public health concern

1. DRUGS FACILITATED SEXUAL
ASSAULT
-PUBLIC HEALTH CONCERN
DR. SHARAD HARI GAJURYAL
MBBS, MD (HOSPITAL ADMINISTRATION)
PUBLIC HEALTH DIRECTOR , NEURO FOUNDATION NEPAL
DEPUTY MEDICAL DIRECTOR ,ANNAPURNA NEUROLOGICAL INSTITUTE & ALLIED SCIENCES
MAITIGHAR, KATHMANDU

2. INTRODUCTION
• Drug-facilitated sexual assault (DFSA), a subset of drug
facilitated crime occurs when a person (male or female) is
subjected to sexual act while they are incapacitated or
unconscious due to the effect of alcohol,drug or other
intoxicating substance, and as a result unable to resist or
consent to such acts.

3. • The true prevalence of DFSA is unknown. Many studies
suggest that fewer than 20 % of sexual assaults are reported
to law enforcement agencies like police and other authorities.
• Victims often are reluctant to report incidents because of a
sense of embarrassment, guilt, or perceived responsibility, or
because they lack specific recall of the assault.

4. PUBLIC HEALTH CONCERN
• Sexual violence is a major public health issue.
• It has a clear measurable impact on physical and mental
health of the victim.
• Every day it also has a major impact on our society and health
care organizations

5. IMPACT OF DFSA IN VICTIM
• Physical impacts
• Psychological & emotional impacts
• Relation & marital impacts
• Social & community impacts
• Financial impacts

6. PHYSICAL IMPACTS
• Greater risk of acquiring HIV and STIs
• Sexual problems (e.g. Painful intercourse, vaginismus in
women)
• Poorer physical health, Poorer perception of physical health
• Occupational disability
• Unwanted pregnancy and decisions regarding abortion
• Risky lifestyles (Addiction to drugs & alcohol )
• Chronic disease

7. PSYCHOLOGICAL & EMOTIONAL IMPACTS
Immediate & short term impacts :
Anxiety and intense fear are the primary responses following
rape
• Fear of contracting HIV/STIs and/or becoming pregnant as a
result of sexual assault
• Fear of the disclosing the incidents
• Fears of future attacks and other harm

8. Medium to long term impacts
• Mental health problems (anxiety, depression, personality
disorders, psychotic disorders, panic disorder, etc.)
• Symptoms of post-traumatic stress disorder
• Self-mutilation
• Suicidal thoughts, attempted or completed suicide
• Drug and alcohol abuse

9. RELATION & MARITAL IMPACTS
• Less trusting of others
• Isolation
• Fear of intimacy
• Marital dissatisfaction
• Less stable relationships with partners
• Spousal violence

10. SOCIAL & COMMUNITY IMPACTS
• Interpersonal relationships ,friendships and family
relationships, can all be affected following sexual assault
• Avoidance of social activity with male
• Feel vulnerable in their local communities and in public
spaces as a consequence of the fear of rape
• The reactions of family, friends and partners can help or
hinder the recovery of the victim/survivor.
• Secondary trauma to non-perpetrator’s family.

11. FINANCIAL IMPACTS
• Loss of actual earnings
• Loss of future earning capacity
• Medical expenses
• Intangible costs (loss of quality of life, pain and suffering) and
• Counselling expenses.

12. EFFECT OF DFSA ( GLOBAL STUDY)
• Sexual assault victim often use drug and alcohol to self medicate their
psychological trauma; have13.4 times more alcohol related problem and
26 times more problem associated with drug abuse which is a public
health issue related to HIV.
• Study on physical and psychological injury, after sexual assault
concluded that 3.8 million women have had sexual assault -related
PTSD,
• Study also conducted that at some places in AIDS clinic, half of the
female patient had been sexually abused

13. • 3 times more prone to depression that other victim
• 4.1 times more likely to have contemplated suicide
• 13 times more likely to have attempted suicide
• 13% of total sexual assault victim attempted suicide which
confirms the potentially and devastation life threatening
condition of impact of sexual assault

14. Factors complicating investigations in DFSA
• Lack of experience among investigators, medical personnel,
laboratories and prosecutors in handling in DFSA cases,
• Lack of recognition of the crime by law enforcement agencies,
• Delays in reporting the incident,
• A broad range of substances that may be used.

15. • When the victim of a DFSA is unclear about the events leading
up to the assault because of the amnesiac effects of the drug
administered, it may lead to a delay in reporting the incident, if
it is even reported at all.
• A considerable amount of time may be spent trying to fill in
memory gaps by speaking with friends who were with the
victim or even with the assailant, if the person is known to the
victim

16. THE LAB WAS DESIGNED TO PROVIDE CRITICAL SCIENTIFIC EVIDENCE TO THE
POLICE AND OFFICIALS INVESTIGATING AND PROSECUTING CRIMES .

17. PUBLIC HEALTH FOCUS
Theme of public health, prevention is better than cure
NEVERTHELESS, SEXUAL ASSUALT IS A PREVENTABLE PUBLIC HEALTH PROBLEM
• Efforts must focus on reducing the risk of sexual assault and drug-facilitated sexual
assault.
• The fact that alcohol is easily, and often cheaply, available and is a major risk factor for
sexual assault should be addressed specifically by increasing awareness and education.
• School & College health & awareness program
• Curriculum Update
• IEC Material to be disseminated as well as to be broadcasted in Media/ SNS
• Training of the existing health professionals
• Establishment of referral center for support and further investigations.

18. • Health care systems, criminal justice systems and volunteer
agencies, may all deal with sexual assault.
• It is essential for everyone involved in dealing with sexual
assault to work in partnership to provide holistic services
centered on the needs of the victim.

19. WHAT AFTER DFSA ?
• Seek medical care as soon as possible after an assault.
• Taking care of the health as soon as assault is an important step in the
healing process.
• Examinations for injuries, some of which victims not be aware of,
• Use of antibiotics to prevent bacterial sexually transmitted diseases and
receive medication to protect against pregnancy.
• Evidence can be collected which may help lead to the conviction of the
assailant in the event that the crime is prosecuted.

20. CONCLUSION
• Alcohol and drugs are common contributors to sexual assault.
• Preventive efforts should focus on providing education and awareness aimed at
reducing the incidence of drug-facilitated sexual assault.
• Initiation of referral center to support/help/councelling and investigating the case,
• Clinicians providing care to victims of sexual assault should take early evidence
samples for toxicology and other evidence where possible.
• Forensic examination should address the different possible types of sexual assault.
• A team approach of health care facility, criminal justice system , and a voluntary
organisations and related stakeholder is necessary.

21. THANK YOU