At-Home Testing for Survivors of Sexual Assault鈥擡mpowerment or Exploitation?

Kushal T. Kadakia; Joseph S. Ross; Reshma Ramachandran

doi:10.1001/jamainternmed.2024.2883

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Health Care Policy and Law

August 12, 2024

At-Home Testing for Survivors of Sexual Assault鈥擡mpowerment or Exploitation?

Kushal T.聽Kadakia,聽MSc¹; Joseph S.聽Ross,聽MD, MHS^2,3; Reshma聽Ramachandran,聽MD, MPP, MHS^2,4

Author Affiliations Article Information

¹Harvard Medical School, Boston, Massachusetts
²Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
³Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
⁴Yale Collaboration for Regulatory Rigor, Integrity, and Transparency, Yale School of Medicine, New Haven, Connecticut

JAMA Intern Med. 2024;184(10):1153-1155. doi:10.1001/jamainternmed.2024.2883

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According to the US Centers for Disease Control and Prevention, 1 in 2 women and nearly 1 in 3 men in the US report experiencing sexual violence during their lifetime.¹ The Violence Against Women Act of 1994² entitles all survivors to receive free sexual assault medical forensic examinations, which are guideline-based evaluations performed by certified Sexual Assault Nurse Examiners (SANEs). Unfortunately, most survivors do not seek medical care or undergo forensic testing due to multiple factors, including access and financial barriers, psychological trauma, and social stigma.³

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1 Comment for this article

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October 8, 2024

Alternate Person-Centered Analyses: At-Home Testing for Survivors of Sexual Assault

Patricia M Speck, DNSc | University of Alabama at Birmingham School of Nursing

Thank you for your analysis. As a researcher interested in person-centered care for the most vulnerable, the self-collection kit is an opportunity for improved healthcare for people without access. Unfortunately, your search did not discover the first publication that analyzed the literature re: self-collection in highly sensitive testing [1]. Not included in your analysis is a good discussion about the implications of self-collection for the patient after being raped. Providing options like self-collection support person-centered care, creating the time necessary for self-determination [2,3,4,5]. Unknown to the reading public is that victims often bring things to the evaluation, and all are accepted, collected, and packaged by the SANE and importantly, not challenged by the courts. The practice aligns with long-standing practices since the 1970s regardless of evidence source or probative value [1,3] where failure to accept is judgmental [4] and an exercise of power and control over the process; judgment is the KEY variable in creating "never-served" populations [2,6]. Supporting research about self-collection is expeditious IF the goal is equitable access to care. Post-coital DNA research expanded the collection timing [7,8,9]. However, the current SANE impact research is often overstated, and heavily weighted to judicial outcomes. When used, trauma-informed principles gain the patient鈥檚 trust and encourages person-centered decision making [10], separating the goals of prosecution as the only outcome. Using citations from organizations with financial interests promoting SANE is unfair to victims since SANEs are a scarce commodity. Self-collection is person-centered and an accessible equitable option. Coupling telehealth improves access and equity in healthcare, not currently available to the most vulnerable in remote or isolated communities. Your suggestion of improvement and aligning with FDA is welcomed, but the FDA process is arduous and expensive when remote, rural, or deployed people need options now. Finally, consider inclusion of all voices with future publications. REFERENCES: [1] Speck, P. M., et al. (2023). Self-Collection Following Rape: An Integrative Literature Review. Journal of the Academy of Forensic Nursing (JAFN) 1(1), 18-41. [2] Speck, P. M., et al (2023). Caring for Women with Past Trauma Using Trauma Informed Care Strategies. [Women鈥檚 Health Section, S. Holley, ed.] Advances in Family Practice Nursing (AFPN) (5th ed.) 5(1) 119-135. [3] Speck, P. M., et al. (2023). Caring for Women with Past Trauma: The Physiology of Stress and Trauma. [Women鈥檚 Health Section, S. Holley, ed.] AFPN (5th ed.) 5(1): 137-149. [4] Speck, P. M., et al. (2023). Recognition of trauma informed care responses in forensic nurses: Learning constructs and pedagogy. JAFN, 1(2), 3-18. [5] SAMHSA (2014). Trauma-informed care in behavioral health services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville,MD. [6] Speck, P. M., et al, (2008). Vulnerable populations: Drug court program clients. Nursing Clinics of North America 43(3), 477-89. Speck, P. M., Hanson, E. (2019). Post Coital DNA Recovery in Minority Proxy Couples. National Criminal Justice Reference Service [Doc# 254366]. [8] Speck, P. M., & Hanson, E. (2019). Post-Coital DNA Recovery in Minority Proxy Couples (2014-NE-BX-0009). Birmingham, AL. [9] Speck, P. M., Ballantyne, J. (2015). Post coital DNA recovery. Washington, DC. [10] AACN. (2021). The Essentials: Core Competencies for Professional Nursing Education.

CONFLICT OF INTEREST: None Reported

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