HJBR Jul/Aug 2024

handle this when they learn it has happened to the person they love? How should physicians handle this? And is this person now scarred for life, either internally and/or to the world? This is why I think this rape and attempted rape stat is so important — women are walking around traumatized and silent. And when they do speak up, they may feel blemished in some way. These are such complex questions! Most people say that you have to disclose and process it, but others say that it depends on the person. I think the best we can say is: This is an incredibly pervasive issue, and if you are a provider working with wom- en, then you are a provider working with people who have been affected by sexual violence, and this sexual violence has long- term consequences, particularly in terms of mental health. Assessing patients for these concerns, validating their disclosure, and connecting them to available services can be an important way to support affected women and their healing process. When do you, as a victim, know you are healed? Are you ever? Again, I think we have no data on this. I am not sure we even have clear agreement on what “healed”means. Why do perpetrators feel like they can do this? Does it change by age? I can understand how a same-sex victim of assault may become a perpetrator later in life. But how do men think this is okay to do to a woman? What are they thinking? Especially male relatives who do this to children? I definitely think that society normalizes sexual violence, and for some boys, there is even encouragement. Terms like “locker room talk” and “boys will be boys” just re- inforce it. n What are the most effective ways of fighting off rape? There are no clear data on this. What are the most effective ways of stopping sexual assault? There are no clear data on this. We don’t tend to focus on this because some survi- vors view the notion of “not stopping it” as victim blaming. You wrote, “Combating sexual violence requires careful and sensitive interven- tion across multiple fronts – judicial, health, and societal.” You have looked very closely at this problem; what do you feel needs to be done to fix it? My opinion is that we have to invest in prevention. Victimization and perpetration are highest in younger ages. Why are we not ensuring prevention programming for youth? We do not put funding toward vio- lence prevention in the state. Should providers be discussing the dangers of cybersex to patients, especially young patients? What safeguards do you recommend for parents that providers can give? It is beyond my expertise to guide pro- viders on the basis of these data, and the existing evidence does not offer clear in- sight into this issue. The Surgeon General has recently recommended social media warning labels. See: https://www.nytimes . com/2024/06/17/opinion/social-media- health-warning.html Should these experiences be shared more by women? What happens to them when they are? Who should they share this with? If this is so common, why the secrecy? Does secrecy help or hurt the victim? Does silence help or hurt our society? How should parents deal with this when they hear it has happened to their child? How should partners Anita Raj, PhD, is the executive director of Newcomb Institute, the leading gender equity research and training institute in the nation, housed at Tulane University. She is also the Nancy Reeves Dreux Chair and Professor at Tulane University School of Public Health and Tropical Medicine. Trained as a developmental psychologist, Raj has been conducting research on gender equity and health for approximately 30 years and has published more than 300 peer-reviewed articles focused on issues of gender-based violence, sexual and reproductive health, maternal and child health, and adolescent health in major medical and public health journals including The Lancet , JAMA , and Social Science & Medicine . She leads the violence experiences (VEX) surveys across multiple states to provide greater insight into issues of violence and discrimination as risk factors for physical, emotional, and behavioral health, with the goal of supporting evidence-based health promotion and public policy. Q&A with Anita Raj, PhD, MS It seems like we have a lot of women walking around with sexual trauma. How can we help them? Also, how can we stop this from happening in the first place? If you identify a patient or client who has experienced sexual violence, you can share the following information with them: If you are in immediate danger, call 911. If you are being abused, call the National Sexual As- sault Hotline at 800-656-HOPE (4673) or chat online with online.rainn.org. Please see this website for additional resources: https://www.rainn.org/resources. Additional guidance and evidence-based recommendations on how to support pa- tients who have been victims of sexual vio- lence can be found here: • https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6170132/#:~:text= Immediate%20needs%20of%20a%20 survivor,Forensic%20Exam%20 (SAFE)%2C%20collaboration • https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC10184971/ • https://pubmed.ncbi.nlm.nih.gov/ 27436857 Does an attempted rape have a higher degree of trauma than sexual assault? How are you defining sexual assault? It looks like you are showing 16% of women have actually been raped in Louisiana. If we compare that to the 20% rape or attempted rape CDC stat, it seems most women were not successful in fighting it off. There is no evidence that compares trauma. Trauma is affected by a number of factors beyond the incident itself, includ- ing characteristics of the survivor and their relationship to the perpetrator. We also do not compare levels of trauma because it can suggest that there is greater or lesser pain for an affected person. 28 JUL / AUG 2024 I  HEALTHCARE JOURNAL OF BATON ROUGE