1. Sex & Violence the Health Implications Dr Olwen Williams Consultant Sexual Health Clinical Director Amethyst SARC North Wales Member EHRC Wales

2. WHO Definition Sexual Violence any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a persons sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work

4. Rape by strangers; rape within marriage or dating relationships systematic war rape" during armed conflict; unwanted sexual advances or sexual harassment, including demanding sex in return for favours; sexual abuse of mentally or physically disabled people; sexual abuse of children; Forced marriage or cohabitation, including the marriage of children denial of the right to use contraception or to adopt other measures to protect against sexually transmitted diseases; Forced abortion violent acts against sexual integrity, including genital mutilation and obligatory inspections for virginity; forced prostitution & trafficking of people for the purpose of sexual exploitation

5. Interlinked domestic abuse /sexual violence 1:4 Worldwide lifetime risk of sexual assault 1:20 of UK women have experienced rape (estimated) 45% Sexual Assault committed by current partner 74% Sexual Assault occurs in the persons own home Attacks by partners double risk of physical injury British Crime Survey 2000 North Wales Police report increase of 3.8% in Sexual Assault in 2011

6. Potential Health Consequences Medical Injuries sustained during the assault Sexually transmitted infections HIV & other Blood Born Viruses Pregnancy and gynaecological complications Psychosocial Higher prevalence of mental health issues Socially ostracised Impact on family, partner and friends Effects on children of witnessing sexual violence

7. Risk Assessment at disclosure Establish recent or historic sexual assault Assess need for medical intervention Assess individuals physical safety Are there any Child protection issues? Explain options available Respect individuals wishes Be supportive…………………………

8. Amethyst SARC A one-stop facility to provide a comprehensive and coordinated response to all victims of rape and sexual assault regardless of whether or not a report is made to the police

9. Police Referral Refer individual to Police where assault took place In North Wales, specialist police teams for dealing with sexual offence allegations based at SARC/Amethyst Centre The police refer to the local sexual assault referral centre (SARC) for forensic medical examination (FME) Evidence managed by the police Follow-up at the SARC

10. Non-police referral to a SARC Patient, Sexual Health, A+E, Maternity Services contact the SARC - to refer - for advice SARC discusses options with client -Appointment made for FME or F/U only depending on patient consent and timing -Not a walk-in service, by appointment only

11. 10 Key Elements of a SARC 24 hour access Crisis Workers Gender Choice of FME Appropriately Trained FME Dedicated Forensically Approved Premises Risk Assessment PEPSE Emergency Contraception Referral for FU ISVA Co-ordinated Interagency arrangements Core Team NHS Standards of Clinical Governance Data Collection

15. Contact Details Sarah.Staveley@ nthwales.pnn.police.uk Tel: 01492 805072 Mobile: 07799342695 Amethyst Centre 1 Bryn Eirias Close Colwyn Bay LL29 8AB olwen.williams@ wales.nhs.uk 01978725924 07799342725