your Health & Rape - Sexual Assault

Sexual Assault

What is sexual assault?

Sexual assault and abuse is any type of sexual activity that you do not agree to, including:

•

Inappropriate touching

•

Vaginal, anal, or oral penetration

•

Sexual intercourse that you say no to

•

Rape

•

Attempted rape

•

Child molestation

Sexual assault can be verbal, visual, or anything that forces a person to join in unwanted sexual contact or attention. Examples of this are voyeurism (when someone watches private sexual acts), exhibitionism (when someone exposes him/herself in public), incest (sexual contact between family members), and sexual harassment. It can happen in different situations: in the home by someone you know, on a date, or by a stranger in an isolated place.

Rape is a common form of sexual assault. It is committed in many situations — on a date, by a friend or an acquaintance, or when you think you are alone. Educate yourself on “date rape” drugs. They can be slipped into a drink when a victim is not looking. Never leave your drink unattended — no matter where you are. Attackers use date rape drugs to make a person unable to resist assault. These drugs can also cause memory loss so the victim doesn’t know what happened.

Rape and sexual assault are never the victim’s fault — no matter where or how it happens.

What do I do if I’ve been sexually assaulted?

These are important steps to take right away after an assault:

•

Get away from the attacker to a safe place as fast as you can. Then call 911 or the police.

•

Call a friend or family member you trust. You also can call a crisis center or a hotline to talk with a counselor. One hotline is the National Sexual Assault Hotline at 800-656-HOPE (4673). Feelings of shame, guilt, fear, and shock are normal. It is important to get counseling from a trusted professional.

•

Do not wash, comb, or clean any part of your body. Do not change clothes if possible, so the hospital staff can collect evidence. Do not touch or change anything at the scene of the assault.

•

Go to your nearest hospital emergency room as soon as possible. You need to be examined, treated for any injuries, and screened for possible sexually transmitted infections (STIs) or pregnancy. The doctor will collect evidence using a rape kit for fibers, hairs, saliva, semen, or clothing that the attacker may have left behind.

While at the hospital:

•

If you decide you want to file a police report, you or the hospital staff can call the police from the emergency room.

•

Ask the hospital staff to connect you with the local rape crisis center. The center staff can help you make choices about reporting the attack and getting help through counseling and support groups.

Where else can I go for help?

If you are sexually assaulted, it is not your fault. Don’t be afraid to ask for help or support. Help is available. You can call these organizations:

•

National Domestic Violence Hotline 1-800-799-SAFE (7233) or 1-800-787-3224 (TDD)

•

National Sexual Assault Hotline 1-800-656-HOPE (4673)

There are many organizations and hotlines in every state and territory. These crisis centers and agencies work hard to stop assaults and help victims. You can find contact information for these organizations at http://www.womenshealth.gov/violence/state. You also can obtain the numbers of shelters, counseling services, and legal assistance in your phone book or online.

How can I lower my risk of sexual assault?

There are things you can do to reduce your chances of being sexually assaulted. Follow these tips from the National Crime Prevention Council.

•

Be aware of your surroundings — who’s out there and what’s going on.

•

Walk with confidence. The more confident you look, the stronger you appear.

•

Know your limits when it comes to using alcohol.

•

Be assertive — don’t let anyone violate your space.

•

Trust your instincts. If you feel uncomfortable in your surroundings, leave.

•

Don’t prop open self-locking doors.

•

Lock your door and your windows, even if you leave for just a few minutes.

•

Watch your keys. Don’t lend them. Don’t leave them. Don’t lose them. And don’t put your name and address on the key ring.

•

Watch out for unwanted visitors. Know who’s on the other side of the door before you open it.

•

Be wary of isolated spots, like underground garages, offices after business hours, and apartment laundry rooms.

•

Avoid walking or jogging alone, especially at night. Vary your route. Stay in well-traveled, well-lit areas.

•

Have your key ready to use before you reach the door — home, car, or work.

•

Park in well-lit areas and lock the car, even if you’ll only be gone a few minutes.

•

Drive on well-traveled streets, with doors and windows locked.

•

Never hitchhike or pick up a hitchhiker.

•

Keep your car in good shape with plenty of gas in the tank.

•

In case of car trouble, call for help on your cellular phone. If you don’t have a phone, put the hood up, lock the doors, and put a banner in the rear mirror that says, “Help. Call police.”

How can I help someone who has been sexually assaulted?

You can help someone who is abused or who has been assaulted by listening and offering comfort. Go with her or him to the police, the hospital, or to counseling. Reinforce the message that she or he is not at fault and that it is natural to feel angry and ashamed.

For more information

For more information on sexual assault, contact the National Women’s Health Information Center at 800-994-9662 or the following organizations:

Division of Violence Prevention, NCIPC, CDC, HHS

Phone: (770) 488-4362

Internet Address: http://www.cdc.gov/ViolencePrevention/index.html

Office on Violence Against Women, OJP, DOJ

Phone: (800) 799-7233

Internet Address: http://www.ovw.usdoj.gov

National Sexual Violence Resource Center

Phone: (800) 692-7445

Internet Address: http://www.nsvrc.org

National Center for Victims of Crime

Phone: (800) 394-2255

Internet Address: http://www.ncvc.org

National Crime Prevention Council

Phone: (202) 466-6272

Internet Address: http://www.ncpc.org

National Domestic Violence Hotline

Phone: (800) 799-SAFE

Internet Address: http://www.ndvh.org

National Sexual Violence Resource Center

Phone: (877) 739-3895

Internet Address: http://www.nsvrc.org

Rape, Abuse, and Incest National Network

Phone: (202) 544-1034

Internet Address: http://www.rainn.org

Reviewed by:

Joyce Lukima

National Sexual Violence Resource Center

Pennsylvania Coalition Against Rape

All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated.

Read More – Go to Women’s Health - http://www.womenshealth.gov/faq/sexual-assault.cfm

October 22, 2009

Rape Victims Denied Health Coverage After Taking PEP

Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month's worth of anti-AIDS medicine.

Only later did she learn that she had made herself all but uninsurable.

Turner, 45, who used to be a health insurance underwriter herself, said the insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication raised too many health questions. They told her they might reconsider in three or more years if she could prove that she was still AIDS-free.

Some women have contacted the Investigative Fund to say they were deemed ineligible for health insurance because they had a pre-existing condition as a result of a rape, such as post traumatic stress disorder or a sexually transmitted disease. Other patients and therapists wrote in with allegations that insurers are routinely denying long-term mental health care to women who have been sexually assaulted.

Susan Pisano, spokeswoman for the health insurance industry's largest trade group, America's Health Insurance Plans, said insurers do not discriminate against victims of sexual assault and ordinarily would not even know if a patient had been raped. These issues you are bringing up, they deserve to be brought up," said Pisano. "People who have experienced rape and sexual assault are victims and we want them to be in a system where everyone is covered."

Turner's story about HIV drugs is not unusual, said Cindy Holtzman, an insurance agent and expert in medical billing at Medical Refund Service, Inc. of Marietta, Ga. Insurers generally categorize HIV-positive people as having a pre-existing condition and deny them coverage. Holtzman said that health insurance companies also consistently decline coverage for anyone who has taken anti-HIV drugs, even if they test negative for the virus. "It's basically an automatic no," she said.

Pisano, of the insurance trade group, said: "If you put down on a form that you are or were taking anti-HIV drugs at any time, they [the insurance companies] are going to understand that you are or were in treatment for HIV, period," she said. "That could be a factor in determining whether you get coverage."

Nurses who deal with sexual assault cases say the industry's policy creates a significant problem for those treating women who have been assaulted. "It's difficult enough to make sure that rape victims take the drugs," said Diana Faugno, a forensic nurse in California and board director of End Violence Against Women International. "What are we supposed to tell women now? Well, I guess you have a choice - you can risk your health insurance or you can risk AIDS. Go ahead and choose."

Turner, now a life and casualty insurance agent, said she went without health coverage for three years after the attack. She second-guesses her decision to take the HIV drugs. "I'm going to be penalized my whole life because of this," she said.

A 38-year-old woman in Ithaca, N.Y., said she was raped last year and then penalized by insurers because in giving her medical history she mentioned an assault she suffered in college 17 years earlier. The woman, Kimberly Fallon, told a nurse about the previous attack and months later, her doctor's office sent her a bill for treatment. She said she was informed by a nurse and, later, the hospital's billing department that her health insurance company, Blue Cross.

Blue Shield, not only had declined payment for the rape exam, but also would not pay for therapy or medication for trauma because she "had been raped before."

Fallon says she now has trouble getting coverage for gynecological exams. To avoid the hassle of fighting with her insurance company, she goes to Planned Parenthood instead and pays out of pocket.

A New Mexico woman told the Investigative Fund she was denied coverage at several health insurance companies because she had suffered from PTSD after being attacked and raped in 2003. She did not want to disclose her name because she feared that she would lose her group health insurance if she went on the record as a rape victim. "I remember just feeling infuriated," she said.

"I think it's important to point out that health plans are not denying coverage based on the fact that someone was raped," said Pisano of the insurance trade group. "But PTSD could be a factor in denied coverage."

Even when patients have coverage, there are fundamental disagreements between insurance companies and doctors about what mental health treatment is medically necessary. The Investigative Fund spoke with doctors, psychologists, and licensed clinical social workers around the country who work regularly with victims of sexual assault. They said that their patients have been experiencing an increase in delays and denials, particularly for talk therapy.

Some therapists and patients said the managed care companies have cut off necessary treatment for sexual assault victims in the name of cost containment. "The companies are peppering them with questions about their symptoms, and about their histories, and asking, 'Well, are you sure you really need therapy?'" said Jeffrey Axelbank, a New Jersey psychologist. "For someone who has been traumatized, it can feel like another trauma, and it makes the therapy less effective."

Pisano, of the insurance association, said it was not fair to draw a larger pattern from such anecdotal evidence. "These situations are evaluated on a person-by-person basis," she said. "There is nothing routine about this."

Magellan Behavioral Health Services, Inc., one of the nation's largest managed-care companies with more than 58 million customers, said that it does not routinely turn down treatment requests from victims of sexual assault or other clients. "We're not denying care. We are exercising our responsibility to make sure that medical necessity is met," said Dr. Lawrence Nardozzi, Magellan's medical director. "I think the process works well."

A former care manager for Magellan said in an interview that she felt pressure to deny care for cost reasons. Lois Gorwitz, a psychologist with thirty years of experience who went to work for Magellan in California in 2000, said her superiors would tell her: "We are not denying this person treatment, we are denying them their benefit. If they want the treatment they can still pay out of pocket." But, Gorwitz said, "You know that means that the person is not going to get the treatment because they can't afford to pay out of pocket." Gorwitz quit after two years. "It's a very uncomfortable feeling of not being able to offer help," she said.

Asked for a response, Magellan's Somers said, "I think you should keep in mind that there have been a lot of changes at Magellan in the last seven years. I think the people who work at Magellan now are not having that experience."