HIV/AIDS Risk Reduction Intervention for Women who have Experienced Intimate Partner Violence

Cervical Cancer Screening and Prevention among Survivors of Intimate Partner Violence

Women who experience intimate partner violence are an underserved population at risk for cervical cancer, precipitated by their heightened risk for human papilloma virus (HPV) and underutilization of gynecological care. This pilot study describes the self-reported behaviors, levels of knowledge, and perceived self-efficacy with cervical cancer screening (i.e., Pap testing) and prevention (i.e., HPV vaccination) among survivors (N = 30) recruited from two domestic violence shelter organizations in the midwestern United States. Survey results indicate a need for increased knowledge and awareness about cervical cancer and prevention strategies among this population; only 23 percent (n = 7) participants reported an up-to-date Pap test and 17 percent (n = 5) participants reported HPV vaccination. Findings also indicate how theoretical constructs from the health belief model, together with feminist understandings of coercive control and empowerment, might explain survivors' proactive cervical health behaviors and offer insights for intervention.

Talking with My Sistahs: Examining Discussions About HIV Risk and Prevention Outcomes Within Black Women Sistah Circles

Black women's health is in a state of crisis. Though Black women make up roughly 12% of the US population, they account for 66% of new HIV cases. One understudied barrier to Black women's sexual health is their communication about the topic of HIV with others and proclivity to dismiss HIV-related information based on self-exemption. Using a group-centered approach called the "sistah circle," this study examines group gatherings of Black women to assess their communication about HIV and determine potential gaps in their understanding of information and HIV-related behavior. Data were derived from five focus groups, with four Black women in each group engaging in a facilitated discussion. Findings from the project extend knowledge about how socializing agents such as school, parents, church, and interventionists have the potential to delay or deter Black women from engaging in communication that supports risk-reducing behaviors and prevention efforts.

HIV/STI Prevention Interventions for Women Who Have Experienced Intimate Partner Violence: A Systematic Review and Look at Whether the Interventions Were Designed for Disseminations

This systematic review of HIV/STI prevention interventions for women who have experienced intimate partner violence (IPV) describes the interventions characteristics, impact on HIV-related outcomes, and whether the studies were designed for dissemination. Six intervention studies met the inclusion criteria. Two studies were randomized controlled trials. The interventions consisted of between one and eight individual and/or group sessions. The interventions durations ranged from 10 minutes to 18 hours. The interventions impacts were assessed across 12 HIV-related outcomes. Two randomized control trials showed significantly fewer unprotected sexual episodes or consistent safer sex among abused women in the treatment conditions compared to the control groups. Two studies chose a delivery site for scalability purposes and three interventions were manualized. Three studies examined intervention acceptability, feasibility or fidelity. HIV/STI prevention interventions for women who have experienced IPV may be improved with randomized control designs and greater efforts to design the interventions for dissemination.

Desired Characteristics of HIV Testing and Counseling among Diverse Survivors of Intimate Partner Violence Receiving Social Services

Despite recent calls to integrate HIV testing into social services addressing intimate partner violence (IPV), few studies have reported on survivors' perspectives regarding the desired characteristics of this integration. The purpose of this study was to describe desired characteristics of HIV and sexually transmitted infection (STI) testing services from a survivor's perspective. A qualitative descriptive approach was taken to describe the perspectives of IPV survivors who may or may not have accessed this service. Four focus groups were conducted with a diverse sample of English and Spanish speakers (N = 25) who sought services through a family justice center and associated shelters. Focus groups were recorded, transcribed, and analyzed using conventional content analysis. Three themes were identified, including (1) peace of mind; (2) interacting stigmas and traumas; and (3) making testing easy, comfortable, and tailored. The findings of this study have the potential to influence survivor-centered practices and policies regarding the integration of culturally informed HIV/STI and IPV services.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

Women's Healing Journey From Intimate Partner Violence: Establishing Positive Sexuality

Survivors of intimate partner violence (IPV) have an elevated risk for negative sexual health outcomes, including HIV and sexually transmitted infection (STI). Given the unique risk contexts for survivors, there is a need for effective sexual health interventions that take into account the imbalances of power for women who are survivors of IPV. Toward the aim of informing contextually relevant intervention approaches, this article describes women's strategies toward maintaining their sexual health in the context of violent, controlling relationships. Strategies are examined across women's healing process. Data were collected through semi-structured, in-person interviews with women who had experienced IPV ( N = 28). Participants had a wide range of negative sexual health outcomes and commonly used an analogy of a journey to describe their healing. Throughout these journeys, women gained more confidence and ownership over their sexuality. Themes centered around enhanced self-acceptance, ownership of personal sexuality, and readiness for desirable sexual partnerships.

Interventions that Address Intimate Partner Violence and HIV Among Women: A Systematic Review

Recognizing the high prevalence of human immunodeficiency virus (HIV)-positive women and girls who are either at risk for or suffer from intimate partner violence (IPV) and the overlapping challenges posed by both public health issues, the White House established an Interagency Federal Working Group to address the intersection of both public health issues in 2012. We conducted this systematic review in response to the Working Group's charge to identify and describe interventions that address both IPV and HIV among women. We identified 14 studies that met our inclusion criteria, including seven studies (nine unique intervention arms) that significantly affected at least one outcome related to IPV and HIV. In this article, we examine the characteristics of these studies including core components, intervention populations, and effectiveness data. We highlight opportunities to improve the effectiveness of existing interventions, guide future research about IPV and HIV, and inform prevention programmatic delivery. This knowledge will improve the lives of populations at risk, reduce gender-related health disparities, and ultimately reduce the societal burden of both public health issues.

Trauma-Informed Decision-Making Among Providers and Victims of Intimate Partner Violence During HIV Testing: A Qualitative Study

We explored the process of implementing an HIV testing program at an intimate partner violence (IPV) service agency from the client and provider perspectives. A qualitative descriptive approach was used wherein semi-structured interviews were conducted with 19 key informants (i.e., women with a history of IPV, HIV service providers, IPV service providers). Interviews focused on facilitators and barriers to HIV testing implementation, the decision-making process during HIV testing, and support needs. All interviews were recorded and transcribed. The text of the interviews was analyzed using directed content analysis. Unique factors were found to influence HIV testing in victims of IPV including potential for re-traumatization, readiness for testing, competing priorities, and the influence of children. The results provided important information that can be used to improve the implementation of HIV testing, tailoring processes so they are more trauma-informed; and better support individuals with a history of IPV.

Rapid Human Immunodeficiency Virus Testing and Risk Prevention in Residents of Battered Women's Shelters

BACKGROUND

Human immunodeficiency virus (HIV) infection and intimate partner violence (IPV) are interconnected public health problems. However, few HIV prevention interventions address the unique needs of IPV survivors in shelter and none of the Centers for Disease Control and Prevention's best-evidence risk reduction interventions adequately explore the complex relationship between IPV and HIV risk. Although battered women's shelters provide a safe and supportive environment for women in crisis, most do not offer HIV risk reduction services or sexual safety planning.

METHODS

This study evaluated the feasibility, acceptability, and initial efficacy of rapid HIV testing and brief risk prevention intervention developed for residents of battered women's shelters. The Safe Alternatives For Empowered sex for intimate partner violence intervention (SAFE-IPV) was evaluated in an open trial (N = 98). Participants were assessed with a series of standardized interviews and self-reports at screening and 3 months after leaving the shelter.

RESULTS

Few eligible participants declined SAFE-IPV and participants who received SAFE-IPV reported high levels of satisfaction. No participants in the open trial tested positive for HIV. However, participants reported significantly fewer unprotected vaginal and anal sexual occasions and increased intentions to engage in risk preventative behaviors 3 months after leaving shelter compared with the 3 months before shelter. Additionally, participants reported significant improvements on HIV risk factors addressed in SAFE-IPV at the 3-month follow-up (i.e., reduced emotional, physical, and sexual harm by abuser, posttraumatic stress symptoms, hazardous alcohol use, and drug use).

DISCUSSION

These results extend prior research on HIV prevention with women with IPV, demonstrating the acceptability, feasibility, and initial efficacy of SAFE-IPV within battered women's shelter settings.

Adapting an Evidence-Based HIV-Prevention Intervention for Women in Domestic Violence Shelters

OBJECTIVE

Despite the documented intersection of intimate partner violence and HIV, there is a paucity of evidence-based HIV prevention interventions for female survivors of intimate partner violence in the United States. This paper describes the adaptation of an effective HIV prevention intervention, Sisters Informing Sisters about Topics on AIDS (SISTA), for women in domestic violence shelters and the steps taken to improve the adapted intervention's implementation.

METHOD

The adaptation process was guided by the ADAPT-ITT framework and data collected from directors, direct client service providers, and residents of two domestic violence shelters located in urban areas, as well as topical experts.

RESULTS

Eleven of 12 shelter staff (92%) reported that HIV interventions had never been implemented at their shelter and 64% reported they had not provided residents with educational brochures about HIV prevention. Changes made to adapt SISTA for this population and enhance the implementation of the intervention included reducing the intervention's duration; adding education about the intersection of intimate partner violence, substance use, and HIV; and adding an HIV risk assessment and safety plan.

CONCLUSIONS

Next steps will include implementing the adapted intervention and evaluating its perceived acceptability and efficacy, and assessing whether contextual factors influence the intervention's implementation.

Minority College Women's Views on Condom Negotiation

This study utilized quantitative and qualitative methods to (1) investigate the relationship between frequency of condom use and negotiation strategies and (2) evaluate experiences with condom negotiations among sexually active, heterosexual, African American college women. One hundred female students from a Historically Black Colleges and Universities (HBCU) completed a questionnaire that included the Condom Influence Strategies Scale (CIS) and participated in a focus group. An ANOVA was conducted to compare differences between never, inconsistent, and consistent condom users. Consistent condom users scored higher than never users on the “withholding sex” subscale of the CIS (4.88 vs. 3.55; p < 0.001) as well as endorsed items more strongly on the “direct request” subscale of the CIS (4.63 vs. 3.82, p < 0.05) than never users. A thematic analysis of open discussions identified overarching themes. Similarly, refusing sex and/or having direct communications with partner emerged as primary strategies. Threats to negotiation included deciding the “right timing” of discussion and having a previous history of sexual intercourse without a condom with their partner. Other key concepts that contribute to condom negotiation are the views that condoms are a male’s responsibility and stigma of women who carry condoms.

Sexual Safety Planning as an HIV Prevention Strategy for Survivors of Domestic Violence

Victims of domestic violence (DV) are not only subject to physical and emotional abuse but may also be at increased risk for less recognized dangers from infection with human immunodeficiency virus (HIV) and other sexually transmitted pathogens. Because of the close link between DV and sexual risk, women need to be educated about the consequences of acquiring a life-threatening sexually transmitted infection, risk reduction measures, and how to access appropriate HIV services for diagnosis and treatment. It is therefore critical for DV workers to receive sufficient training about the link between DV and HIV risk so that sexual safety planning can be incorporated into activities with their clients in the same way as physical safety plans. In this article, we discuss how the Many Hands Working Together project provides interactive training for workers in DV and DV-affiliated agencies to increase their knowledge about HIV and teach sexual safety planning skills to achieve HIV risk reduction.

HIV-Testing Rates and Testing Locations Among Women Who Have Experienced Intimate Partner Violence: Data From the Centers for Disease Control Behavioral Risk Factor Surveillance System, 2006

Data from the Centers for Disease Control and Prevention's (CDC) 2006 Behavioral Risk Factor Surveillance System were analyzed to report the HIV-testing rates and locations of women who have experienced intimate partner violence (IPV). Of the 18,917 women in the sample, 19.8% reported experiencing IPV. Over half of the women who experienced IPV reported testing rates of 52.4%, compared with 35.5% of the overall sample. Testing rates and locations significantly differed by race/ethnicity. Findings and their implications are explored, with an emphasis on increasing access to HIV testing and treatment for women who have experienced IPV and providing sexual safety planning for women accessing HIV-testing services.

Rapid HIV testing and counseling for residents in domestic violence shelters

Over one million Americans live with the human immunodeficiency virus (HIV), and roughly 20 percent of those living with HIV are unaware of their status. One way to decrease this epidemic is community-based rapid testing with high-risk populations. One high-risk population that has received limited attention is victims of intimate partner violence who seek shelter. In an effort to gain foundational information to implement rapid HIV testing and counseling services in domestic violence shelters, the current study conducted a series of focus groups with eighteen residents and ten staff of local shelters from October 15 to December 12, 2012. Participants provided valuable insight into how HIV rapid testing and counseling might be best implemented given the resources and constraints of shelter life. Despite identifying some potential barriers, most believed that the promise of quick results, the convenience and support afforded by the shelter venue, and the timing of the intervention at a point when women are making life changes would render the intervention acceptable to residents. Further insights are discussed in the article.

Factors related to sexual abuse and forced sex in a sample of women experiencing police-involved intimate partner violence

Intimate partner sexual violence (IPSV) is a significant social problem, particularly among women who are concurrently experiencing physical violence in their intimate relationships. This research examined the prevalence and factors associated with IPSV among a sample of women recruited at the scene of police-involved intimate partner violence incidents (N = 432). Within this sample, 43.98 percent of participants reported experiencing IPSV; this includes 17.36 percent who reported sexual abuse and 26.62 percent who reported forced sex. Multinomial logistic regression was used to examine the factors related to sexual abuse and forced sex, controlling for victim and relationship characteristics. Compared with women not reporting IPSV, women who were sexually abused or forced into sexual intercourse were significantly more likely to experience strangulation, feelings of shame, and posttraumatic stress disorder symptoms. Women whose partners had forced sex were more likely to report that they had a child in common with their abusive partner; and that their partner was sexually jealous, had threatened to kill them, had stalked or harassed them, or caused them to have a miscarriage due to abuse. These findings can be used to better inform social work practitioners about the prevalence and nature of IPSV and the associated risk factors, and can assist in routine screening and intervention.

Intimate partner sexual violence: a comparison of foreign- versus US-born physically abused Latinas

Men's violence against women-particularly intimate partner sexual violence (IPSV)-is associated with the transmission of HIV. Men who physically abuse their female intimate partners often also sexually abuse them. Latinas are one of the fastest growing populations in the USA and at high-risk for contracting HIV, though little is known about IPSV against physically abused Latinas, including whether there is an association between nativity of the victim and the likelihood of sexual violence by intimate partners. This study examined the (1) prevalence of recent (past 6 months) IPSV against 555 physically abused, help-seeking Latinas and (2) relationship of nativity to recent IPSV. This study used data collected in 2002–2003 from participants in one major city on the East Coast and one West Coast county, who were involved in the Risk Assessment Validation (RAVE) Study. The RAVE Study assessed the accuracy of four different methods for predicting risk of future intimate partner violence. IPSV was defined as an abusive male partner physically forcing sex (rape) or making the woman have sex without a condom. Recent IPSV was reported by 38 % of the sample. Among those reporting recent IPSV, multiple assaults were common: 30%of women were raped and 51%were made to have unprotected sex six or more times during the past 6 months. IPSV was significantly associated with nativity. Physically abused Latinas who were foreign born had two times greater odds of reporting recent IPSV than physically abused Latinas born in the USA, after controlling for other demographic covariates. Exploratory post hoc analyses examining all pairwise comparisons of IPSV against Latinas born in the USA, Mexico, Central America, South America, and the Caribbean also revealed some significant differences that warrant further study with larger samples. HIV prevention efforts aimed at reducing IPSV in this population are needed.

The intersection of intimate partner violence and HIV in U.S. women: a review

The purposes of this study were to (a) review original research in the United States on the intersection of HIV risk and intimate partner violence (IPV) in women, and (b) identify trends that promote nursing and public health prevention and intervention strategies. Twenty-three original, peer-reviewed articles in the medical literature from 2008 to April 2012 were reviewed. Articles were eligible for inclusion if they addressed both HIV and IPV in women. Studies identified relationships between intimate partner victimization and HIV risk behaviors. Other factors compounding the complex relationship between IPV and increased HIV risk in women included sexual decision-making, male behavior, and substance use. A promising trend was found in the publication of studies addressing interventions. Prospective studies are needed to determine causality and temporal associations. Nursing interventions should focus on identifying women at risk for IPV, assessing HIV exposure risks, and providing culturally sensitive interventions and preventive measures.

Experiences of HIV-positive African-American and African Caribbean childbearing women: a qualitative study

This qualitative study examined the experiences of HIV-positive African-American and African Caribbean childbearing women related to decisions about HIV testing, status disclosure, adhering to treatment, decisions about childbearing, and experiences in violent intimate relationships. Twenty-three women completed a 60-minute in-depth interview. Six themes emerged: perceived vulnerability to HIV infection; feelings about getting tested for HIV; knowledge, attitudes, and behaviors after HIV diagnosis; disclosure of HIV status; living with HIV (positivity, strength, and prayer); and, experiences with physical and sexual violence. Three women (13%) reported perinatal abuse and 10 women (n = 23, 43.4%) reported lifetime abuse. Positive experiences and resilience were gained from faith and prayer. Most important to the women were the perceived benefits of protecting the health of their baby. Findings suggest that policies supporting early identification of HIV-positive childbearing women are critical in order to provide counseling and education in forming their decisions for safety precautions in violent intimate partner relationships.