Sexual Violence Impacts Sexual and Ethnic Minority Women The Most: What Can We Do?
Sexual violence in the United States (i.e. rape and other forms of sexual assault) is a public health crisis disproportionately affecting women, particularly women who are from underrepresented groups such as sexual minority and ethnic and racial minority women. In the U.S., 1 in 5 women have experienced sexual violence including rape (Muehlenhard et al., 2017). In separate studies, 75% of bisexual women (Walters et al., 2013) and 85% of sexual minority and two-spirit Native American and Alaskan Native women reported they have experienced sexual violence at least once in their lives (Lehavot et al., 2010).
The trauma from experiencing sexual violence is linked to poorer mental health, particularly in relation to traumatic stress symptoms in women (Dworkin et al., 2017). A recent systematic review of 10-24 year-olds found 60% had developed PTSD one year after being raped or sexually assaulted (MacGregor et al., 2019).
Yet, there is hope for recovery from the trauma of sexual violence and for resilience building in women. Evidence based interventions exist for reducing women’s vulnerability to sexual violence; in other words, things women can do to reduce their risk. They include models of bystander and self-defense/resistance strategy interventions. Evidence based bystander interventions, like Bringing in the Bystander® (www.soteriasolutions.org/college/), assume everyone in the community has a responsibility for addressing the problem of sexual violence against women. Bringing in the Bystander® incorporates discussions on developing empathy for those who have experienced sexual violence, safe and effective methods to intervene, and a commitment to taking action. A study of sorority women demonstrated they had a greater willingness and confidence to intervene and a sense of responsibility as a bystander after participating in Bringing in the Bystander® (Moynihan et al., 2011).
Evidence based self-defense and resistance strategy interventions, like Flip the Script (TM) (http://sarecentre.org/), focus on sexual assault resistance strategies that include physical techniques and assertiveness skills, while enhancing self-knowledge and addressing emotional barriers that might impact implementation of these skills/techniques. Women who completed Flip the Script (TM) were significantly less likely to experience both attempted and completed acts of sexual violence even two years after participating (Senn et al., 2017). In addition, women who have already experienced rape find their participation in these programs therapeutic (Rosenblum & Taska, 2014), reducing shame. Both of these interventions incorporate psychoeducation including local community examples and statistics as well as active learning exercises and informed discussions concerning identifying risky scenarios in which acts of sexual violence often occur.
Yet, this evidence begs the question, what about sexual and gender minority people? And in particular, sexual minority women such as bisexual women who are subjected to acts of sexual violence at a much higher rate than other women? Are there any interventions that have been customized for them, or that have research support proving effectiveness for this group of women? There may be individual researchers starting to customize interventions for sexual minority people, including women, but do any of them have an empirical evidence base that fulfills the American Psychological Association’s Division 12 guidelines for evidence based interventions? If any evidence based interventions to reduce minority women’s vulnerability to sexual violence exist, they are not well promoted to other sexual violence clinicians and researchers, let alone the public. The very same questions can be asked regarding ethnic and racial minority women and women of color, as well as women with intersecting identities, such as a woman who is Hispanic and visually impaired. What preferences and needs do diverse groups of women have for an intervention to be acceptable and attractive to them? Should we really assume that Bringing in the Bystander® or Flip the ScriptTM appeal to all women equally? Or are equally effective?
Sexual, ethnic, and racial minority people have experienced historical discrimination in mental health care services and treatment settings that may lead them to be less likely to seek out these services and higher treatment dropout rates when they do seek them out (Greene & Blitz, 2012). Swift and colleagues’ (2011) analytic review of 18 studies found that people were 50% less likely to drop out of therapy treatments if their preferences for treatment were considered and accommodated. For example, preferences in this study included preferring a type of treatment or therapist and being drawn to certain content and activities involved in a therapeutic treatment over others (Swift et al., 2011). Wade and colleagues (2019) found the dropout rate fell 14% for teenagers 14-19 years old when they were given their preferred treatment option (face-to-face, online, or self-guided family problem-solving therapy) following a traumatic brain injury over when they were given their nonpreferred treatment (27% dropout rate). Cochran and colleague’s (2008) research into women’s treatment preferences after sexual assault found that 73% of women selected treatment efficacy as a primary reason for their treatment preference. Over half of women (59.3%) were wary of medication as treatment and 41% reported liked the talking component of cognitive behavioral therapy (Cochran et al., 2008).
These statistics and research findings indicate that to effectively address the sexual violence epidemic, it is crucial to understand acceptability of interventions aimed at reducing vulnerability to sexual violence among diverse groups of sexual, gender, and ethnic minority women. Increasing the ability of providers to disseminate relevant and informed, appealing and culturally sensitive sexual violence vulnerability reduction interventions will greatly assist in helping us all to effectively address this public health crisis disproportionately impacting minority women.
That being said, the onus to address and stop sexual violence should not lie squarely on the shoulders of vulnerability reduction interventions or victims/survivors. Research into perpetration and perpetrator behavior generally—and