By Mylika Scatliffe,
AFRO Women’s Health Writer
To many people, the terms are likely interchangeable–Google both and you will find multiple unsettling definitions.
If a sexual assault victim chooses to go to a hospital for treatment, they will be asked to consent to a sexual assault forensic exam (SAFE), also colloquially known as a “rape kit.” This type of forensic exam collects evidence from a victim if there is a chance their case will go to court. However, having just experienced the significant physical and emotional trauma of sexual violence, many victims are reluctant to subject themselves to a physical exam.
“When a sexual assault occurs, the victim’s body unfortunately is the crime scene and the trauma of an assault might be intensified during evidence collection,” said Laura Clary, program manager of the Greater Baltimore Medical Center (GBMC) Sexual Assault Forensic Examination, Domestic Violence and Child Protection Program.
Just before the COVID-19 pandemic, some companies began to market self-administered sexual assault kits.
“Self-adminsitered sexual assault kits are a commercial product that purport to allow survivors to collect evidence of rape. Some survivors are reluctant to go to a hospital to have a physical exam, and others have trouble getting an exam because of the nursing shortage and other barriers,” said Lisae Jordan, executive director and Counsel at the Maryland Coalition Against Sexual Assault (MCASA).
Even so, there has been significant controversy surrounding these kits.
“Self-administered sexual assault kits have been widely criticized because they do not meet the standards necessary to be admitted in court as evidence because there is not a reliable chain of custody and they have not been administerd by qualified staff. In addition, women pay for those tests while they are widely available free at hospitals and health facilities,” said Assistant Attorney General Kathryn M. Rowe in response to the Attorney General’s Office of Counsel to the Maryland General Assembly concerning these kits.
“For this reason, and others, attorneys general in many states have issued cease and desist orders against their sale,” said Rowe.
Clary weighed in on the home collection kits.
“My immediate reaction on hearing about do-it-yourself rape kits is ‘Oh my gosh, people will think that is the best option and there is so much more to an exam than collecting physical evidence.’ As a nurse, my mind immediately thinks of the medical aspects and benefits of the exam,” said Clary.“There are so many benefits to an exam performed at a SAFE center or similar medical setting, that patients will miss out on trying to do it themselves. There are antibiotics for infection or prophylactic treatment for pregnancy, medical treatments for injuries sustained during an assault, crisis counseling and it is all 100 percent free of charge.”
Chain of custody is crucial if a case involving sexual assault makes it to court. This is one aspect that can be problematic if self- administered kits are used because they are not admissible in court. Chain of custody tracks the pathway of evidence from the crime scene, or the victim’s body, according to Clary.
She described the steps taken and what a victim will encounter if they decide to come to the SAFE Center for an examination.
“A nurse will get a medical forensic history by talking to the victim about what happened, conduct an exam, and collect evidence based on the information they received about how the attack occurred,” said Clary. “Evidence can be collected internally and externally; we can take vaginal, anal, and fingernail swabs based on what we learn from the victim about their attack. We get the patient’s consent for every aspect of the exam so they always feel in control of what is happening.”
Clary added that “the evidence is collected to forensic standards, stored and locked until a crime technician can come and collect the evidence for storage at the crime lab. It is usually collected within 24 hours.”
Without these chain of custody and forensic standards of collection, evidence from a self administered kit will likely not be admissible in court. Clary purchased one of these kits and found the instructions to be overwhelming. She shared a slide show of the instructions with the AFRO. There were approximately nine steps, with each step having multiple bullet points of instructions before moving on to the next step. The kit supplies include sterile gloves, four swabs, two fingernail swabs, one sterile water bullet, swab boxes and tape to collect hair and debris. There was also a permanent marker, evidence tape, a clothing bag, and a bag for trace evidence.
The final page of the instructions notes in fine print that the kit is not a substitute for collection of evidence by law enforcement or an examination performed by trained personnel and that there is no guarantee the evidence will be admissible in court.
For someone who has experienced the trauma of a sexual assault, just reading the instructions can be a task–let alone actually following them to the letter. If a victim manages to complete all the steps, they could eventually be disheartened at best and devastated at worst to find out the results can’t be used as evidence in court.
“I don’t particularly have an opinion about the cease and desist orders, but I think it is really important that the companies marketing these products are transparent about the limitations of these kits,” said Clary.
Medical staff are able to provide information and support to survivors.
“When a forensic exam is performed at a hospital, the nurse-examiner is highly trained and expert. Care is taken to preserve evidence so it can be used at trial if the survivor wishes to pursue criminal justice. Even more importantly, survivors are provided with a medical exam and medications to prevent STIs and, if needed, emergency contraception. None of this happens with self-administered kits,” said Jordan.
“MCASA supports the decisions of survivors and it is vital that these decisions be informed and based on correct information,” said Jordan. “Maryland needs to do better to make sure that sexual assault forensic exams are accessible and that the community knows about them.”
Clary said supports victims, but they need to be completely informed about the facts.
“I want survivors to be able to make the decision that is best for them, even if that means they take a self-administered exam, but I think they should be educated about all the implications before making that decision,” she said. “It can be appealing to someone who has been significantly traumatized, but a self-administered exam is not a medical exam and does not replace medical services.”