There is a recognised gap, both within the research literature and clinical settings, regarding provision of specialised support and treatment for male and gender-diverse (including all gender identities outside the gender binary male/female) survivors of sexual harm (including any type of forced or coerced sexual contact, assault, harassment or behaviour that happens without consent).[[1,2]] Specialised treatment and support interventions to date have been developed and tested in relation to meeting the needs of females.[[3]] More recently, agencies and clinicians consider, and provide, survivor-centred, trauma-informed, specialised care for male or gender-diverse survivors. In provision of such care, there are unique gender-related factors that indicate that support and treatment for survivors of sexual harm need to be gender specific.[[4,5]] For example, cultural constructions of masculinity and males’ internalised masculine norms alter the adverse effects of sexual harm for male survivors and produce a barrier to male survivors seeking support.[[6,7]] Furthermore, the predominant traditional dichotomy of gender as either male or female has meant that the support and treatment needs of gender-diverse survivors has gone largely unexamined and need to be considered in the provision of specialist services.[[8]] Given that gender-diverse persons are over-represented in sexual harm statistics[[9,10]] it is important to examine the specific support and treatment needs that they present with.

Provision of gender-sensitive services for those who experience sexual harm is one key element for reducing harm in the aftermath of sexual assault, however, also important to consider is whether persons experiencing sexual harm seek help from such services. Of interest, are there gender-based differences in help-seeking behaviours? Although the help-seeking behaviours of survivors of sexual harm have been investigated by several researchers, these studies have generally not considered help-seeking through a gendered lens. Studies that included only female survivors or that did not distinguish findings by gender show survivors of sexual crime and interpersonal violence (including sexual assault and intimate partner violence) often choose not to seek help.[[1,11–13]] Evidence also suggests that university-aged students may be less likely to seek help than young people not at university or the general population;[[12–14]] and survivors may be more likely to disclose to informal supports such as family and friends than more formal supports such as the police or mental health services.[[12]]

More recently, a small number of studies have examined help-seeking behaviours of gender-diverse persons related to having experienced physical or sexual harm. Research conducted examining intimate partner violence (domestic violence and abuse) indicates that gender-diverse persons tend to seek support from more informal sources rather than formal supports.[[15,16]] Research conducted examining experience of sexual harm indicates that male survivors are less likely than female survivors to seek help.[[17–20]] Overall, there is a paucity of research examining the similarities or difference in help-seeking behaviours of gender-diverse survivors compared to female and male survivors. It has been documented that male and gender-diverse persons who have experienced sexual harm may encounter distinct and unique access barriers to support services.[[1,19,21]] Furthermore, in New Zealand, Hare[[ 21]] reports LGBTQI survivors of sexual harm rarely seek help or justice.

A lack of professional help sought is concerning given the potential for long-term negative consequences, mental, physical and emotional, of sexual harm.[[22-24]] It is known that long-term negative consequences can be mitigated by seeking help.[[25,26]] Marginalised and potentially underserved groups have diverse support needs that, if not met, may compound the consequences of sexual harm.[[1]] Additionally, there is also risk of negative reactions to support seeking if services are not equipped to serve survivors with a diverse range of gender identities; negative reactions may impede well-being or result in secondary victimisation.[[27,28]] In order to provide equitable, effective and accessible help for survivors of sexual harm, a better understanding of help-seeking behaviours, taken through a gendered lens, is required.

This study reports from a cross-sectional survey of experiences of sexual harm among students at a large campus of a university in New Zealand and takes a gendered focus. We examine an existing data set drawn from the 2019 Campus Climate Survey[[11]] to better understand how cisgender (a person whose gender identity is the same as their sex assigned at birth) women, cisgender men and gender-diverse persons who report experience of sexual harm differ (or not) in terms of their experience of sexual harm and their help-seeking behaviours. Findings from this project will inform New Zealand specialist sexual violence support agencies and all health professionals, as well as providing strategic direction for future research. Based on past research reviewed above, it was hypothesised that there would be gender difference in experiences of sexual harm and help-seeking among university students, with cisgender women and gender-diverse persons more likely to experience sexual harm than cisgender men, and cisgender women more likely to seek help after experiencing sexual harm than cisgender men and gender-diverse persons.

Method

Measures

The Campus Climate Survey[[11]] was developed from the Administrator-Researcher Campus Climate Consortium (ARC3) survey tool and was piloted to confirm the ARC3 was culturally appropriate for use in New Zealand. Participants were asked a range of questions about their perceptions of campus climate regarding misconduct; and experience of harms such as stalking victimisation; cyberbullying; dating and flatting violence. Results and analysis presented here are from the ARC3 Sexual Assault Victimisation module of the survey. In this module of the survey students were asked specifically about sexual harm experiences, including sexual harassment by faculty staff or student, attempted sexual contact without consent, “attempted sexual assault” and sexual contact without consent (with or without oral, anal or vaginal penetration) and “sexual assault” by any person (i.e., not limited to staff or student perpetrator). Participants were asked to report sexual harm experienced since enrolment at the university, that took place on or off campus, and either during semester or a university holiday break. Participants who reported experiencing some sort of sexual harm were then also asked “Did you tell anyone about the incident before this questionnaire?” and “Who did you tell?” Telling someone about the incident was considered help-seeking behaviour. The survey was distributed via email to all (approximately 20,000) university students studying, in person, at the main campus of one of the universities in New Zealand during 2019 (see Beres and colleagues for full methodology[[11]]).

Participants

A total sample of 1,540 (7.7%) valid survey respondents was recorded. For the purpose of this analysis participants who reported sexual harm (n=425, 28%) are included here for analysis. Sexual harm included sexual harassment by faculty staff or student, threatened or attempted sexual assault and sexual assault without consent by any person. The final sample of 425 participants who reported experience of sexual harm identified themselves as cisgender women (n=324; 76.2% of those experiencing sexual harm), cisgender men (n=97; 22.8%) or gender-diverse persons (n=4; 1.0%). Participants ranged in age from 18 to 72 years (M=22.03 years; SD=6.40; 83% of the sample were between 18 and 23 years). Participants identified as New Zealand European/Pākehā descent (n=306; 72.0%); Māori descent (n=45; 10.6%); Pacific Island descent (n=11; 2.6%); Asian descent (n=43; 10.1%); and other ethnicities (n=19; 4.5%). Participants were able to select multiple ethnic identities therefore totals for each ethnic group may exceed 100%.

Results

Type of sexual harm experience

A series of 3 (gender: cisgender women, cisgender men, gender-diverse people) x 2 (experience: yes, no) for each type of sexual harm experience (i) sexual harassment by staff, (ii) sexual harassment by student, (iii) attempted sexual assault, (iv) sexual assault without penetration, (v) sexual assault including penetration (oral, vaginal or anal penetration), chi-square analysis showed significant gender differences in experience of attempted sexual assault (X[[2]](2, N=425)=7.82; p=0.02; C{{v}}=0.02), and experience of sexual assault without penetration (X[[2]](2, N=425)=12.38; p<0.00; C{{v}}<0.00). For experience of attempted sexual assault post hoc analysis (calculation of z-scores and p-values with Bonferroni correction for type-1 error), showed no significant difference in the proportion of cisgender women (14%) and gender-diverse people (25%; Bonferroni corrected p=0.008) who experienced sexual assault and no significant difference in the proportion of cisgender men (4%) and gender-diverse persons (25%; Bonferroni corrected p=0.008) who experienced attempted sexual assault. However, a significantly greater proportion of cisgender women (14%) experienced attempted sexual assault compared to cisgender men (4%; Bonferroni corrected p=0.008). Similarly, for experience of sexual assault without penetration post hoc analysis showed no significant difference in the proportion of cisgender women (26%) and gender-diverse persons (25%; Bonferroni corrected p=0.008) who experienced sexual assault without penetration and no significant difference in the proportion of cisgender men (9%) and gender-diverse persons (25%; Bonferroni corrected p=0.008) who experienced sexual assault without penetration. However, a significantly greater proportion of cisgender women (26%) experienced sexual assault without penetration compared to cisgender men (9%; Bonferroni corrected p=0.008). Note, results need to be considered in light of the small number of gender-diverse survivors in the sample and the limitations that this places on the conclusions that can ultimately be drawn (see also Discussion).

There was no significant relationship found between gender and sexual harm experience for experiences of sexual harassment by staff, sexual harassment by student or sexual assault, nor for sexual assault including penetration.

Did respondents tell someone about their experience of sexual harm?

A 3 (gender: cisgender women, cisgender men, gender-diverse persons) x 2 (told someone: told, not told) Chi-squared analysis showed a significant relationship between gender and whether the survivor told someone about the sexual harm or not (X[[2]](2, N=425)=10.22, p<0.01; C{{v}}=0.16). Post hoc analysis (conducted as described above) showed no significant difference in the proportion of cisgender women (31%) and gender-diverse persons (25%; Bonferroni corrected p=0.008) who told someone about the sexual harm and no significant difference in the proportion of cisgender men (14.4%) and gender-diverse persons (25%; Bonferroni corrected p=0.008) who told someone about the sexual harm. However, significantly fewer cisgender men told someone about the sexual harm (14.4%) compared to cisgender women (31%; Bonferroni corrected p=0.008; Table 1). Furthermore, odds ratio calculations showed that cisgender men were 2.65 times more likely to not tell someone about the sexual harm compared to cisgender women (odds ratio=2.65; CI¬{{0.95}}=1.43; 4.88). Again, we note the low number of gender-diverse survivors in this sample which limits conclusions drawn in relation to the gender-diverse group. Replication of this comparison with a larger gender-diverse group is necessary.

Who did respondents tell about their experienced sexual harm?

For those who reported telling someone about their sexual harm (n=115), a 3 (gender: cisgender women, cisgender men, gender-diverse persons) x 4 (who told: Family/friends, sexual victimisation specialist services, medical and mental health services, other services) chi-square analysis showed no significant relationship between gender and who the participant reported telling someone about their sexual harm. Irrespective of gender identity, all respondents who had told someone that they had experienced sexual harm had told friends or family. Some (20% of respondents), in addition to telling friends or family also reported having told persons at specialist services or other professional or help services about the sexual harm. Of those who did tell services about their experience of sexual harm, all were cisgender women, and no cisgender men or gender-diverse persons reported their experiences of sexual harm to services (see Table 2).

View Tables 1–2.

Discussion

Contrary to the traditional and often-persistent schema that sexual harm is limited to female victims at the hands of male perpetrators, our research demonstrates that cisgender men and gender-diverse students are also experiencing sexual harm of all types. This finding emphasises the need for sexual harm research, interventions and supports to be directed at and to consider the needs of a broader range of persons who present across a range diverse genders. Recognising that cisgender men and gender-diverse persons also experience sexual harm legitimises and makes transparent their experiences as sexual harm.[[29]] Understanding and raising awareness that sexual harm is not solely a cisgender women issue enables survivors of all genders to interpret and report their sexual experience as harmful, which in turn may increase the likelihood of reaching out for support and treatment. Legitimising sexual harm as experienced by cisgender men and gender-diverse persons may also help make services more responsive to specific gender needs and recognise the need to routinely ask about sexual harm across gender.

The present study was primarily directed at examining the help-seeking behaviour of cisgender women, cisgender men and gender-diverse university students. Telling someone about the experience was considered as a proxy of help-seeking behaviour in terms of seeking support from others. Similar to previous research, in our study only a small number of respondents who experienced sexual harm told someone about that experience.[[1,12,13,20]] Also in keeping with previous research (see Sabina and Ho[[ 12]] for a review), in our study those who did tell someone told informal supports such as family or friends, with only a small number of the total cisgender women participants (6.2%) additionally disclosing to more formal supports such as specialist and medical services. In Sabina and Ho’s[[12]] review of 45 empirical studies they report that disclosure to informal supports such as friends and family is much more frequent than disclosure to formal supports, with rates of between 41% and 100% disclosure to informal supports. Disclosure rates to formal supports (e.g., police and campus authorities) ranged from 0% to 16%. Sabina and Ho[[12]] considered that the lower rates of disclosure reported in some of the reviewed empirical studies may be explained by the inclusion of men who are less likely to disclose abuse. In our study, cisgender men (14%) were less likely to tell someone about their experience compared to cisgender women (31%). Similarly, Banyard and colleagues[[18]] also report that male university students in the US were less likely to disclose (67%) than female students (85%). The difference in rates of disclosure between this study and US research are likely to reflect different ways of asking about help-seeking and recruiting participants. In this study, few gender-diverse persons who had experienced sexual harm had told someone, however, caution should be taken in interpreting findings for the gender-diverse group given the small number of gender-diverse respondents. Further research with a bigger sample size of gender-diverse survivors is needed to understand the support needs of these students who have experienced sexual harm.

Generally, non or delayed disclosure of sexual harm is not uncommon and has been previously linked to feelings of shame; doubt around how the disclosure may be handled and concerns about secondary victimisation.[[11,27,28]] Cisgender men may also downplay the severity of the sexual harm resulting in lower rates of reporting.[[12,18,30]]

The findings of the present study need to be considered in light of its limitations. This survey study includes a self-selected sample of university students from one city but had a similar response rate to international research.[[11]] The sample also includes only a small number of gender-diverse persons. Additional research is therefore needed with a larger sample size of gender-diverse persons to draw firm conclusions about the rates and type of help-seeking behaviours for this group. The results reported here, though, do provide important preliminary statistics and information that are relevant to the provision of sexual harm support services within New Zealand. Specifically, that support services need to consider how to best support and accommodate clients from a range of gender identity groups. In particular, they need to consider marketing or advertising their services in a gender-inclusive way so that it represents the full range of persons who may seek help in relation to sexual harm. Given that disclosure rates are low, and typically lower for cisgender males, health professionals should routinely ask about experiences of sexual harm irrespective of gender identity. Additionally, as the vast majority of those who did tell someone about their experience reported telling family or friends, this identifies a unique opportunity for family and friends to provide a supportive response and assist the survivor to identify supports available and the benefits of such support. In this way, consideration not only needs to be given as to how to support survivors directly but how to support and inform the potential supporters of survivors in our community.

Although the present study shed some light on help-seeking behaviour for persons who have experienced sexual harm, further qualitative research is needed to consider the reasons why those who have experienced sexual harm did not tell someone about their experience or seek help from formal support services.[[18]] Qualitative research could also explore enablers and barriers to seeking help from specialist services. This would inform both specialised sexual harm and more general support services in the development of services tailored to meet the needs of a wide spectrum of gender identities including cisgender women, cisgender men and gender-diverse persons.

In conclusion, New Zealand health professionals and specialist sexual violence support agencies need to examine accessibility for cisgender men and gender-diverse persons as these populations are experiencing sexual harm alongside cisgender women. Policy makers and specialist sexual violence service providers need to adapt a more holistic approach to accommodate the support needs of people who experience sexual harm and consider accessibility for a diverse range of gender identities. Future research needs to examine the reasons why students and others who experience sexual harm are not reaching out to more formal service providers.