Injury in Latina Women after Sexual Assault: Moving Toward Health Care Equity

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DESCRIPTION (provided by applicant): Skin color plays a distinct role in the detection of and perhaps the protection from skin injury in sexual assault. We have found significant differences in ano-genital injury prevalence in Black and White females after consensual sexual intercourse and sexual assault that can be more fully explained by skin color than by race/ethnicity. Little is known about the generalizability of this phenomenon to the largest minority population in the US: Latinos. While major developments in the empirical basis of DNA and toxicology samples have occurred in the past 20 years, the development of empirically-based science in the context of sexual assault has not occurred with respect to injuries. We are proposing to study ano-genital injury prospectively through digital image analysis in 200 Latinas in the U.S. and Puerto Rico following consensual sexual intercourse, and compare their injuries to those documented in medical records of 200 Latinas following sexual assault. We will combine these data with a sample of predominantly Black and White women (n=800) and analyze approximately 36,000 digital images from consensual participants and records of sexual assault victims (N=1,200) to achieve the following aims: 1) determine prevalence, frequency, and severity of intercourse- related ano-genital injuries in consensual participants and sexual assault victims; 2) determine if sexual assault victims have more discrete digital image characteristics than women who have had consensual sexual intercourse (e.g., larger area of injury, better-defined shape, more localized location, texture more distinct from adjacent areas, more redness than adjacent areas); 3) determine if previously reported differences in the prevalence, frequency, and severity of intercourse-related ano-genital injury between racial/ethnic groups will be accounted for by quantification of skin color; 4) investigate if ano-genital injuries significantly vary as a function of skin mechanics (skin elasticity and skin hydration) and factors that could potentially determine the overall health of epidermal tissue (age, body mass index, sun exposure, and health status); 5) identify the constellation of ano-genital injury type and location, socio-demographic, and intercourse-related variables that most effectively differentiates those who experienced consensual intercourse versus sexual assault. PUBLIC HEALTH RELEVANCE: Forensic documentation of ano-genital injuries influences decision-making throughout the criminal justice process, especially at pivotal gate-keeping stages from victim reporting to sentencing. The forensic exam used to collect evidence after rape needs to be equally sensitive for females with dark skin as well as females with light skin.