Geographies of Sexual Assault: A Spatial Analyses to Identify Neighborhoods Affected by Sexual and Gender-Based Violence.

Emergency departments are a common access point for survivors of sexual and gender-based violence (SGBV), but very little is known about where survivors live and the neighborhoods they return to. The objectives of this study were to describe the patient population that present for a sexual or partner-based assault and explore the geographic distribution of cases across the Ottawa-Gatineau area. Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (January 1 to December 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using six-digit postal codes converted into Canadian Census Tract units to identify geographic areas with concentrated cases of SGBV. Concentrated areas were defined as Census Tracts with seven or more SGBV cases within a single calendar year. In 2015, there were 406 patients seen at the SAPACP and 348 had valid postal codes and were included in the analyses. More than 90% of patients were female and 152 (43.68%) were below 24 years of age. More than 70% knew their assailant and the most common locations of the assault were at the survivors' home (31.03%), assailants' home (27.01%), or outdoors (10.92%). Eight concentrated areas were identified including three in the downtown entertainment district, three lower income areas, one high-income neighborhood, and one suburb more than 20 km from downtown. The findings from this study describe the typical clinical presentation of sexual and domestic assault survivors and also challenge geographic stereotypes of where survivors live and what areas of the city are most affected by SGBV. Using residential information provides a survivor-centric approach that highlights the widespread nature of SGBV and supports the need for population-based approaches to improve care for survivors.

HIV nonoccupational postexposure prophylaxis for sexual assault cases: a 3-year investigation.

OBJECTIVE: Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care. DESIGN: Retrospective analysis. METHODS: The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI). RESULTS: The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78). CONCLUSION: We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.