Forensic Exams During COVID-19

This is a very challenging time for all Americans, especially those on the frontlines of healthcare. This includes those dedicated professionals providing forensic exams and healthcare to victims of sexual assault.  These exams are provided in a variety of settings (and now more varied since the COVID-19 crisis has grown). The basic CDC guidelines (of which we are all well aware) apply universally, but the specific applications will be different in each unique exam setting. Dr. Angie Vickers, CCFMTC’s Education Director, is working with CalSAFE to develop more comprehensive guidelines. At this time there are no California guidelines for dealing with COVID-19 in the context of providing Sexual Assault Forensic Exams (CCFMTC has reached out to the California Department of Public Health). Because there are so many local variables, it is prudent for each examiner or exam team to work closely with your medical director, local public health department, and (if applicable) your local hospital to develop community strategies to facilitate the safe provision of these essential forensic/medical services for victims.

William M. Green, MD, FACEP

New Data Shows Sexual Assault Rates Have Doubled

Originally published as a blog by Jennifer Benner on the National Sexual Violence Resource Center website (nsvrc.org) (October 2019)

The U.S. Department of Justice, Bureau of Justice Statistics (BJS), recently released new criminal victimization data for 2018. This report highlights data from BJS’s 2018 National Crime Victimization Survey (NCVS), which is a nationally representative survey that surveyed approximately 160,000 people about crime victimization they experienced in the prior six months of the survey. It collects information on threatened, attempted, and completed non-fatal crimes (including rape and sexual assault, robbery, battery, etc.) and household property crimes (burglary, trespassing, car theft, etc.) from people ages 12 and older. The survey collects data on crimes that were reported to the police, and crimes that were not reported to the police.  
 
Key highlights 

Thirty-seven percent (37%) of the total violent victimization experienced was identified 

  • as rape or sexual assault. 
  • The self-reported incidence of rape or sexual assault more than doubled from 1.4 victimizations per 1,000 persons age 12 or older in 2017, to 2.7 in 2018.  
  • Based on data from the survey, it is estimated that 734,630 people were raped (threatened, attempted, or completed) in the United States in 2018.    
  • Despite the increase in self-reports of rape and sexual assault, there was a decrease in reporting to police from 2017 to 2018. Forty-percent (40%) of rapes and sexual assaults were reported to police in 2017, but only about 25% were reported to police in 2018.

The 2018 NCVS survey was conducted during the energizing of the #MeToo movement, and high-profile news stories such as Harvey Weinstein and Dr. Christine Blasey Ford’s testimony during Brett Kavanaugh’s Supreme Court nomination. The #MeToo movement has led to an increase in awareness about sexual assault and rape, and has led to more people recognizing harmful experiences as rape or sexual assault. 

However, the 2018 NCVS data continues to show that rape and sexual assault remain the most underreported crimes. One reason sexual assault survivors do not report to police is because of the many barriers they experience in the criminal justice system, such as long timelines, financial costs, and lack of privacy. So, while more people may be identifying what has happened to them as sexual assault or rape, these same people may not be reporting them to the police. This highlights the importance of prevention work and the goals of creating safe, respectful communities and healthy, positive relationships. 

Important Legislation Related to HIV/PEP for SAFE/SANE Teams

Governor Gavin Newsom signed into law groundbreaking legislation to increase access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention. Senate Bill 159, authored by Senator Scott Wiener (D-San Francisco), is the first law of its kind in the nation to authorize pharmacists to furnish PrEP and PEP without a physician prescription. The legislation also prohibits insurance companies from requiring patients to obtain prior authorization before using their insurance benefits to obtain these critical HIV prevention medications. 

Malinda Wheeler, NP, Owner/Director, Forensic Nurse Specialists, Long Beach had long recognized the problem affecting sexual assault victims, and brought SB 159 to the attention of the CALSAFE Board. CALSAFE contacted Senator Scott Wiener, wrote a letter of support, and informed the California Pharmacists Association about their collegial recognition and support for the bill.

SB 159, passed the California Legislature with overwhelming bipartisan support, will increase the places where people can access these medications, increase the number of healthcare professionals who can provide them and remove onerous and unnecessary insurance barriers.

PrEP and PEP are critical tools to ending the HIV epidemic in California and across the country. PrEP is a once-daily pill for HIV-negative people that almost entirely eliminates the risk of acquiring HIV. PEP is medication that a person takes after a potential exposure in order to prevent the virus from taking hold. PEP must be started within 72 hours and continued for 28 days to prevent HIV acquisition. With the passage of SB 159, pharmacists will be able to provide a 60-day supply of PrEP, after which the patient will need to see a physician for ongoing PrEP prescriptions. For PEP, pharmacists will be able to furnish the full 28-day medication regimen. Prior to dispensing PrEP and PEP, pharmacists will be required to receive appropriate training and provide necessary testing and counseling consistent with guidelines from the Centers for Disease Control and Prevention. SB 159 directs the California Board of Pharmacy to adopt regulations to implement the legislation by July 1, 2020.

PrEP and PEP are covered by most private insurance plans, as well as by Medicare and Medi-Cal. For individuals who need help paying for PrEP and PEP, California recently launched a statewide PrEP Assistance Program (PrEP-AP). The program is run by the California Office of AIDS and provides financial assistance with PrEP medication and related medical expenses.

SB 159 was co-sponsored by APLA Health, San Francisco AIDS Foundation, Los Angeles LGBT Center, Equality California, and the California Pharmacists Association. SB 159 was co-authored by Senators Steven Glazer (D-Orinda) and Jeffrey Stone (R-La Quinta), and Assembly members Todd Gloria (D-San Diego), Mike Gipson (D-Carson), Lorena Gonzalez (D-San Diego), and David Chiu (D-San Francisco).

For full text of the bill, please click here.