Investigating drug-facilitated sexual assault at a dedicated forensic centre in Cape Town, South Africa

Drug-facilitated sexual assault (DFSA) is a well-recognised public health concern. In South Africa however, epidemiological and toxicological data associated with suspected DFSA are not available. Toxicological screening is currently not routinely available in clinical forensic practice in the Western Cape, or elsewhere in South Africa.

To preliminary investigate and characterize DFSA in a specific metropolitan setting in South Africa and to identify the drugs/xenobiotics associated with these reported DFSAs.

In total, 107 survivors of suspected DFSA who reported to Victoria Hospital Clinical Forensic Unit in Cape Town, between 1 October 2013 and 30 June 2016, were included. Blood, urine, and/or hair specimens from survivors were screened for drugs of abuse using a targeted LC-MS/MS method. Breath alcohol measurements were conducted using the Dräger Alcotest 6820 after July 2015. Patient, incident and examination history were recorded on standardized data sheets.

Of the 107 cases investigated, most of the patients were female (n=104, 97%), between the ages of 18-25years (n=54, 50%), and had reported to the Clinical Forensic Unit within 24h (n=78, 73%). Altogether, 30 patients (28%) reported a history of mental health issues, drugs and/or alcohol use, or prior sexual abuse. Most incidents took place in the late evening/early morning at the home of the assailant(s), a friend or of the patient (n=62, 58%), and most assailants were known to the victim (n=66, 62%). Specimens were positive for drugs and/or ethanol in 72 patients (67%), with drugs other than ethanol being detected in 60 patients (56%). Breath alcohol measurements were conducted in 58 cases during the prospective leg of the study with an average reading of 0.1mg/L (range not detected-0.98mg/L).

DFSA in this setting is mostly opportunistic, with ethanol suggested to be the most commonly involved drug, despite limitations in detection due to delays in reporting. Other common drugs observed were methamphetamine, methaqualone and diphenhydramine either alone or in combinations. The complexity and current inadequacy surrounding investigation of these cases is highlighted in this study as well as the necessity for greater investment into the development of infrastructure to support systematic toxicological analyses and services to assist in the investigation and understanding of these intricate cases. Training and empowerment of role players dealing with the investigation and management of DFSA is required, and subsequent public health education and policy development is essential.