Synthetic cathinones in drug-facilitated sexual assault: A case report involving the novel generation substituted cathinone N-ethylpentedrone and a review of the literature.

The use of 3,4-methylenedioxymethamphetamine (MDMA) in drug-facilitated sexual assault (DFSA) is not uncommon. Indeed, the effects associated with the use of this substance may lead to disinhibition. Several synthetic cathinones, such as mephedrone or methylone, also possess marked entactogenic properties. This manuscript aims to (i) report a DFSA case involving a novel cathinone derivative, namely N-ethyl-pentedrone (NEPD) and (ii) review previously reported DFSA cases involving synthetic cathinones. Using liquid chromatography-high-resolution mass spectrometry (LC-HRMS), NEPD was detected in both plasma and urine collected from a 36-year-old male who had been victim of DFSA. Furthermore, an exhaustive, non-period-specific English-language literature search was performed using several different electronic databases to identify DFSA cases involving synthetic cathinones. Overall, five synthetic cathinones have been associated with DFSA:methylenedioxypyrovalerone, 4-methylethcathinone, α -pyrrolidinopentiophenone, mephedrone, α -pyrrolidinohexiophenone, and methylone, which appears to be the most frequently reported. Methylone is the ß-keto analog of MDMA, with which it shares substantial pharmacological similarities. Indeed, the pharmacological effects of methylone are similar to those associated with MDMA. By contrast, little is known regarding NEPD's pharmacological effects in humans. Based on subjective reports, NEPD can produce both positive and negative effects in human. Unlike what is reported in the case of methylone or mephedrone, only a small minority of NEPD users report slightly entactogenics effects. Such properties theoretically make NEPD more suitable for use in a chemsex context than in DFSA context; even though, the boundary between these two specific forms of sexualized drug use can sometimes appear tenuous.

Healers that hurt: a scoping review of media reports of cases of rape in healthcare settings.

BACKGROUND: Sexual assault occurring within healthcare settings represents a significant breach of public trust. This scoping review aimed to highlight the profile of people raped, those who committed the rape within the health facilities, and the legal actions taken to resolved cases. METHODS: Media-reported data on incidents of rape in healthcare settings were collected. The search was conducted in May and June 2023, focusing on English-language publications with accessible full texts. Reports that lacked information on the survivors or incidents that occurred outside of healthcare settings were excluded. Descriptive statistics were used to summarize the categories of the collected publications, and graphical representations were employed for visualization purposes. RESULTS: A total of 62 cases were retrieved, originating from Africa (n = 17; 27.4%), Europe (n = 14; 22.6%), Southeast Asia (n = 14; 22.6%), the Americas (n = 11; 17.7%), the Western Pacific Region (n = 5; 8.1%) and Eastern Mediterranean region (n = 1; 1.6%). In addition, 69 individuals were implicated in 59 cases. They were 31 doctors (44.9%), 17 (24.6%) nurses, four (5.8%) nurse/healthcare assistants, three (4.3%) cleaners/ward boy, two (2.9%) traditional medical doctors, and two (2.9%) security guards. Others included six (8.7%) staff members without designations and one (1.4%) ambulance driver. All perpetrators were male, ranging in age from 22 to 67 years. There were 66 victims identified in the 62 cases with age ranging from 2 to 92 years. Except for one case, all victims were female, and all but one case were patients. Most assaults occurred in consulting rooms/clinics (n = 21; 31.8%), 16 (24.2%) happened under sedation, and six (9.1%) were repeatedly raped, Survivors typically reported the cases the police (n = 12; 19.4%), family/friends (n = 11; 17.7%) or to hospital authorities (n = 10; 16.1%). Out of the 69 perpetrators, 19 (30.6%) were imprisoned with sentences ranging from 12 months to an indefinite period and one (1.6%) received a death sentence. CONCLUSION: The raping of patients by healthcare providers within healthcare settings calls for urgent and extensive measures. Stakeholders in healthcare management need to prioritize raising awareness about the problem, implement robust prevention and reporting strategies, and create healthcare environments that are safe, respectful, and supportive for all individuals seeking care.

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda.

Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations.Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups.Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males.Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

This research identified key differences in how specific traumatic experiences and social factors correlate with psychological distress for male and female Congolese refugees, underscoring the need for tailored support strategies.The study reveals that while discrimination is a stronger predictor of depression in men, experiences of rape are more closely linked to depression in women. Conversely, social factors like literacy and group membership offer more protection to men, whereas relationship status and community connection are more protective for women.The findings shed light on the importance of gender-sensitive mental health and psychosocial support interventions.

A qualitative study on the health system-related needs in women survivors of rape.

BACKGROUND: Rape, as an adverse incidence, leads to irreparable complications and consequences in women. Provision of health services to women survivors of rape requires catering for their real needs and identifying current deficits as well as barriers. The present study aimed to explore health system-related needs in women survivors of rape. METHODS: In the present qualitative study, the participants consisted of 39 individuals, including 19 women survivors of rape and 20 individuals with work experience in providing services to women survivors of rape. The participants were selected using the purposive sampling method with a maximum variation in Isfahan, Iran. Data were collected through in-depth interviews as well as field notes and were concurrently analyzed via conventional qualitative content analysis method. RESULTS: After analyzing the interviews, the health system-related needs of women survivors of rape were classified into two main categories: 1- The need for efficient medical care services with three sub-categories, namely "receiving services with respect for privacy and confidentiality", "non-judgmental behavior and approach", and "the need to receive empathy and the feeling of not being alone", and 2- The need for desirable conditions and structure to provide services with two sub-categories, namely "the need to receive comprehensive and integrated services", and "establishing specialized centers for providing services to survivors". CONCLUSIONS: Overall, explaining and highlighting the health system-related needs of women survivors of rape could provide a suitable basis for policy-making and planning according to their real needs. Receiving continuous services in separate centers with confidentiality and empathy could reduce the worries and concerns of women survivors of rape and help improve their health.

Comparison of Clinical Characteristics, Gender Perceptions, and Rape-Related Beliefs of People Assessed for Criminal Liability for Rape Against Children and Adults. / Çocuga ve Eriskine Yönelik Tecavüz Suçu Nedeniyle Ceza Sorumlulugu Degerlendirilen Kisilerin Klinik Özelliklerinin, Toplumsal Cinsiyet Algilarinin ve Tecavüze Iliskin Inançlarinin Karsilastirilmasi.

OBJECTIVE: This study aimed to compare the criminal, sociodemographic and clinical characteristics, paraphilic behaviors, sexual attitudes, gender perceptions, and rape-related beliefs of people assessed for criminal liability for rape against adults and children. METHOD: The study compared 40 people investigated for criminal liability for rape against an adult (RAA) with 40 individuals investigated for criminal liability for crime of rape against a child (RAC), and 43 age, sex and education matched individuals without any sexual crime history using the Structured Clinical Interview form for DSM-5 disorders, Hendrick Brief Sexual Attitude Scale, Gender Perception Scale, Illinois Rape Myth Acceptance Scale, and Barratt Impulsiveness Scale-11. RESULTS: All participants were male. There was no difference between the groups in terms of lifelong or existing psychiatric diseases. All participants had full criminal responsibility during the crime. No participant in any group was diagnosed with a paraphilic disorder. It was determined that people in both RAC and RAA groups tended to use sexuality as a tool, paid less attention to birth control methods, had a far less egalitarian perception of gender, and their myths about rape were significantly higher compared to the control group. The control group was much more impulsive than the sex offenders. CONCLUSION: Our results show that the act of sexual assault should not be explained only by impulsivity or psychiatric disorders, and that gender perception and sexual myths may also be influential. The fact that all individuals had full criminal responsibility emphasizes the need for more research on the social and cultural origins of sexual violence.

Insufficient responses to rape in Ouagadougou: Reflections on the experiences of young female survivors / Insuffisances des réponses aux viols à Ouagadougou : réflexions à partir du vécu de jeunes survivantes.

The rape of girls and women raises questions about both prevention and the response in Burkina Faso. This article looks at the inadequacy of the response to rape in Ouagadougou. It is based on an analysis of cases of rape experienced by young women in the city and documented between 2005 and 2009. The study highlights the gap between the attitude of the victims, whether or not they are inclined to report the act and seek support, and the existing response in this area, whether in their entourage, at the community level, or at the institutional level. The study concludes that there is a need for more in-depth research into the representations and experiences of rape survivors in Ouagadougou and, more broadly, in Burkina Faso. Such research will enable us to identify gaps and appropriate strategies so that survivors are offered a holistic response that is more conducive to respect for their sexual and reproductive rights. Appropriate responses should involve improving the response system, so as to minimize obstacles and make institutional support more accessible to survivors.

Les viols sur des filles et femmes interpellent autant au sujet de leur prévention que par rapport aux réponses qui y sont apportées au Burkina Faso. L'article fournit une réflexion sur les insuffisances de réponses à ces viols à Ouagadougou. La réflexion s'appuie sur l'analyse de cas de viols vécus par des jeunes femmes dans cette ville et documentés entre 2005 et 2009. La réflexion met en exergue le fossé entre la posture des victimes, leur propension ou non à dénoncer l'acte et à rechercher un soutien et la réponse existante en la matière, que cela soit dans leur entourage, au niveau communautaire ou au niveau institutionnel. L'article démontre la nécessité de mener des investigations plus approfondies sur les représentations et le vécu des survivantes de viols à Ouagadougou et, plus largement, au Burkina Faso. Cela permettra d'identifier les gaps à combler ainsi que les stratégies adéquates pour offrir aux survivantes une réponse holistique et plus propice au respect de leurs droits sexuels et reproductifs. Les réponses appropriées devraient passer par l'amélioration du dispositif de réponse, de façon à minimiser ces entraves et à rendre le soutien institutionnel plus accessible aux survivantes.

State Abortion Bans Heap Burdens on Already Traumatized Rape Survivors.

The laws exacerbate stigma and impede access to needed health care.

The mental health prognosis of offspring born of genocidal rape is influenced by family members, the community and their perceptions toward them.

BACKGROUND: There is little known about the family and community maltreatment of the offspring born of the genocidal rape and the offspring's self-perceptions and how they influence their recovery from mental health problems. This study aimed to examine how the mental health prognosis of these offspring could be influenced by the family or community perceptions and attitudes toward them and their self-perception and coping strategies. METHODS: Thirty-two semi-structured qualitative interviews were conducted on 16 dyads of mothers and their offspring who were selected from countrywide. The interviews were audio-recorded and transcribed verbatims that were analysed inductively using thematic analysis within the NVivo 12 software. RESULTS: Participants reported long-term psychological and psychosomatic consequences stemming from being born of genocidal rape. Notably, family and community maltreatment of the offspring and their self-perception exacerbated psychological distress and affected their capacity to recover. The majority of the offspring were using coping strategies such as sole collaboration with peers with the same history, efforts to hide their birth history, social Isolation (silence, untrusting, involvement in media etc), hardworking, reversed roles in the parental relationship, extreme involvement in praying, and harmful alcohol use. CONCLUSION: Given the documented detrimental effects of individual, family and community attitudes and perceptions on psychological, and psychosomatic symptoms as well as the offspring coping strategies, culturally relevant mental health interventions are required to support the well-being and social reintegration of individuals born of genocidal rape while minimizing stigma and their maladaptive coping strategies.

Exploring the Underlying Constructs of Rape-Related Cognition Scales and Their Relationships With Sexual Aggression.

Rape-related cognitions (typically defined as encompassing any number of cognitive constructs) are thought to play a role in sexual aggression. However, rape-related cognition scales often assess these cognitive constructs as one. The purpose of this study is to explore the factor structure of these measures using a sample of 191 community men. We found that items from the Rape Myth Acceptance, RAPE, and Illinois Rape Myth Acceptance (IRMA) scales formed one factor, which was significantly related to sexual aggression. We further found that four and six IRMA subscales were significantly related to past and likelihood of sexual aggression, respectively. Additionally, one IRMA subscale was independently related to past and likelihood of sexual aggression. The results are discussed in terms of implications and direction for future research.

Correlates of Sexual Victimization Among Community College Women.

The current study documents the correlates associated with the severity of sexual victimization among women enrolled in a 2-year community college. Comparisons between women with a history of severe sexual victimization (i.e., rape and attempted rape), moderate sexual victimization (i.e., unwanted contact and sexual coercion), and no history of sexual victimization revealed that women with a history of severe sexual victimization endorsed more drinks per week, increased problem drinking behavior, and more use of drug before sex and higher levels of self-protective dating behaviors compared with women with no history of sexual victimization. These findings suggest that programs should target the intersection of alcohol and drug use as correlates of sexual victimization among community college women.

Sexual assault/rape and serial sexual homicide: Clinical and investigative considerations.

The frequent absence of a documented history of sexual assault/rape in the prior research on serial sexual murderers is curious. In order to address several methodological problems in prior research, a closed-case archival review of a nonrandom national sample of 53 serial sexual homicide cases was conducted which identified 14 offenders with a history of sexual assault/rape for an overall prevalence rate of 26.4%. Of the 14 offenders with a prior known history of sexual assault/rape, 11 (78.6%) sexually penetrated at least one of their homicide victims at the crime scene. Implications for investigation of serial sexual homicide as well as for further understanding of this exceptionally rare crime are presented.

Decriminalization of abortion by the Mexican Supreme Court.

In September 2021, the Mexican Supreme Court issued a decision disallowing any federal or local judicial authority to indict someone for the offense of voluntary or consensual abortion. This decision also declared unconstitutional penalties imposed on medical personnel who facilitate or assist such procedures. Furthermore, the Court decided that limiting access to abortion in cases of rape to a specific time frame was disproportionate. Later on, in September 2023, the Supreme Court confirmed that absolute criminalization of abortion was unconstitutional and declared that the rule supporting criminalization in the Federal Penal Code was without effects. Consequently, healthcare providers who work in public federal health institutions cannot be criminalized for guaranteeing the right to abortion. This article reviews the reasons advanced by the Supreme Court to guarantee the right of reproductive self-determination, as well as the effects of both decisions beyond the decriminalization of abortion by Mexican federal and state legislatures. The paper also examines the scope and limitations of these rulings and identifies the remaining challenges regarding voluntary abortion procedures in Mexico.

[Relations Between Rape Myths and Behavioral and Personality Characteristics in Males Convicted of Rape]. / Verhaltens- und persönlichkeitsbasierte Korrelate von Vergewaltigungsmythen bei Männern, die aufgrund einer Vergewaltigung verurteilt wurden.

OBJECTIVE: To date the relationships between rape myths and other psychological constructs within males who have committed rape have not been explored sufficiently. Considered as a risk factor for the perpetration of rape it seems significant to examine their association to individual behavioral and personality characteristics more in detail. METHODS: Therefore, we analyzed the relations between self-reported rape myth acceptance and the self-evaluation of aggressiveness, assertiveness, hypersexuality, social anxiety, sexual anxiety, SCID personality characteristics and the external assessment of psychopathy within a sample of N=569 males convicted of rape. RESULTS: The results showed significant correlations with all constructs except sexual anxiety, antisocial personality and psychopathy. Furthermore, findings indicated the assignment of the relevant variables to two principal components: rape myths, aggressiveness, hypersexuality, paranoid and narcissistic personality (K1) on the one hand and psychopathy and antisocial personality (K2) on the other hand. DISCUSSION: Following the results, rape myths are contextualized within the investigated psychological constructs and their potential differentiation from psychopathy and antisocial personality is discussed.

Pranks, Obscene Chatters, and Ambiguous Content: Exploring the Identification and Navigation of Inappropriate Messages to a Web-Based Sexual Assault Hotline.

Sexual assault crisis hotlines provide crucial support for survivors. Though some hotline users engage in inappropriate conduct (e.g. prank or obscene calls), few studies explore these interactions. To address the lack of literature exploring inappropriate hotline interactions, we conducted a secondary data analysis of chat transcripts (n = 233) shared with the research team as part of the formative evaluation of a university-based sexual assault program's web-based crisis hotline. From those transcripts, we analyzed potentially inappropriate interactions (n = 38), most of which (n = 28) hotline responders flagged as inappropriate in post-chat log forms. We used codebook thematic analysis to explore how hotline responders identified and navigated these interactions. Our analysis generated three themes describing the processes through which responders seemed to identify potentially inappropriate chats - detecting implausibly graphic and abusive content, identifying patterns of presumably inauthentic chat topics, and interpreting ambiguous content. Hotline responders seemed to navigate ambiguous and less egregious boundary violations by gently redirecting conversations, and addressed clearer violations by setting firm, direct boundaries. Chatters responded to boundary setting by desisting and disconnecting or attempting to reengage responders. Findings highlight ambiguities and challenges web-based sexual assault hotline responders face and suggest a need for additional responder support, training, and debriefing options.

Individual agency and social support in healing from conflict-related sexual violence: A case history from eastern DRC.

Examining the experience of a male survivor of rape through the salutogenic model and ecological theory, this case study explores how he imoved towards the direction of health after an atrocious experience of sexual violence perpetrated by members of an armed group. The study illustrates how he was able to deploy agency by undertaking a number of health-promoting actions to recover from the physical, mental, and social effects of conflict-related sexual violence. Initiatives in the process of improving one's health include self-care practice, searching for specialised care when self-care seems inefficient, relocation to new a setting post-rape, starting a business, testing one's reproductive capacities, marrying, taking care of the way he dressed, learning a new language, developing public speaking skills, owning a piece of land, having regular medical check-ups and ascending to power and decision-making bodies. His narrative shows how these initiatives are mirrored by both opportunities and setbacks. While more traditional survey-based studies focus on identifying which practices might be helpful in a healing context, this study sheds light on how an individual healing process might be complex and nuanced and is an important starting point towards our efforts to theorise resilience for male survivors.

COMMENTARY: Right to abortion of survivors of rape in India.

The Medical Termination of Pregnancy (MTP) Amendment Act, 2021, contains some progressive changes. However, survivors of rape will continue to go through mental as well as physical trauma to secure an abortion. We argue that the MTP Amendment Act, 2021, fails to address the rights of rape survivors adequately.

Perils and possibilities of health exception laws: A narrative review.

Forty-seven of the 203 countries with abortion laws detailed by the Center for Reproductive Rights have a health exception (HE) clause, inconsistent in both wording and implementation, even within countries. This narrative review sought to determine the understanding and implementation of the legally permissible HE in different countries, or states, to provide clarification and guidance for strategies that will maximize permitted access to safe abortion within the law and avoid undue delays that harm the lives and health of women and their families. A multimethod approach was used. The literature search for countries with HE laws, including physical, mental, and social health, and exceptions for threat to life, rape, incest, and fetal anomaly, returned sparse results. The review of emblematic cases that had reached regional courts on the grounds of human rights violation for failure to obtain legal abortion under the country's HE clause included some examples qualifying on multiple grounds. We interviewed 15 physician advocates from 14 countries about use of the HE in their countries. Informants from Latin America interpreted the HE to refer to physical, psychological, and social health. HE laws are common but confusing, with significant opportunities to improve access through clarification and implementation. Where multiple grounds permit ending a pregnancy, the least onerous exception for the patient is the most ethical. Examples of progress in Colombia and Ghana demonstrate successful approaches to broader HE implementation.

Forensic evidence preservation following an incident of rape: The role of the victim.

BACKGROUND:  Rape has a high prevalence in South Africa. The collection of credible and valid forensic evidence is a key legal factor that impacts case trial outcomes. Victim behaviour around the time of the rape can impact the collection and the integrity of forensic evidence, and can have a direct effect on case progression and conviction. Despite the importance of victim behaviour, few studies have been done on the role of victims in preserving forensic evidence. This article discusses how common personal hygiene practices undertaken by rape victims after being raped can impact the quality and validity of forensic evidence. This investigation was done with the aim of elucidating the role of victims in preserving forensic evidence post rape. METHODS:  This was a descriptive, retrospective clinical audit of all rape victims managed at Robert Mangaliso Sobukwe Hospital forensic unit in South Africa from 01 January 2020 to 31 March 2022. RESULTS:  A total of 192 rape cases over the study period were included in this review. The median age of rape victims was 20 years (minimum 2 years; maximum 76 years). The majority (n = 178; 92.7%) of the victims were female. About 44.8% (n = 86) of the victims reported that they had urinated post-rape and prior to forensic examination, 20.8% (n = 40) had changed their clothing, 8.3% (n = 16) had showered, 6.8% (n = 13) had bathed, 4.2% (n = 8) had douched, and only 1.0% (n = 2) had defecated. Only 44 (22.9%) of the victims reported to have ingested alcohol or spiked drinks before the rape. CONCLUSION:  These findings suggest that some rape victims engaged in personal hygiene practices that could militate against forensic evidence preservation. This finding, therefore, indicates the need for public awareness about ways to preserve evidence to the greatest extent possible after an incident of rape.Contribution: We provide simple guidelines for victims on the preservation of forensic evidence following rape and before detailed forensic medical examination and evidence collection.