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Health & Science

Survey: Fear Of Legal System Keeps Homeless Youth From Seeking Exams After Sexual Assault

The tendency can keep young adults from accessing crucial follow-up medical care.

The adult exam room is designed with a poster on the wall reading "Wish, Love, Inspire, Believe" spelling out the word "Hope".
An exam room used by Texas Forensic Nurse Examiners.

A survey across seven cities, including Houston, found fewer than 30% of young adults experiencing homelessness seek a medical exam after being sexually assaulted, largely for fear of involving the legal system even if they don't have to.

The tendency can keep young adults from accessing crucial follow-up medical care to prevent disease transmission and pregnancy, and address trauma early on.


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"That's a misconception that is really prominent in the community," said Diane Santa Maria, interim dean of the UTHealth Cizik School of Nursing and lead author on a study analyzing the survey published in the American Journal of Preventive Medicine. Adults who are sexually assaulted can choose whether or not to press charges, Santa Maria said.

The survey is one of the first on the subject with findings across multiple large metro areas. Researchers found no differences in survey results between cities.

Participants who were homeless or unstably housed between the ages of 18 and 26 were asked about their experiences with sexual violence. Nearly a quarter of respondents reported being sexually assaulted or forced into sex. Rates were highest among mixed-race, cisgender women and LGBT youth, according to the study.

More than 70% of respondents who were sexually assaulted did not receive a medical exam afterwards, the survey found. Race and ethnicity appeared to be the only characteristic significantly associated with receiving an exam, with a higher percentage of Latino youth pursuing exams than youth of other races.

Researchers found youth who had experienced dating violence, engaged in trading sex, or who had been involved with the juvenile justice system were significantly more likely not to want to involve the legal system after an assault.

"Young people who are experiencing homelessness, in general, are oftentimes not trusting of institutions and adults specifically," Santa Maria said. "Their experience which led them to the street is oftentimes a series of being let down by the people that were supposed to be caring for them."

Also high on the list for not seeking an exam: not knowing a post-assault exam was important, and not knowing about them.

Researchers pointed to several additional barriers young people face when seeking care, such as most sexual assault nurse examiner programs being housed in a hospital’s emergency department, which are often hectic and stressful for patients.

“The environment itself poses a barrier,” said Khara Breeden, chief executive at Texas Forensic Nurse Examiners, who also provided insights on patient needs for the study. “The emergency care they need doesn’t have to be provided in an emergency department.”

Breeden’s group provides forensic nurses to clinics and hospitals, and focuses on creating a calm and peaceful environment where survivors can access trauma-informed care.

The group began seeing patients in March 2019, Breeden said. In June, the group announced plans to open a dozen free clinics in Fort Bend County.