IPV, SA, Trafficking and STI Risk in Indigenous Women (Part 2)

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IPV, SA, Trafficking and STI Risk in Indigenous Women (Part 2)

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The Intersection of Intimate Partner Violence, Sexual Assault, Trafficking and STI/HIV Risk in Indigenous Women Providing Survivor Led, Advocacy Driven, and Culturally SafeCare Content developed December 2020 Welcome everyone! Thank you for joining this webinar, "The Intersection of Intimate Partner Violence, Sexual Assault, Trafficking and STI Risk in American Indian Women: Providing Survivor Led, Advocacy Driven and Culturally Safe Care." 1 Thank You To Our Co-Sponsors 2 We are honored to co-sponsor this event with the UW School of Nursing STREAM Program, Native American Center for Health Professions and UW Milwaukee's School of Nursing and Women's and Gender Studies program. And, we are very excited to have you all join us today for this webinar. And,thank you to everyone who also joined last week's program that provided foundational knowledge for this event. 2 Disclaimer Funding: This presentation is supported by the Health Resources andServices Administration (HRSA) of the U.S. Department of Health andHuman Services (HHS) as part of an award totaling $3,994,961 with nopercentage financed with nongovernmental sources. The contents arethose of the author(s) and do not necessarily represent the official viewsof, nor an endorsement, by HRSA, HHS or the U.S. Government. The research study referenced in this presentation was supported by a generous giftfrom the Forest Country Potawatomi Foundation. Terminology: We are committed to using terminology that respects andhonors the individuals to whom this research is concerned. Currently, thereare over 560 federally recognized American Indian and Alaskan NativeIndian tribes in the U.S. While no single term is universally accepted by allindigenous peoples in the U.S., the terms "American Indian, AlaskanNative, Indigenous, and Native American," are used for data reportingpurposes only, and appear in the form the terminology was originallypublished. It is not meant to minimize, exclude or generalize the individualsinvolved nor endorse one form of terminology over the other. 3 I'd also like to acknowledge that this program is funded by HRSA. 3 Land Acknowledgement 4 Before we begin the presentation I would just like to acknowledge that the University of Wisconsin Madison campus is located on the ancestral lands of the Ho-Chunk nation. 4 Presenters Jeneile Luebke, PhD, RN she/her Post-doctoral Nurse Research Associate UW-Madison School of Nursing Ashley Ruiz, RN, BSN, PhD(c)she/they Sexual Assault Nurse Examiner, Aurora Sinai University of Wisconsin Milwaukee Katie Klein, BA she/they MA Student & Instructor Women's & Gender Studies, UW-Milwaukee 5 This presentation was prepared by Dr.Jeneile Luebke, Ashley Ruiz and Katie Klein. Jeneile Luebke PhD, RN is a post-doctoral nurse research associate at University of Wisconsin-Madison. She received her early nursing degrees (LPN and ADN) in Bemidji, MN, and her BS and MS Nursing from the University of Wisconsin- Madison, and her PhD at UW-Milwaukee. She in an enrolled member of Bad River Band of Lake Superior Chippewa Indians. Her area of research and expertise include intimate partner violence in the lives of American Indian women, community health nursing and utilization and application of postcolonial and indigenous feminist methodologies.She is a survivor of intimate partner violence and is passionate about sharing her knowledge and personal experiences to help to support and empower other women to transition to survivorhood. Ashley is a sexual assault nurse examiner at Aurora Sinai, and nursing scholar studying at the University of Wisconsin Milwaukee.Her expertise focuses on nurse-patient interactions following experiences of sexual violence.Through this expertise, Ashley offers insight into available resources and healthcare service available to survivors of sexual violence in Wisconsin. Katie Klein (she/they) is a master's student and instructor in Women's & Gender Studies at UW-Milwaukee, and a 2020 Graduate Student Excellence Fellow. Katie's praxis is rooted in intersectional feminism and centered on eliminating gender-based violence. Their thesis research & activism focuses on the racialized, gendered, and sexualized precarity experienced by workers in the US service industry. 5 Learning Objectives Recognize how gender-based violence (GBV) such as intimate partner violence (IPV), sexual assault (SA), and trafficking increases American Indian (AI) women's risk for contracting sexually transmitted infections (STIs) or HIV Describe three strategies for delivering culturally safe care to survivors of GBV Identify two resources to support STI screening, pre-exposure prophylaxis (PrEP), and immediate access to HIV post-exposure prophylaxis (PEP) 6 6 Review GBV such asIPV, SA, and human trafficking impacts women globally Violence impacts AI women disproportionately (crisis) GBV is a global human rights and public health issue (PREVENTABLE!) GBVthe most common killer of women around the world SILENT EPIDEMICprevalence rates MUCH higher than reported Devastating impacts to health and well-being Impacts future generations 7 7 POLLING QUESTION! Of the 574 Federally recognized tribes in the US, how many tribally-created or Native-centered domestic violence shelters are there? 8 Answer: Less than 60 (National Indigenous Women's Resources Center) 8 VIOLENCE AND RISK OF STI & HIV What are the connections? 9 9 Intersection of GBV and STI/HIV Risk There are many commonalities between GBV such as IPV, SA, and trafficking Many survivors have experiencedmultiple forms of abuse by more than one partner IPV, SA, and trafficking survivors are vulnerable to manySTIs, includingHIV The risk of HIV acquisition increases exponentially incertaincircumstances 10 10 Prevalence of Violence Against AI Women Crisis of violence against AI women (SA/ IPV/trafficking) in both urban and reservation areas(Burnette, 2016; Casselman, 2016) AI women disproportionately impacted byIPV, SA,andtrafficking Gap in the data: qualitative study addresses this gap No studies published about IPV with AI women inWisconsin previously AI women at risk forSTI/ HIV transmission during SAandtrafficking 11 11 Rates of STIs Kaiser Family Foundation. (2020, February 18). Sexually Transmitted Infections (STIs): An Overview, Payment, and Coverage. https://www.kff.org/womens-health-policy/fact-sheet/sexually-transmitted... 12 The rate of reported chlamydia cases among AI's in the UnitedStates as 3.7 times the rate amongWhites In 2018, the rate of reported gonorrhea among AI's(329.5cases per 100,000 population) was 4.6 times the rate amongWhites, and a bigger disparity among AI women at 6.3 timesthe rate among White females than for AI/ANmales (3.3 timesthe rate among White males). In 2018, the rate of reported P&S syphilis cases among AI/ANwas 2.6 times the rate among Whites (15.5 versus 6.0 casesper 100,000 population, respectively). This disparity wasgreater for AI/AN females (5.4 times the rate among Whitefemales) than for AI/AN males (2.1 times the rate among Whitemales) 12 Rates of HIV: Wisconsin HIV disproportionately affects people of color (POC) New HIV diagnoses affecting POC rose from 20% in 1982 to 68% in 2019 During 2019, racial and ethnic minorities made up just 18% of WI's population, but accounted for 68% of new HIV diagnoses During 20102019, 15 AI people were diagnosed with HIV infection WI Department of Health Services, Division of Public Health. (2020).Wisconsin HIV surveillance annual report, 2019. https://www.dhs.wisconsin.gov/publications/p00484.pdf-0 13 Three out of four of these recent diagnoses weremale. Forty-seven percent were under 30 at the time ofdiagnosis. All but two were diagnosed in either the southeastern (53%) ornortheastern (33%)regions. Nine diagnoses were attributed to male-male sexual contact (60%),two were attributed to injection drug use (13%), and four had anunknown transmission category (27%). 13 2020 Ethnographic Study Data Qualitative study conducted in the spring of 2020 to better understand how IPV manifests in the lives of urban WI AI women (N=34) Two major themes were chosen to focus upon due to the urgency related to the COVID pandemic: Structural barriers to help seeking after an experience with IPV IPV experienced during the pregnancy period Reported linkages between IPV, SA, and contraction of STIs (Luebke, 2020) 14 This major theme reveals the complexity of IPV experienced within the local context and how colonialism has contributed to the present-day IPV experiences of urban AI women in Wisconsin. The COVID-19 pandemic served to exacerbate barriers to help seeking (job loss, housing,etc). Of the 34 survivors interviewed: 67.6% (N=23) refused/ unable to seek medical attention after IPV experience regardless of injury 24% (N=8) of survivors received medical care only because the IPV was witnessed and a call to 911 was placed on their behalf 17% (N=7) sought other types of help such as a domestic violence shelter, counseling, or a call to the police. 14 Study:Participant Stories Laurie's* story demonstrates the connections between exposure toviolence and STI risk Laurie* experienced IPV, SA and was trafficked This resulted in her contracting STIs and severe physical injuries She sought medical care for her injuries, but was not screened for IPV It is vital that we heed her advice to medical professionals and fellow survivors (Luebke, 2020) 15 Laurie's*storyreflects the need for screening: "I wish doctors would notice the signs so that theycan help us before we get damaged." Laurie's*advice to nurses & allied health professionals: "Let usknowwe'resafe. Take us to a safe place. Ifthey see what's happening, bring us somewhere. Tryto get us away from the abuser, even ifthey'resittingright outside. Let them know thatit'sokay, we can getyou out safely." Laurie* share what would be helpful for other women: "Safe testing for us and let them know thatit'sokay toopen up. It took me years. This is actually the firsttime opening up." 15 MEDICAL MANAGEMENT OF SEXUAL ASSAULT What should happen? 16 16 Polling Questions! Have you ever recommended or prescribed post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP) for a patient? Do you know where the closest SANE nurse to you is? Do you know where to find this information? 17 17 Management The medical management of SA survivorsshould include the evaluation, treatment,and prevention of STIs if indicated, and the evaluation for prevention of pregnancy Contracting an STI from an assailant is a risk, and significantconcern of SA survivors Adolescent and adult survivors of SA potentially exposed to STIs should be offered and given all recommended prophylactic medications, if indicated 18 18 Post-Exposure Prophylaxis (PEP) Use of antiretroviral (ARV) medication to prevent HIV infection in an HIV-negative individual who has had a specific high-risk exposure to HIV Exposure to HIV is a medical emergency, because HIV establishes infection very quickly (often within 24 to 36 hours after exposure) The use of PEP is recommended as soon as possible in the first 72 hours [of a SA encounter] The Wisconsin SAFE Fund now covers the entirety of HIV PEP medication for victims if prescribed during a SA forensic exam (up to$1,290.Per 2179.05(1)(am) Stats. and certified by the department of revenue under s. 79.05(2m), Stats. 19 19 Pre-Exposure Prophylaxis (PrEP) When a person who does not have HIV takes daily antiretroviral medication to prevent HIV acquisition in the event of an exposure to HIV through sexual contact or injection drug use Practitioners may want to consider PrEP for women who experience repeat violence, sex work, and other behavioral risk factors for HIV PrEP recommendation for treatment will be determined by provider on an individual basis Survivor ability to comply with medication directions, status of kidney/liver function, etc. 20 20 PROVIDING SURVIVOR LED, ADVOCACY DRIVEN, AND CULTURALLY SAFE CARE How Can We Provide Safe Care? 21 21 Mistakes of Providers Invalidating her experience Paternalistic attitude Victim shaming/blaming Ignoring her need for safety Not respecting her autonomy/self-sovereignty Trivializing and minimizing abuse Missed opportunities for screening Missed opportunities to provide resources 22 Building on some of the things that were just discussed 22 Trauma-Informed Care (TIC) A strength-based framework that recognizes the impact that trauma can have on health and well-being TIC is a patient-centered approach top roviding care. TIC shifts the focus from "What's wrong with you?" to "What happened to you?" by: Realizing the widespread impact of trauma (including historical and intergenerational trauma) and understanding potential paths for recovery Recognizing the s/s of trauma in survivors, families, and staff Integrating knowledge about trauma into policies, procedures, and practices Always seeking to actively resist re-traumatization 23 TIC it places the survivor at the center of all healthcare decisions. The survivor knows what is best for her- not the practitioner!. TIC fosters the relationship with the patient based on respect, trust, and safety, allowing the patient to feel empowered. This also fosters the patient's ability to make decisions about reporting and the criminal justice process. 23 What Can I Do? Humanisticcare(respect and non-judgement) Listen attentively Respect confidentiality Promote access to services Help in safety planning Respect autonomy (self-sovereignty) Believe and validate experiences Acknowledge the injustice 24 Normalize the topic of violence and screen EVERY woman at every point of care- will discuss more in detail in the next few slides Respect survivors' decisions that they make for themselves. They are the experts in their own care. Use your intuition. A survivor may decline the "violence screener". Make them aware of the resources available to them and you may frame it around having them share the information to anyone that they may know. The more times that they hear that there IS help, and that help is safe and accessible, the more likely she will be open to getting help. 24 TIC/Strength-Based Care con't We always want to highlight the things that she is doing RIGHT. Emphasize that IPV and SAis NOT her fault. Check your social attitudes, practice self-reflection. Never shame a victim.She will make mistakes.We all do because we are human. Empower by creating a plan with her and letting her take charge of it (self-sovereignty!). Remind her that she is not alone.There is hope! 25 (how could you ever put up with that!OR why don't you just leave?!?). 25 Culturally Safe Care Cultural safety creates environment that is spiritually, emotionally, and socially SAFE where there is no assault, challenge, or denial of their identity and needs Cultural safety ensures that we don't replicate oppressive practices that put survivors "in a box", that can lead to "othering" Offer culturally specific resources when available, especially advocacy services Don't be afraid to ask questions "How can I best support you?" "Is there anything I need to know about your cultural preferences?" 26 26 Mandated Reporting Generally, we are mandated to report assault to authorities for survivors aged 16 and younger Survivors know what's best for them Mistakes in reporting to authorities can cost survivors their lives Always consult with a nurse manager,social worker,or advocacy service if you're unsure how to proceed Referral to advocacy services and SANE nursing services 27 Under Chapter 48 of the Wisconsin Statutes or Executive Order 54, nurses are we are mandated reporters. Meaning if a survivor is below the age of 16, and has experienced violence, we are required to report this to child protective services or CPS. This is typically explained by sane nurses before a report is filed. This is one difference between SANE nurses and advocates, is that advocates are not mandated reporters. If you ever have any questions about mandated reporting consulting with you're a nurse manager, social worker, or advocacy service is a great way to address these questions. 27 EXAMPLES OF ADVOCACY DRIVEN CARE What is being done? 28 Tracking Our Truth Exemplar of an academic community partnership to provide survivor led and advocacy driven care to AI women $2 million service grant from the DOJ (OVAW) Development of SANE Programs with paired SANE RN/ Advocates International Association of Forensic Nurses (IAFN) trainings in Milwaukee and Northern Wisconsin Community partners to engage in culturally specific 40-hour SA advocacy training program Development of Tribal Sexual Assault Response Team 29 addresses a gap in care 29 Tracking Our Truth (cont) Development of two new SANE programs in Milwaukee and one in Rice Lake Partnership and provisions of care to St Croix Chippewa Indian Tribe and LacCourtesOreilles (LCO) Band of Lake Superior Chippewa Indians (Embrace) will provide 24/7 advocacy-driven medical forensic care Culturally tailored SA advocacy training program for those who assist survivors Support from Great Lakes Inter-Tribal Council (GLITC),Red Wind,and American Indians Against Abuse (AIAA) 30 Academic Community partnerships! 30 Other Indigenous Led Advocacy Women's Leadership Cohort (Menominee) Wise Women Gathering HIR Wellness Institute Gerald Ignace Indian Health Care Center (IHCC) (SANE services/Circles of Strength) Many individuals! 31 31 Culturally Specific Resources Wisconsin tribal health clinics: https://www.dhs.wisconsin.gov/lh-depts/tribal.htm Milwaukee: Gerald Ignace Indian Health Care Center (Urban/ SANE): 1-414-383-9526 HIR Wellness Institute (Advocacy/ no SANE): 1-414-748-2592 (CARES Line) Green Bay: Wise Women Gathering: 1-920-490-0627 Other Areas: Embrace Services, Inc: 1-800-924-0556/ 1-715-532-6976 (text) (24/7) St. Croix Valley SART: 1-715-425-6443 (24/7 Support Line) Strong Hearts Native Helpline:1-844-7NATIVE (1-844-762-8483)www.strongheartshelpline.org 32 32 Other Resources IPV, SA and Trafficking Domestic Abuse Intervention Services: 608-251-4445 (helpline) Rape Crisis Center: 608-251-7273 (24/7help line) RAINN's (Rape, Abuse & Incest National Network): 1-800-656-4673 (helpline)|www.rainn.org/ National Domestic Violence Hotline: 1-800-799-723 www.thehotline.org (live chat availableonline) National Human Trafficking Hotline:1-888-373-7888 (TTY: 711) Text 233733|https://humantraffickinghotline.org(live chat availableonline) For clinical care teams National Clinician Consultation Center (NCCC):nccc.ucsf.edu/ AETC NCRC nPEP Toolkit:https://aidsetc.org/resource/non-occupational-post-exposure-prophylaxis-... Sexual Assault: PEP is an Urgent Health Need:https://aidsetc.org/blog/sexual-assault-pep-urgent-health-need 33 33 Review:How Can I Help?What Can I Do? Know where the closest SANE provider is located Identify the closest pharmacy that carries PEP/ PrEP/emergency contraception Increase your understanding and awareness of the injustices AI women experience Create safe spaces through examining violence within context Practice self-reflection and acknowledge bias Promote self-sovereignty 34 Nurses and allied care professional have a unique opportunity to help STOP the cycle of abuse through an increased understanding and awareness of the injustice experienced by AI women! When you think about saving someone versus empowering them, when we break that down, that's a system of colonization Self-sovereignty is self-love and self-care.My body= my rules. As healers,one of the most important things we can do is encourage and support self-healing of survivors 34 References Centers for Disease Control and Prevention. 2015 STD Treatment Guidelines. https://www.cdc.gov/violenceprevention/pdf/ipv/13_243567_Green_AAG-a.pdf. Dawson, L., Kates, J., Ramaswamy, A. (2019). HIV, Intimate Partner Violence (IPV), and Women: An Emerging Policy Landscape. Kaiser Family Foundation. https://www.kff.org/hivaids/issue-brief/hiv-intimate-partner-violence-ip.... Draughon, J. E. Sexual assault injuries and increased risk of HIV Transmission. Adv Emerg Nurs J. 2012 Jan-Mar; 34(1): 8287. doi:10.1097/TME.0b013e3182439e1a. Office on Women's Health. Violence against women and HIV risk. US DHHS. https://www.womenshealth.gov/hiv-and-aids/women-and-hiv/violence-against.... Robinson, J. C. (2020). IAFN Sexual Assault Nurse Examiner Certification: A Review for the SANE-A and SANE-P Exams: Springer Publishing Company. 35 Discussion, Questions & Answers! Miigwech (thank you) for joining us today! Please feel free to ask any questions or share any feedback with us at this time! 36 Videos and Movies- Learn More! The Search- MMIW:https://youtu.be/mdPv0NDfMbA Our Sisters in Spirit: https://youtu.be/zdzM6krfaKY Peace River Rising:https://youtu.be/6GbGL7dmEwA A Broken Trust- Sexual Assault on Tribal Lands:https://youtu.be/-slFVM4ECUk Silent No More:https://youtu.be/DdjXyUPXtZs Between the Lines:https://youtu.be/hOXyGJuRMmo Highway of Tears:https://youtu.be/xz63Vppw3gE 37