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Factsheets: HIV/AIDS & Victim Services
In the first ten years of the epidemic, the human immunodeficiency virus (HIV), the causative agent of acquired immuno-deficiency syndrome (AIDS), has claimed more American lives than the Korean and Vietnam wars combined. It is believed that practically everyone in America has been touched by the AIDS epidemic. This is not news to victim advocates on the front lines who have listened to the concerns expressed by many victims regarding potential HIV exposure. Whether or not cases of HIV transmission to victims have been documented, the fear of exposure is very real. The complex nature of the HIV/AIDS epidemic, and its impact on victim services, does not lend itself to a thorough discussion in the context of this INFOLINK bulletin. The intent of this publication is to provide an overview of the issue, suggest some points of discussion, and encourage further investigation of the epidemic and its consequences for victim service providers and the individuals they serve. AIDS is a complex disease characterized by severe damage to the natural immune system. Once damaged, the immune system is then more susceptible to unusual opportunistic infections. AIDS is caused by the human immunodeficiency virus (HIV). AIDS is a complex disease characterized by severe damage to the natural immune system. Once damaged, the immune system is then more susceptible to unusual opportunistic infections. AIDS is caused by the human immunodeficiency virus (HIV). The transmission of the virus was a mystery during the initial years of the epidemic. It is now understood that the virus is transmitted by having sexual intercourse (anal, vaginal, or oral) with an HIV+ person or sharing a needle/ syringe with an HIV+ person. Other modes of transmission include receiving blood transfusions infected with the virus and HIV+ pregnant women passing the virus to their infants before, during or after birth. The likelihood of contracting the virus from a blood transfusion has been greatly reduced since the implementation of strict screening practices utilized when blood is donated. The decision to be tested for HIV is very personal, and should be made only after a person has received pre-test counseling. Due to the social stigma associated with AIDS, it is important that the testing site provide for anonymous testing. The danger associated with confidential testing is that although the results are to remain confidential unless release is authorized by a client, there exists the chance that the results can be accidentally released. For comprehensive information about the medical aspects of HIV and AIDS, please consult your local AIDS service organization or public health department. Working with Adult Sexual Assault Victims With the onslaught of the HIV/AIDS epidemic, the trauma of a sexual assault has evolved into a potentially life-threatening concern after the actual victimization. To date, there have been no documented cases of HIV being transmitted during the rape of an adult in the United States. This does not mean that transmission is not possible. Certainly, anecdotal stories have circulated during the last few years indicating that transmission is possible. There are several reasons why no cases have been documented. First, the Centers for Disease Control, the agency that officially tracks AIDS cases, does not track cases by consensual and non-consensual sex. Second, given the nature of the disease and the testing methods, it is difficult to link exposure to the virus to a rape. Regardless of the lack of confirmed cases where the virus was transmitted through a rape, the concern about exposure to the virus is very real for victims of rape and their consensual sexual partners. Trained victim advocates have developed the skills to address the normal spectrum of issues confronting victims of crime. When working with sexual assault victims, the advocate now needs to have a basic understanding of HIV/ AIDS. Victim service programs should arrange for advocates to be trained by HIV/AIDS professionals. However, due to the complex nature of the disease, it may be useful for an advocate to refer a victim to an AIDS service organization when more in-depth information and counseling are needed. Many advocates have asked for guidance about how and when to approach the subject of HIV/ AIDS with a sexual assault victim. Although there is no prescribed point at which the topic should be introduced, there are a few suggested occasions. During the rape exam or a discussion of general health concerns may seem like a natural arena in which to initiate a conversation. However, advocates need to remember that many victims may not be able to incorporate the idea of exposure to HIV into their processing of the attack during the rape exam. If a victim does not raise the issue during the exam, it would be helpful to give the victim a brochure that discusses several issues they should be aware of, including HIV, that they can review at a later date. A victim should be encouraged to contact the advocate to discuss any concerns. The advocate may also want to contact the victim within a few days of the attack to check on how they are and answer any additional questions. An advocate can also wait for the victim to raise the issue — which is likely to happen. Many people who believe they may have been exposed to the virus are reluctant to be tested due to the fear of knowing the results. Sexual assault victims may have similar reactions. The desire to have an offender tested for the presence of HIV is understandable. The belief that knowing the offender’s HIV status will bring emotional relief to the victim is plausible, but complicated. Due to the nature of testing and the unknown period in which the virus can lie dormant in the body, knowing the offender’s HIV status will not absolutely guarantee that the victim has not been exposed to HIV. Current research indicates that a person could be exposed to the virus, not test positive for months or even years, but still transmit the virus to another person. Additionally, in many cases the offender may never be apprehended. Although a number of states have legislated mandatory testing of alleged and/or convicted offenders, not all have provided for immediate testing or automatic notification to the victim. For more information about the status of HIV/AIDS testing legislation, please refer to our GETHELP Series bulletin on HIV/AIDS Legislation. Given all these issues, victim advocates should focus their discussion with sexual assault victims on the decision to be tested independent of the offender being tested. If the victim decides to be tested, he/she should receive pre- and post-test counseling by qualified professionals. It is rec-ommended that the victim be tested immediately after the assault to obtain a baseline reading. If the results are negative, another test should be conducted three months later. Current research indicates that most people who contract the virus will test positive within three months after exposure. If the victim tests positive, he/she will be receiving very stressful and devastating news. The advocate’s very best skills will be needed to assist the victim with emotionally processing the results. While helping the victim understand the impact of the results, an advocate should discuss the following issues:
Working with Child Sexual Assault Victims Due to the high-risk behavior of many sexual offenders, and the frequency with which children are assaulted by the same offender, the risk of infection for children — as compared with adults — increases. The incidence of HIV infection in children is so low that testing is not recommended unless there is a strong belief or evidence that the offender engages in high-risk behavior or the child exhibits symptoms of sexually transmitted diseases. In-depth studies need to be conducted to determine the actual transmission rate of HIV to adult and child victims of sexual assault. If testing is warranted, permission must be obtained by the parent(s) or legal guardian(s). If the test result is positive, then basic counseling methods used when working with children would apply. Advocates should use age-appropriate language, dolls, and/or pictures when explaining the disease to a child. It is important to be consistent with the terms used and repeat explanations when necessary. The disease manifests differently in children than in adults. In many ways, they are more susceptible to infections since their immune systems are not yet fully developed. Working with Domestic Violence Victims Undoubtedly, most people automatically think of sexual assault victims as the victim population at greatest risk for HIV infection. Perhaps they are, but domestic violence victims cannot be overlooked. Many batterers abuse drugs and may also be involved in other high-risk behavior. Victims may be coerced into using intravenous drugs, and therefore, exposed to the virus through needle-sharing. In addition, victims of domestic violence may not be able to negotiate safer sex with the batterer and, in fact, many are sexually assaulted by their partners. In those situations, women could be exposed to the virus through unprotected sex. There are many elements to be considered when discussing possible responses to the HIV/AIDS question. With the growing epidemic touching almost every American, not only will advocates need to respond to victims who may have been exposed to HIV, but they will also be dealing with victims who were HIV+ prior to their victimization. Advocates must receive HIV/AIDS training from qualified HIV/AIDS professionals. Without accurate, current information, advocates will not have the best tools available to provide the most comprehensive assistance to victims. This is especially critical because of the evolving nature of HIV/AIDS research. Additionally, advocates need to be aware of current laws regarding testing of offenders and releasing the test results to victims. By remaining informed, advocates will be better able to serve victims. Jointed United Nations Programme on HIV/AIDS. (2000). Report on the global HIV/AIDS epidemic, June 2000. Centers for Disease Control and Prevention (2001). Morbidity and Mortality Weekly Report. Vol. 50/No.21. Joint United Nations Programme on HIV/AIDS. (1999). UNAIDS Launches Year-Long Campaign Force for Change: World AIDS Campaign with Children and Young People. Centers for Disease Control and Prevention (2000). HIV/AIDS Surveillance Report, (December 2000). Alexander, Diane. (1992). “HIV/AIDS and Victims.” The Road to Victim Justice: Mapping Strategies for Service, A Series of Regional Training Conferences. Washington, DC: National Center for Victims of Crime and National Organization for Victim Assistance. Allers, Christopher et al. (1991). “HIV Vulnerability and the Adult Survivor of Childhood Sexual Abuse.” Child Abuse and Neglect, 17: 291-298. Baker, Timothy et al. (1990). “Rape Victims’ Concerns about Possible Exposure to HIV Infection.” Journal of Interpersonal Violence, 5(1): 49-60. Burgess, Ann and Timothy Baker. (1992). “AIDS and Victims of Sexual Assault.” Hospital and Community Psychiatry, 43(5): 447-448. Fuller, A. Kenneth and Robert Bartucci. (1991). “HIV Transmission and Childhood Sexual Abuse.” Journal of Sex Education & Therapy, 17(1). Gostin, Lawrence et al. (1994). “HIV Testing, Counseling, and Prophylaxis After Sexual Assault.” Journal of the American Medical Association, 271(18): 1436-1444. Jenny, Carole et al. (1990). “Sexually Transmitted Diseases in Victims of Rape.” The New England Journal of Medicine, 322(11). Johnson, Earvin “Magic.” (1992). What YOU Can Do to Avoid AIDS. New York: Times Books. National Center for Victims of Crime. (1996). “Acquaintance Rape.” INFOLINK Bulletin. Arlington, VA. National Center for Victims of Crime. (1996). “Child Sexual Abuse.” INFOLINK Bulletin. Arlington, VA. National Center for Victims of Crime. (1995). “Domestic Violence.” INFOLINK Bulletin. Arlington, VA. National Center for Victims of Crime. (1995). HIV/AIDS and Victim Services: A Critical Concern for the 90's, A Training Manual. Arlington, VA. National Center for Victims of Crime. (1995). “HIV/AIDS Legislation.” INFOLINK Bulletin. Arlington, VA. National Center for Victims of Crime. (1996). “Rape-Related Posttraumatic Stress Disorder.” INFOLINK Bulletin. Arlington, VA. National Center for Victims of Crime. (1995). “Rights of Crime Victims.” INFOLINK Bulletin. Arlington, VA. National Center for Victims of Crime. (1996). “State Compensation Laws.” INFOLINK Bulletin. Arlington, VA. United States. (1988, June 24). Report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic. Washington, DC: U.S. Government Printing Office. For additional information, please contact: Centers for Disease Control Provides information 24-hours a day, 7 days a week, about HIV/AIDS and will send free, written information, including legal services, counseling and therapies. National AIDS Clearinghouse Distributes a variety of educational materials to the public. Provides expert referrals. All rights reserved. Copyright © 2001 by the National Center for Victims of Crime. This document may not be reproduced in whole or in part, by photocopy or by any other means, without the express written permission of the National Center for Victims of Crime. |
Voices and Faces:
Holly Hughes 
"On TV, the only time they called it rape was when it was a stranger. So I didn't think what happened to me was rape. If I did, maybe I would have told someone. Maybe I would not have lost so many years of my life."
Read more about Holly at The Voices and Faces Project »
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