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Ingold KA, Teasdale B. Explaining the Relationship Between Intimate Partner Violence Victimization and Human Immunodeficiency Virus Status in Transgender and Nonbinary Individuals. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3373-3395. [PMID: 38345002 PMCID: PMC11283746 DOI: 10.1177/08862605241230551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
STUDY QUESTIONS Previous research has shown that human immunodeficiency virus (HIV) status and intimate partner violence (IPV) victimization are correlated. Furthermore, it has been consistently reported that transgender individuals are at an increased risk of experiencing IPV victimization and testing positive for HIV compared to cisgender individuals. However, past research examining the potential explanations for the correlation between HIV status and IPV victimization in transgender individuals using a large and inclusive sample is nonexistent. SUBJECTS A total of 12,592 transgender and nonbinary individuals from across the United States were included in the analyses. METHODS Through a bivariate probit analysis of data from the 2015 U.S. Transgender Survey, this study examines potential explanations for the association between HIV and IPV victimization in a sample of transgender individuals. FINDINGS The results support previous research, which indicates that a transgender individual's HIV status is significantly correlated with their likelihood to experience IPV victimization. Additionally, a participant's involvement in sex work and other risk-taking behaviors, such as binge drinking, was found to, in part, explain this co-occurring relationship. Other variables, such as coercive control and prescription drug misuse, were found to correlate significantly with IPV victimization but not HIV status. The relationships between participants' demographic variables, such as their race, sexuality, sex assigned at birth, IPV victimization, and HIV status, were examined and discussed as well. IMPLICATIONS We conclude that it is imperative for LGBTQ + organizations to provide services aimed at protecting transgender individuals suffering from IPV victimization who have also tested positive for HIV through increased accessibility of care and a deeper understanding of the potential relationships in which a person may be involved. This type of outreach would likely be an important first step in allowing transgender individuals to feel safer in their romantic relationships while simultaneously encouraging safe sex practices and a healthy lifestyle, which would increase overall quality of life.
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Fredericksen RJ, Mixson LS, Drumright LN, Nance RM, Delaney JAC, Ruderman SA, Whitney BM, Hahn A, Ma J, Mayer KH, Christopoulos KA, Willig AL, Napravnik S, Bamford L, Cachay E, Eron JJ, Saag M, Jacobson J, Kitahata MM, Crane HM. Correlates of Intimate Partner Violence, Including Psychological Partner Violence, in a Multisite U.S. Cohort of People in HIV Care. AIDS Behav 2024:10.1007/s10461-024-04402-2. [PMID: 39014029 DOI: 10.1007/s10461-024-04402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
We examined past-year intimate partner violence (IPV), including psychological violence without physical/sexual violence, and health outcomes among people with HIV (PWH) in care in a multi-site U.S. cohort. Between 2016 and 2022, PWH reported 12-month psychological, physical, and sexual IPV in a routine assessment. We used linear and logistic regression models adjusted for age, race/ethnicity, and site to examine relationships with health outcomes. Among 9748 PWH (median age 50 years, 81% cisgender male/16% cisgender female/1% transgender female; 44% non-Hispanic white/36% non-Hispanic Black/15% Hispanic), 9.3% (n = 905) reported any IPV in the past 12 months; half reported psychological IPV without physical/sexual IPV (n = 453). PWH reporting any type of IPV were on average younger than those who did not experience IPV. In adjusted models, any IPV was associated with increased likelihood of unstable housing, HIV viral load detection (HIV viral load ≥ 75 copies/mL), moderate-to-severe depressive symptoms, anxiety with panic symptoms, substance use (methamphetamines, cocaine/crack, illicit opioids, marijuana, heavy episodic/hazardous drinking), and concern about exposure to sexually transmitted infection. PWH reporting any IPV in the past 12 months had 4.2% lower adherence to antiretroviral therapy, 2.4 more HIV-related symptoms, a 1.9 point higher HIV stigma score, and a 9.5% lower quality of life score than those without IPV. We found similar associations among PWH reporting only psychological IPV, without physical/sexual IPV. IPV was common among PWH. Half reporting IPV reported only psychological IPV and had similarly poor outcomes as those reporting physical/sexual IPV, demonstrating the need to assess psychological as well as physical and sexual IPV.
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Affiliation(s)
- R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - A Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - K A Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A L Willig
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - S Napravnik
- University of North Carolina, Chapel Hill, NC, USA
| | - L Bamford
- University of California, San Diego, CA, USA
| | - E Cachay
- University of California, San Diego, CA, USA
| | - J J Eron
- University of North Carolina, Chapel Hill, NC, USA
| | - M Saag
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - J Jacobson
- Case Western Reserve University, Cleveland, OH, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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3
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Wu Y, Wang Y, Long H, Liu L, Dai L, Cao W, Liu J, Liu M. Prevalence of Intimate Partner Violence and Associated Factors Among People With HIV: A Large-Sample Cross-Sectional Study in China. J Infect Dis 2023; 228:1592-1599. [PMID: 37565503 PMCID: PMC10681864 DOI: 10.1093/infdis/jiad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 08/12/2023] Open
Abstract
To assess the prevalence and exacerbating factors of intimate partner violence in people with human immunodeficiency virus (PWH) in China, we conducted a cross-sectional study, involving 2792 PWH in 4 provinces in China from 1 September 2020 to 1 June 2021. The categories of intimate partner violence (IPV) included physical violence, sexual violence, emotional abuse, and controlling behavior. The severity of a violent act was divided into mild, moderate, and severe. Among PWH, the prevalence of IPV was 15.4% (95% confidence interval, 14.1%-16.8%). The severity of physical violence was mainly moderate, and the severity of sexual violence, emotional abuse, and controlling behavior was mainly mild. The prevalence of IPV in men was higher than that in women. Results from the multivariable logistic regression showed that age, ethnic, registered residence, education, and duration of HIV antiretroviral therapy were factors related to IPV in PWH (P < .05).
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Affiliation(s)
- Yu Wu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Yaping Wang
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Hai Long
- Guiyang Public Health Clinical Center, Guizhou, China
| | - Lirong Liu
- Shangqiu Center for Disease Prevention and Control, Henan, China
| | - Lili Dai
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wanxian Cao
- Hefei Infectious Disease Hospital, Anhui, China
| | - Jue Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
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4
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Wang L, Hong C, He N, Xavier Hall CD, Simoni JM, Wong FY. Depression as a mediator between intimate partner violence (IPV) and CD4 cell count among men who have sex with men (MSM) living with HIV in China. AIDS Care 2023; 35:1667-1676. [PMID: 37018752 DOI: 10.1080/09540121.2023.2195608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Intimate partner violence (IPV) is associated with adverse mental and physical outcomes among men who have sex with men (MSM) living with HIV. Few studies focus on psychological IPV, such as verbal threats. This study examined the associations between different forms of IPV and depression and CD4+ cell count, with depression as a mediator for the association between IPV and CD4+ cell count. Data for these analyses were derived from a larger cross-sectional study on HIV-HCV co-infection among MSM in Shanghai, China (N = 1623). We estimated the average causal mediation effects (ACME) and average direct effects (ADE) through three steps. About 16% of participants experienced IPV, with forced sex (7%), verbal threats (5%), and thrown objects (4%) being most common. Verbal threats showed the strongest link with depression and low CD4+ cell count. Depression fully mediated the relationship between verbal abuse and low CD4+ cell count, suggesting it as a potential pathway between psychological IPV and poorer HIV-related health outcomes. More research on psychological IPV is warranted to examine its health impacts. Mental health could be a potential focus of intervention to enhance HIV-related health outcomes among MSM with IPV experience.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Chenglin Hong
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Na He
- School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, WA, USA
| | - Frank Y Wong
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, FL, USA
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
- John D. Bower School of Population Health, Department of Population Health Science, University Mississippi Medical Center, Jackson, MS, USA
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5
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Sang JM, Moore DM, Wang L, Chia J, Toy J, Montaner J, Skakoon-Sparling S, Cox J, Lambert G, Grace D, Hart TA, Lal A, Jollimore J, Lachowsky NJ. Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada. BMC Public Health 2023; 23:2124. [PMID: 37904163 PMCID: PMC10614320 DOI: 10.1186/s12889-023-17049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The secondary impacts of the COVID-19 pandemic may disproportionately affect gay, bisexual, and other men who have sex with men (GBM), particularly related to HIV prevention and treatment outcomes. We applied syndemic theory to examine PrEP disruptions during the during the height of the COVID-19 pandemic in Vancouver, Canada. METHODS Sexually-active GBM, aged 16 + years, were enrolled through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every six months and data were linked to the BC PrEP Program (program responsible for publicly funded PrEP in the province) to directly measure PrEP disruptions. The analysis period for this study was from March 2018-April 2021. We used univariable generalized linear mixed models to examine (1) six-month trends for syndemic conditions: the prevalence of moderate/severe depressive or anxiety symptoms, polysubstance use, harmful alcohol consumption, intimate partner violence, and (2) six-month trends for PrEP interruptions among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine whether syndemic factors were associated with PrEP interruptions. RESULTS Our study included 766 participants, with 593 participants who had at least one follow-up visit. The proportion of respondents with abnormal depressive symptoms increased over the study period (OR = 1.35; 95%CI = 1.17, 1.56), but we found decreased prevalence for polysubstance use (OR = 0.89; 95%CI = 0.82, 0.97) and binge drinking (OR = 0.74; 95%CI = 0.67, 0.81). We also found an increase in PrEP interruptions (OR = 2.33; 95%CI = 1.85, 2.94). GBM with moderate/severe depressive symptoms had higher odds (aOR = 4.80; 95%CI = 1.43, 16.16) of PrEP interruptions, while GBM with experiences of IPV had lower odds (aOR = 0.38; 95%CI = 0.15, 0.95) of PrEP interruptions. GBM who met clinical eligibility for PrEP had lower odds of experiencing PrEP interruptions (aOR = 0.25; 95%CI = 0.11, 0.60). CONCLUSION There were increasing PrEP interruptions since March 2020. However, those most at risk for HIV were less likely to have interruptions. Additional mental health services and targeted follow-up for PrEP continuation may help to mitigate the impacts of the COVID-19 pandemic on GBM.
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Affiliation(s)
- Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
- BC Centre on Substance Use, Vancouver, BC, Canada.
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Joseph Cox
- Research Institute of the McGill University Health Center, Montreal, Canada
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
| | - Gilles Lambert
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
- Institut national de santé publique du Québec, Quebec City, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University (formerly Ryerson), Toronto, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Nathan J Lachowsky
- Community Based Research Centre, Vancouver, Canada
- University of Victoria, Victoria, Canada
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Llenas-García J, Masiá M, Pascual Perez R, González-Cuello I, Agulló Re V, Romero Nieto M, Amat Díaz M, Padilla Urrea S, Rodríguez Lucena FJ, Wikman-Jorgensen P. Systematic screening of gender violence and domestic violence among HIV-positive patients: the VIHOLETA study. AIDS Care 2023; 35:1443-1451. [PMID: 36169405 DOI: 10.1080/09540121.2022.2125929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
We conducted a multicentre observational study in people living with HIV (PLHIV) on antiretroviral therapy in Alicante (Spain) from 2019 to 2020 aiming to analyse the prevalence of abuse and assess treatment adherence according to this variable. We used the Abuse Assessment Screen tool, the simplified medication adherence questionnaire and the medication possession ratio to assess outcomes.. Of the 161 included PLHIV, 53 (32.9%) had suffered abuse (27 emotional abuse, 6 physical abuse, 3 sexual abuse, 13 emotional and physical abuse, 4 unknown type). Seven (4.3%) had suffered abuse in the last year (5 emotional, 2 physical). Abuse had lasted a median of 48 months (interquartile range 12-81). HIV status was considered as a cause of violence by 9.4% of victims. In the multivariable analysis, only abuse was independently associated with non-adherence [adjusted odds ratio (aOR) 3.92; 95% confidence interval (CI) 1.80-8.84; p = 0.0007]. Abuse (aOR 6.14; 95% CI 1.63-27.70; p = 0.001) and previous incarceration (aOR 15.08 95% CI 2.71-104.71; p = 0.003) were associated with detectable viral load. In conclusion, the prevalence of abuse is high in PLHIV, hampering adherence and virological success. Abuse screening tools should be incorporated into routine HIV care.
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Affiliation(s)
- Jara Llenas-García
- Internal Medicine, Hospital Vega Baja-FISABIO, Orihuela, Spain
- Clinical Medicine Department, Universidad Miguel Hernández, Elche, Spain
| | - Mar Masiá
- Clinical Medicine Department, Universidad Miguel Hernández, Elche, Spain
- Infectious Diseases Unit, Hospital General Universitario de Elche-FISABIO, Elche, Spain
| | - Reyes Pascual Perez
- Clinical Medicine Department, Universidad Miguel Hernández, Elche, Spain
- Infectious Diseases Unit, Hospital General Universitario de Elda-FISABIO, Elda, Spain
| | | | - Vanesa Agulló Re
- Clinical Medicine Department, Universidad Miguel Hernández, Elche, Spain
- Infectious Diseases Unit, Hospital General Universitario de Elche-FISABIO, Elche, Spain
| | - Mónica Romero Nieto
- Clinical Medicine Department, Universidad Miguel Hernández, Elche, Spain
- Infectious Diseases Unit, Hospital General Universitario de Elda-FISABIO, Elda, Spain
| | - María Amat Díaz
- Farmacology Department, Hospital General Universitario de Elda-FISABIO, Elda, Spain
| | - Sergio Padilla Urrea
- Clinical Medicine Department, Universidad Miguel Hernández, Elche, Spain
- Infectious Diseases Unit, Hospital General Universitario de Elche-FISABIO, Elche, Spain
| | | | - Philip Wikman-Jorgensen
- Internal Medicine, Hospital Universitario San Juan de Alicante-FISABIO, Sant Joan d'Alacant, Spain
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Denney MR, Pichon LC, Brantley ML. Violence, Discrimination, Psychological Distress, and HIV Vulnerability Among Men Who Have Sex With Men in Memphis, Tennessee. Am J Mens Health 2023; 17:15579883231163727. [PMID: 36992529 PMCID: PMC10064477 DOI: 10.1177/15579883231163727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionally impacted by HIV. Discrimination, violence, and psychological distress (PD) may influence engagement with HIV prevention services and amplify HIV vulnerability among this priority population. These dynamics are understudied in the Southern United States. Understanding how these relationships interact is critical to designing effective HIV programs. We examined associations between MSM-related discrimination, MSM-related violence, and severe PD with HIV status among 2017 National HIV Behavioral Surveillance study participants in Memphis, Tennessee. Eligible participants were aged ≥18 years, born and identified as male, and reported having sex with another man in their lifetime. Participants completed a Centers for Disease Control and Prevention-designed anonymous survey and self-reported discrimination and violence across their lifetime, and PD symptoms within the past month, scored on the Kessler-6 Scale. Optional HIV rapid tests were performed on-site. Logistic regressions examined the associations between the exposure variables and HIV antibody-positive results. Among 356 respondents, 66.9% were aged <35 years and 79.5% identified as non-Hispanic Black; 13.2% reported experiencing violence, 47.8% reported discrimination, and 10.7% experienced PD. Of the 297 participants who tested, 33.33% were living with HIV. Discrimination, violence, and PD were significantly associated with each other (p < .0001). HIV antibody-positive test results were associated with violence (p < .01). Memphis-based MSM face a complex array of social experiences, which may increase vulnerability to HIV. On-site testing at community-based organizations and clinical settings among MSM may be an opportunity to screen for violence and incorporate strategies when designing HIV programs.
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Affiliation(s)
- Meredith R. Denney
- School of Medicine, Vanderbilt University, Nashville, TN, USA
- HIV/STI/Viral Hepatitis Section, Tennessee Department of Health, Nashville, TN, USA
| | | | - Meredith L. Brantley
- HIV/STI/Viral Hepatitis Section, Tennessee Department of Health, Nashville, TN, USA
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Kalokhe AS, Adam E, Colasanti J, Livingston M, Root C, Sales JM. Differences in trauma-informed care implementation by clinic-level factors across Ryan White HIV clinics in the Southeastern United States. AIDS Care 2023; 35:222-229. [PMID: 36129400 PMCID: PMC10027618 DOI: 10.1080/09540121.2022.2124225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
Trauma is common among people with HIV (PWH) and associated with low HIV care engagement, thus trauma-informed care (TIC) integration within HIV services is critical. From December 2019 to April 2020, we conducted surveys with 321 administrators, providers, and staff of 46 Ryan White HIV clinics (RWCs) in 8 Southeastern U.S. states to assess level of TIC implementation and clinic-level factors associated with TIC adoption. The mean score for TIC implementation was highest for the Physical Environment domain (μ = 4.08, SE = 0.07), followed by Screening, Assessment, and Treatment Services (μ = 3.96, SE = 0.07), Cross-sector Collaboration (μ = 3.75, SE = 0.08), Engagement and Involvement (μ = 3.92, SE = 0.09); and Training and Workforce Development (μ = 3.54, SE = 0.12). Greatest gaps were in staff TIC training, staff support, presence of onsite legal, spiritual, and housing services, and seeking patients' definitions of safety and developing their individualized crisis/safety plans. Across most TIC implementation domains, clinic type, urbanicity, academic affiliation, and presence of onsite psychosocial support services were associated with level of TIC adoption. Thus, RWCs have the necessary foundation to integrate TIC practices, but further progress will require addressing identified gaps. The overall lack of significant difference in TIC implementation across domains by clinic-level factors suggests that a RW network-wide approach to enhancing TIC integration is feasible.
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Affiliation(s)
- Ameeta S. Kalokhe
- Emory School of Medicine Division of Infectious Diseases
- Emory Rollins School of Public Health Department of Global Health
| | - Elizabeth Adam
- Emory Rollins School of Public Health Department of Epidemiology
| | - Jonathan Colasanti
- Emory School of Medicine Division of Infectious Diseases
- Emory Rollins School of Public Health Department of Global Health
| | - Melvin Livingston
- Emory Rollins School of Public Health Department of Behavioral, Social, and Health Education Sciences
| | - Chris Root
- Emory School of Medicine Division of Infectious Diseases
| | - Jessica M. Sales
- Emory Rollins School of Public Health Department of Behavioral, Social, and Health Education Sciences
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9
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Harris RM, Xavier Hall CD, Mills JC, Pence BW, Bgneris J, Wong FY. Beyond Viral Suppression-The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients. J Acquir Immune Defic Syndr 2023; 92:59-66. [PMID: 36099083 PMCID: PMC11079852 DOI: 10.1097/qai.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV. DESIGN We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 ( n = 284). METHODS A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress. RESULTS The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms ( P <0.001), increased depressive symptoms ( P <0.001), and increased HIV symptom distress ( P < 0.01). HIV symptom distress displayed the largest association with HRQoL ( P < 0.001), followed by depressive symptoms ( P = 0.001) and PTSD symptoms ( P < 0.001). These factors explained approximately 51% of the variance in HRQoL ( R2 = 0.51, P < 0.001). CONCLUSIONS Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.
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Affiliation(s)
- Rachel M Harris
- Center for Population Sciences and Health Equity College of Social Work, Florida State University, FL
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Center for Population Sciences and Health Equity, Northwestern University, Florida State University, FL
| | - Jon C Mills
- College of Medicine, Center for Population Sciences and Health Equity, Florida State University, FL
| | - Brian W Pence
- Gillings School of Global Public Health, University of North Carolina, Chape Hill, NC
| | - Jessica Bgneris
- Center for Population Sciences and Health Equity, Graduate College of Social Work, Florida State University, University of Houston, TX; and
| | - Frankie Y Wong
- Center for Population Sciences and Health Equity, Florida State University, FL
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10
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Wirtz AL, Burns PA, Poteat T, Malik M, White JJ, Brooks D, Kasaie P, Beyrer C. Abuse in the Continua: HIV Prevention and Care Outcomes and Syndemic Conditions Associated with Intimate Partner Violence Among Black Gay and Bisexual Men in the Southern United States. AIDS Behav 2022; 26:3761-3774. [PMID: 35661018 PMCID: PMC9561062 DOI: 10.1007/s10461-022-03705-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
Intimate partner violence (IPV) has been implicated in HIV acquisition and worse HIV outcomes. Limited research focuses on the experiences of Black gay and bisexual men. Using data from cross-sectional surveys in Baltimore, Maryland, and Jackson, Mississippi, we analyzed the association between IPV victimization and HIV-related outcomes among 629 adult Black gay and bisexual men, among whom 53% self-reported a negative result at last HIV test. 40% of participants reported lifetime physical, sexual, and/or psychological IPV victimization, and 24% past-year victimization. Recent and lifetime IPV were associated with recent clinical diagnosis of STI (adjPrR: 1.44; 95%CI: 1.08-1.92) and ART medication interruptions (adjPrR: 1.59; 95%CI: 1.25-2.01), respectively. Physical IPV was inversely associated with current PrEP use (adjPrR: 0.35; 95%CI: 0.13-0.90). Recent IPV was independently correlated with depression symptomatology (adjPrR: 2.36; 95%CI: 1.61-3.47) and hazardous alcohol use (adjPrR: 1.93; 95%CI: 1.42-2.61), with evidence of interactions. IPV-HIV relationships were intersected by internalized stigma, housing instability, poverty, and lack of insurance. Tailored IPV services are urgently needed for comprehensive HIV services for Black gay and bisexual men in the U.S.
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Affiliation(s)
- Andrea L. Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD,Corresponding Author
| | - Paul A. Burns
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS
| | - Tonia Poteat
- Center for Health Equity Research, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Mannat Malik
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | - Jordan J. White
- School of Social Work, Morgan State University, Baltimore, MD
| | | | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD
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11
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Davis DA, Rock A, Santa Luce R, McNaughton-Reyes L, Barrington C. Intimate Partner Violence Victimization and Mental Health Among Men Who Have Sex With Men Living With HIV in Guatemala. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1637-NP1657. [PMID: 32552467 PMCID: PMC7941092 DOI: 10.1177/0886260520928960] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by poor mental health compared to their heterosexual counterparts. One factor that may increase mental health problems among MSM is intimate partner violence (IPV) victimization. The objectives of this study are to (a) describe the prevalence of different forms of IPV victimization experienced by MSM living with HIV in Guatemala City and (b) examine the relationship between IPV victimization and mental health. We analyzed cross-sectional survey data from a cohort of MSM living with HIV in Guatemala City (n = 374) to describe the burden of IPV, including physical, sexual, and emotional IPV. We then examined relationships between lifetime IPV and each form of recent IPV (past 12 months) with self-reported anxiety and depression using multivariable logistic regression. Over a quarter (27.3%) of the participants screened positive for anxiety and nearly one fifth (17.9%) screened positive for depression. Over a quarter of the participants (28.6%) reported ever having experienced any IPV victimization and 8.8% reported having experienced any form of recent IPV. In multivariable analyses, participants who experienced any form of lifetime IPV had roughly twice the odds of experiencing anxiety (OR: 1.86; 95% CI = [1.03, 3.38]) and depression (OR: 2.02; 95% CI = [1.02, 3.99]) compared to those who had not. Participants who experienced recent emotional IPV had over seven times the odds of experiencing anxiety (OR: 7.23; 95% CI = [1.46, 38.85]) compared to those who had not. MSM living with HIV in Guatemala experience a high burden of anxiety, depression, and IPV victimization. Those participants who had experienced lifetime IPV and recent emotional IPV were significantly more likely to screen for anxiety and depression. To improve their mental health, HIV clinics and other health services should provide support for MSM who have experienced IPV victimization.
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Affiliation(s)
- Dirk A. Davis
- The University of North Carolina at Chapel Hill, USA
| | - Amelia Rock
- The University of North Carolina at Chapel Hill, USA
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12
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Chuang DM, Newman PA, Fang L, Lai MC. Syndemic Conditions, Sexual Risk Behavior, and HIV Infection Among Men Who Have Sex with Men in Taiwan. AIDS Behav 2021; 25:3503-3518. [PMID: 33950337 DOI: 10.1007/s10461-021-03269-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)-childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.
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Affiliation(s)
- Deng-Min Chuang
- Graduate Institute of Social Work, National Taiwan Normal University, No. 162, Sec. 1, Heping E. Rd., Da'an Dist., Taipei, 106, Taiwan, ROC.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lin Fang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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13
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Fredericksen RJ, Nance RM, Whitney BM, Harding BN, Fitzsimmons E, Del Rio C, Eron J, Feaster DJ, Kalokhe AS, Mathews WC, Mayer KH, Metsch LR, Mugavero MJ, Potter J, O'Cleirigh C, Napravnik S, Rodriguez B, Ruderman S, Jac D, Crane HM. Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care. BMC Public Health 2021; 21:1824. [PMID: 34627181 PMCID: PMC8502266 DOI: 10.1186/s12889-021-11854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Among people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes. We examined non-physical, psychological intimate partner violence (psy-IPV) and HIV care outcomes using data from two U.S. consortia. Methods We conducted multivariable analyses with robust standard errors to compare patients indicating/not indicating psy-IPV. Results Among PLWH (n = 5950), 9.5% indicated psy-IPV; these individuals were younger (− 3; 95% CI [− 2,-4], p-value < 0.001), less likely to be on antiretroviral treatment (ART) (0.73 [0.55,0.97], p = 0.03), less adherent to ART (− 4.2 [− 5.9,-2.4], p < 0.001), had higher odds of detectable viral load (1.43 [1.15,1.78], p = 0.001) and depression (2.63 [2.18,3.18], p < 0.001), and greater use of methamphetamines/crystal [2.98 (2.30,3.87),p < 0.001], cocaine/crack [1.57 (1.24,1.99),p < 0.001], illicit opioids [1.56 (1.13,2.16),p = 0.007], and marijuana [1.40 (1.15,1.70), p < 0.001]. Conclusion Psychological IPV, even in the absence of physical or sexual IPV, appears to be associated with HIV care outcomes and should be included in IPV measures integrated into routine HIV care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11854-x.
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Affiliation(s)
- R J Fredericksen
- Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - B N Harding
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - E Fitzsimmons
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - C Del Rio
- Department of Global Health, Emory University, Atlanta, Georgia
| | - J Eron
- School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - D J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - A S Kalokhe
- Department of Medicine, Emory University, Atlanta, Georgia
| | - W C Mathews
- Department of Medicine, University of California - San Diego, San Diego, California, USA
| | - K H Mayer
- The Fenway Institute, Boston, MA, USA
| | - L R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - J Potter
- Department of Medicine, Harvard University, Cambridge, MA, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - S Napravnik
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - B Rodriguez
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - S Ruderman
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Delaney Jac
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
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14
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Douglas EM, Hines DA, Dixon L, Celi EM, Lysova AV. Using Technology to Conduct Focus Groups With a Hard-to-Reach Population: A Methodological Approach Concerning Male Victims of Partner Abuse in Four English-Speaking Countries. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP5257-NP5280. [PMID: 30226079 DOI: 10.1177/0886260518799459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research shows that the experiences of male victims of partner abuse (PA) are often denied by the public and the professionals who are charged to support PA victims. Recruiting female victims for research on PA victimization is relatively easy because there are existing structures to serve this group of victims. Thus, male victims are considered a hard-to-reach (HTR) population, and studying them can be difficult. This article focuses on the use of technology to collect qualitative data from male PA victims in an international study focusing on male victims. The researchers used their own professional networks to recruit and screen a convenience sample of male victims of female-to-male PA, in four different English-speaking countries: Australia, Canada, England, and the United States. Four web-based, video-enabled, focus groups were held for each country-for a total of 12 groups and 41 male participants. This article addresses recruitment methods, the use of technology in data collection, protecting the confidentiality of male victims, methods for informed consent, and lessons learned to facilitate future research.
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Affiliation(s)
| | | | | | | | - Alexandra V Lysova
- Simon Fraser University, Vancouver, British Columbia, Canada
- Far Eastern Federal University, Vladivostok, Russia
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15
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Latent Profile Analysis of a Syndemic of Vulnerability Factors on Incident Sexually Transmitted Infection in a Cohort of Black Men Who Have Sex With Men Only and Black Men Who Have Sex With Men and Women in the HIV Prevention Trials Network 061 Study. Sex Transm Dis 2021; 47:571-579. [PMID: 32496390 DOI: 10.1097/olq.0000000000001208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are important public health concerns among black men who have sex with men only (BMSMO), as well as those who have sex with both men and women (BMSMW). Sexually transmitted infections also increase risk of acquiring and HIV, which is also a critical concern. Compared with BMSMO, research shows that BMSMW experience elevated levels of HIV/STI vulnerability factors occurring at the intrapersonal, interpersonal, and social/structural levels. These factors may work independently, increasing one's risk of engaging in high-risk sexual behaviors, but often work in a synergistic and reinforcing manner. The synergism and reinforcement of any combination of these factors are known as a syndemic, which increases HIV/STI risk. METHODS Data from the HIV Prevention Trials Network (HPTN) 061 study (n = 799) was used to conduct a latent profile analysis to identify unique combinations of risk factors that may form a syndemic and that may vary between BMSMO and BMSMW. We hypothesized that the convergence of syndemic factors would differ between groups and predict sexual risk and subsequent incident STI. RESULTS For BMSMO who had a high sexual risk profile, the syndemic factors characterizing this group included perceived racism, incarceration, intimate partner violence, depression, and binge drinking. For BMSMW with a high sexual risk profile, the syndemic factors that characterized this group were incarceration, depression, and binge drinking. CONCLUSIONS The current analysis highlights syndemic profiles that differentiated BMSMO and BMSMW from one another and supports the need for tailored interventions that address specific syndemic factors for both subpopulations of black men who have sex with men.
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16
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Sharma A, Kahle E, Sullivan S, Stephenson R. Sexual Agreements and Intimate Partner Violence Among Male Couples in the U.S.: An Analysis of Dyadic Data. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1087-1105. [PMID: 32705389 PMCID: PMC7855288 DOI: 10.1007/s10508-020-01783-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/13/2020] [Accepted: 06/22/2020] [Indexed: 05/29/2023]
Abstract
Prior research with male couples has focused on how sexual agreements can influence relationship dynamics, sexual risk taking, and health promoting behaviors. Little is known about the association between sexual agreements and the experience or perpetration of intimate partner violence (IPV) in this population. Our study sought to evaluate these associations using dyadic data from a sample of 386 male couples residing in the U.S. Both partners independently reported on their relationship characteristics, sexual agreements, and specific acts reflecting physical, emotional, controlling, and monitoring IPV in separate surveys. Participants were more likely to have experienced IPV in the past year if they were in a relationship for ≥ 3 years versus < 3 years (aOR = 1.62, 95% CI = 1.03-2.53). Among 278 couples who had formulated sexual agreements, men who concurred with their partners on being in an "open" relationship were less likely to have experienced IPV versus those in a "closed" relationship (aOR = 0.47, 95% CI = 0.25-0.89). However, participants were more likely to have experienced IPV if their partners believed they had previously broken their sexual agreement (aOR = 2.79, 95% CI = 1.03-7.52). The verbal explicitness and duration of sexual agreements were not associated with either experiencing or perpetrating IPV in the past year. However, increasing levels of depressive symptomatology were associated with a greater likelihood of both experiencing and perpetrating IPV. Our findings highlight the need to prioritize dyadic interventions for male couples that focus on skills building around enhancing mutual communication and negotiating sexual agreements to reduce IPV.
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Affiliation(s)
- Akshay Sharma
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA.
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Erin Kahle
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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17
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Budd AS, Krentz HB, Rubin LH, Power C, Gill MJ, Fujiwara E. Long-term consequences of interpersonal violence experiences on treatment engagement and health status in people living with HIV. AIDS 2021; 35:801-809. [PMID: 33369906 DOI: 10.1097/qad.0000000000002798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of previous interpersonal violence (IPersV) experiences on long-term healthcare engagement and health outcomes in a large Canadian HIV-cohort. DESIGN People living with HIV (PLHIV) were screened for IPersV, and their healthcare outcomes over the nine subsequent years were analyzed. METHODS A total of 1064 PLHIV were screened for past and present IPersV experiences through semistructured interviews. Follow-up included core treatment engagement (e.g. clinic visits) and health-status variables (HIV viral load, CD4+ T-cell count, mortality, comorbidities), analyzed descriptively and with longitudinal Cox regressions. RESULTS At intake, 385 (36%) PLHIV reported past or present IPersV including childhood (n = 224, 21%) or adulthood experiences (n = 161, 15%) and were offered conventional social work support. Over 9 years, individuals with any IPersV experiences were 36% more likely to discontinue care, 81% more likely to experience viremia, 47% more likely to experience a drop in CD4+ cell counts below 200/μl, and 65% more likely to die compared with patients not reporting IPersV (P < 0.05). Outcomes were similar when adjusted for sociodemographic factors. Childhood IPersV in particular was linked to several of the outcomes, with higher rates of discontinuation of care, viremia, and mortality related to mental health/addiction or HIV-related complications. CONCLUSION IPersV is associated with an increased risk over time of healthcare discontinuation, poorer long-term HIV-related health outcomes, and increased mortality, especially for patients victimized in childhood. Apart from targeted IPersV screening to initiate conventional supports (e.g. through social work), increased efforts to engage vulnerable populations in their long-term care seems warranted.
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Affiliation(s)
- Alexandra S Budd
- Department of Psychiatry
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton
| | - Hartmut B Krentz
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leah H Rubin
- Department of Neurology
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher Power
- Department of Psychiatry
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton
| | - Michael J Gill
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Esther Fujiwara
- Department of Psychiatry
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton
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18
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Kadengye DT, Iddi S, Hunter L, McCoy SI. Effectiveness of Potential Interventions to Change Gendered Social Norms on Prevalence of Intimate Partner Violence in Uganda: a Causal Inference Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:1043-1053. [PMID: 30929129 DOI: 10.1007/s11121-019-01010-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Evidence of the effectiveness of programs to change gendered social norms related to intimate partner violence (IPV) is growing, but their potential to significantly impact actual occurrence of IPV at population level is lacking. We study whether modest changes in gendered social norms related to wife-beating can result in significant changes in the incidence of emotional, physical, and sexual IPV among ever married women in Uganda. We employ an imputation-based causal inference approach, based on nationally representative Demographic Health Survey data. The steps are (1) model the association between adjusted neighborhood norms and experiences of IPV using a random effects logistic regression model, (2) impute unobserved counterfactual probabilities of experiencing IPV for each woman while manipulating her neighborhood norms by setting it to different values, (3) average the probabilities across the population, and (4) bootstrap confidence intervals. Results show that statistically significant inverse associations between more prohibitive neighborhood IPV norms and women's experiences of different forms of IPV at the population level exist. The effect is however small, that even if an entire community disapproves of wife-beating, incidence of IPV falls by about 10 percentage points to 48.5% (95% CI 46.0%-50.9%) from the observed value of 57.6% (95% CI 55.2%-59.9%). Furthermore, changes in neighborhood social norms are found to have no statistical significant effect on the incidence of sexual violence. In conclusion, changing gendered social norms related to wife-beating will not result in significant reductions in different forms for IPV at the population level.
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Affiliation(s)
- Damazo T Kadengye
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Samuel Iddi
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.,Department of Statistics, University of Ghana, P.O. Box LG 115, Legon, Accra, Ghana
| | - Lauren Hunter
- Department of Epidemiology, University of California, 779 University Hall MS 7360, Berkeley, CA, 94720, USA
| | - Sandra I McCoy
- Department of Epidemiology, University of California, 779 University Hall MS 7360, Berkeley, CA, 94720, USA
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19
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Ogbonnaya IN, Wanyenze RK, Reed E, Silverman JG, Kiene SM. Prevalence of and Risk Factors for Intimate Partner Violence in the First 6 Months Following HIV Diagnosis Among a Population-Based Sample in Rural Uganda. AIDS Behav 2020; 24:1252-1265. [PMID: 31538284 DOI: 10.1007/s10461-019-02673-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research in Uganda examining HIV-positive status disclosure and IPV victimization is scarce, and existing findings may not generalize to community-based samples of men and women newly diagnosed with HIV in Uganda. We investigated the prevalence of lifetime IPV, IPV experienced between HIV diagnosis and 6 months following diagnosis (recent IPV), and IPV specifically related to a partner learning one's HIV-positive status among a sample of men and women newly diagnosed with HIV in a population-based study in rural Uganda. We also examined correlates of recent IPV, including HIV-positive status disclosure. The sample included 337 participants followed for 6 months after HIV diagnosis. Lifetime IPV findings showed that over half of the sample reported experiencing emotional IPV (62.81% of men, 70.37% of women), followed by physical IPV (21.49% of men, 26.39% of women) then sexual IPV (7.44% of men, 17.59% of women). For recent IPV, men and women reported similar rates of physical (4.63% and 8.29%, respectively) and emotional (19.44% and 25.91%, respectively) IPV. Women were more likely than men to report recent sexual IPV (8.29% vs. 1.85%); however, this relationship was no longer significant after controlling for other risk factors associated with sexual IPV (AOR = 3.47, 95% CI [0.65, 18.42]). Participants who disclosed their HIV-positive status to their partner had 59% lower odds of reporting emotional IPV (AOR = 0.41, 95% CI [0.21, 0.81]) than participants who did not disclose their HIV-positive status. Younger age, non-polygamous marriage, lower social support, and greater acceptance for violence against women were also significantly associated with experience of recent IPV. Overall, 12.20% of participants who experienced recent IPV reported that the IPV was related to their partner learning their HIV-positive status. Findings highlight the need for IPV screening and intervention integrated into HIV diagnosis, care, and treatment services.
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Affiliation(s)
- Ijeoma Nwabuzor Ogbonnaya
- San Diego State University School of Social Work, San Diego, CA, USA
- Arizona State University School of Social Work, Phoenix, AZ, USA
| | | | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | - Jay G Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
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20
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Wang N, Huang B, Ruan Y, Amico KR, Vermund SH, Zheng S, Qian HZ. Association between stigma towards HIV and MSM and intimate partner violence among newly HIV-diagnosed Chinese men who have sex with men. BMC Public Health 2020; 20:204. [PMID: 32039716 PMCID: PMC7008577 DOI: 10.1186/s12889-020-8259-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV- and MSM-related stigma are well documented as common for Chinese men who have sex with men (MSM) living with HIV, yet there is sparse literature on intimate partner violence (IPV) and its relationship with stigma in this vulnerable population. To evaluate the association between HIV-stigma and stigma related to homosexuality and IPV among newly HIV-diagnosed MSM in China. METHODS Data were collected in the baseline survey among newly HIV-diagnosed Chinese MSM in a randomized clinical trial via face-to-face interviews. Univariate logistic and multivariate logistic regression analyses were performed to assess the associations between IPV and HIV- and MSM-related stigma. RESULTS Of 367 newly HIV-diagnosed Chinese MSM, 23.7% experienced any IPV, including 16.6% physical, 7.4% psychological and 5.2% sexual IPV. Positive associations were found between HIV- and MSM-related stigma and IPV. Men with high HIV-related stigma (score ≥ 27) were 1.67 times as likely to experience any IPV as those with low stigma (adjusted odds ratio [AOR]: 1.67, 95% confidence interval [CI]: 1.02-2.76). Men with high MSM-related stigma (score ≥ 6) were 1.99 times as likely to experience any IPV as those with low stigma (AOR: 1.99, 95% CI: 1.18-3.36). CONCLUSIONS HIV- and MSM-related stigmas was positively associated with IPV experiences among newly diagnosed MSM in China. The manner in which stigma may exacerbate IPV, and/or the influence of IPV on worsening stigma should be further evaluated. The high prevalence of IPV and stigma in this population suggests that interventions should be taken to reduce stigma and prevent this risky behavior among MSM.
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Affiliation(s)
- Na Wang
- School of Public Health, Guilin Medical University, Guilin, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Nanning, China
| | - Bo Huang
- School of Public Health, Guilin Medical University, Guilin, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | | | - Shimin Zheng
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN USA
| | - Han-Zhu Qian
- Yale University School of Public Health, New Haven, CT USA
- SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University (SJTU), Shanghai, China
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21
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Abstract
There has been limited study of the syndemic link between HIV and intimate partner violence (IPV) among rural populations in the United States. We utilized the Revised Conflict Tactics Scale-2 to examine the past year prevalence, type (psychological aggression, physical assault, and sexual assault), and the impact of IPV on HIV clinical outcomes among men living with HIV in rural Appalachia. Approximately 39% of participants experienced some type of IPV in the preceding year, with 67% of those individuals experiencing more than 1 type of IPV. Approximately 77% of participants endorsing IPV exposure experienced psychological aggression. Most participants exposed to psychological aggression (70%) and/or physical assault (57%) were both victims and perpetrators, and those experiencing sexual assault reported being exclusively victims (65%). There were no significant differences in clinical outcomes including viral load and CD4 count, which may be secondary to small sample size derived from a clinic population with a high rate of virologic suppression (94%). This study demonstrates the need to assess IPV exposure in men living with HIV and further highlights the intricacies of relationship violence in these individuals.
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22
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Khan MR, McGinnis KA, Grov C, Scheidell JD, Hawks L, Edelman EJ, Fiellin DA, McInnes DK, Braithwaite RS, Justice AC, Wang EA. Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US .. AIDS Care 2019; 31:349-356. [PMID: 30064277 PMCID: PMC6699634 DOI: 10.1080/09540121.2018.1499861] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.
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Affiliation(s)
- Maria R Khan
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | | | - Christian Grov
- c CUNY Graduate School of Public Health and Health Policy & The CUNY Institute for Implementation Science and Population Health , New York , NY , USA
| | - Joy D Scheidell
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Laura Hawks
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - E Jennifer Edelman
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
- e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - David A Fiellin
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
- e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - D Keith McInnes
- f Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center , Bedford , MA , USA
- g Department of Health Law, Policy, and Management , Boston University School of Public Health , Boston , MA , USA
| | - R Scott Braithwaite
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Amy C Justice
- b VA Connecticut Healthcare System , West Haven , CT , USA
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
- e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - Emily A Wang
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
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Whitton SW, Newcomb ME, Messinger AM, Byck G, Mustanski B. A Longitudinal Study of IPV Victimization Among Sexual Minority Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:912-945. [PMID: 27147275 PMCID: PMC6538483 DOI: 10.1177/0886260516646093] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Although intimate partner violence (IPV) is highly prevalent among lesbian, gay, bisexual, and transgender (LGBT) youth, little is known regarding its developmental patterns, risk factors, or health-related consequences. We examined IPV victimization in an ethnically diverse community-based convenience sample of 248 LGBT youth (aged 16-20 at study outset) who provided six waves of data across a 5-year period. Results from multilevel models indicated high, stable rates of IPV victimization across this developmental period (ages 16-25 years) that differed between demographic groups. Overall, 45.2% of LGBT youth were physically abused and 16.9% were sexually victimized by a dating partner during the study. Odds of physical victimization were 76% higher for female than for male LGBT youth, 2.46 times higher for transgender than for cisgender youth, and 2 to 4 times higher for racial-ethnic minorities than for White youth. The prevalence of physical IPV declined with age for White youth but remained stable for racial-ethnic minorities. Odds of sexual victimization were 3.42 times higher for transgender than for cisgender youth, 75% higher for bisexual or questioning than for gay or lesbian youth, and increased more with age for male than female participants. Within-person analyses indicated that odds of physical IPV were higher at times when youth reported more sexual partners, more marijuana use, and lower social support; odds of sexual IPV were higher at times when youth reported more sexual partners and more LGBT-related victimization. In prospective analyses, sexual IPV predicted increased psychological distress; both IPV types marginally predicted increased marijuana use.
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Affiliation(s)
| | | | | | - Gayle Byck
- Northwestern University, Chicago, IL, USA
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24
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Lau C, Kendall CE, Burchell AN, Bayoumi AM, Loutfy M, Rourke SB, Antoniou T. Outcomes Among Persons with HIV Following a Mental Health Admission: A Population-Based Study. AIDS Res Hum Retroviruses 2018; 34:590-597. [PMID: 29661003 DOI: 10.1089/aid.2017.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To compare outcomes following psychiatric hospitalization between people with and without HIV. Population-based study of people with (n = 1,089) and without (n = 280,888) HIV who were hospitalized for psychiatric illness between January 1, 2006 and December 31, 2014. Overall, 9 (0.8%) people with HIV died within 30 days of discharge, compared with 3,710 (1.3%) HIV-negative individuals. Following multivariable adjustment, there was no difference in the risk of readmission or emergency department (ED) visits for psychiatric illness in the 90 days following discharge. Conversely, people with HIV were at higher risk of ED visits for substance use disorders and less likely to receive psychiatry follow-up during this period. HIV is associated with ED use for substance use disorders and less psychiatry follow-up within 90 days of hospital discharge for psychiatric illness. Interventions facilitating continuity of care following discharge are warranted.
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Affiliation(s)
- Cindy Lau
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Claire E. Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- CT Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Ann N. Burchell
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ahmed M. Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Mona Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Sean B. Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
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25
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Duncan DT, Goedel WC, Stults CB, Brady WJ, Brooks FA, Blakely JS, Hagen D. A Study of Intimate Partner Violence, Substance Abuse, and Sexual Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in a Sample of Geosocial-Networking Smartphone Application Users. Am J Mens Health 2018; 12:292-301. [PMID: 26873342 PMCID: PMC5818104 DOI: 10.1177/1557988316631964] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Geosocial-networking smartphone applications ("apps") are widely used by gay, bisexual, and other men who have sex with men (MSM) and facilitate connections between users based on proximity and attraction. MSM have sexual encounters and relationships of varying degrees of emotional and physical intimacy with app-met individuals, potentially placing them at risk for intimate partner violence (IPV). The purpose of the current study was to utilize a geosocial-networking application to investigate relationships between experiences of IPV victimization as it relates to substance use and sexual risk behaviors in a sample of MSM. Participants ( n = 175) were recruited by means of broadcast advertisements on an application widely used by MSM (Grindr) to seek sexual partners. Multivariable regression models were fit to examine associations between IPV, substance abuse, and sexual risk behaviors. Lifetime experiences of IPV victimization were common, where 37.7% of respondents reported having experienced at least one form of IPV. While a marginally significant positive association between IPV and substance abuse was detected in multivariable models ( p = .095), individual forms of IPV were strongly associated with substance abuse. For example, sexual IPV victimization was associated with an increase in substance abuse in the preceding month ( p = .004). Experiences of IPV victimization were associated with higher numbers of partners for both condomless receptive and insertive anal intercourse ( p < .05). Given the relatively high prevalence of IPV victimization and its associations with substance abuse and sexual risk behaviors, these findings suggest that IPV screening and prevention programs may reduce substance abuse and sexual risk behaviors in this population.
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26
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Mullinax M, Grilo SA, Song XS, Wagman J, Mathur S, Nalugoda F, Lutalo T, Santelli J. HIV-Risk Behaviors of Men Who Perpetrate Intimate Partner Violence in Rakai, Uganda. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:527-539. [PMID: 29283273 PMCID: PMC6710836 DOI: 10.1521/aeap.2017.29.6.527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Little is known about men who perpetrate IPV in communities also at risk for HIV infection. Using data from the Rakai Community Cohort Study (RCCS), five survey rounds were used (n = 21,157, observation from n = 10,618 men) to examine HIV risk and prevention behaviors among men who reported acts of violence against their wife/primary partner in the past 12 months. Overall, 10.4% men reported perpetrating physical violence and 17.3% perpetrating verbal violence, 3.1% reported sexual violence, 3.1% used violence to have sex with their wife/partner, and 1.1% used verbal coercion. Factors associated with IPV were: age 20-24 years, lower socio-economic status, being married, no male circumcision, drinking alcohol before sex, no consistent condom use, multiple sex partners in the past 12 months, multiple partners ever, and working in a bar. Protective HIV behaviors predicted fewer reports of perpetration and HIV-risk behaviors predicted more reports of perpetrating IPV.
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Affiliation(s)
| | - Stephanie A Grilo
- Columbia University Mailman School of Public Health, Sociomedical Sciences, New York, New York
| | - Xiaoyu S Song
- Department of Population Health Science and Policy and the Tisch Cancer Center, both at Icahn School of Medicine at Mount Sinai, New York
| | - Jennifer Wagman
- University of San Diego School of Medicine, Division of Global Public Health, San Diego, California
| | | | | | - Tom Lutalo
- Rakai Health Sciences Program, Rakai, Uganda
| | - John Santelli
- Columbia University Mailman School of Public Health, Population and Family Health, New York, New York
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27
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Pantalone DW, Valentine SE, Jackson MA, Andrasik MP, Simoni JM. Partner Abuse Among HIV-Positive Sexual Minority Men: "That Was All I Deserved . . .". QUALITATIVE HEALTH RESEARCH 2017; 27:1713-1724. [PMID: 28799477 DOI: 10.1177/1049732317699179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Living with HIV can be both a precipitant and a consequence of partner abuse (PA) across populations, including male-male partnerships. However, overlapping experiences of living with HIV and experiencing PA are not well characterized. We conducted 24 qualitative interviews with urban HIV-positive sexual minority men (SMM) recruited from a public hospital HIV clinic in Seattle, Washington, who reported lifetime PA histories, and analyzed them using content analysis. Participants reported psychological, physical, and sexual victimization from partners, varying in severity. Themes included (a) how HIV and minority stress (e.g., through self-stigma, serosorting) and (b) familial and repeated exposure to violence (e.g., through normalization or acceptance of PA, partnering as strategy for increasing one's own safety, esteem, or social status), independently and in combination, provided a context for the men's victimization. Our findings suggest that PA-related interventions might focus on coping with stigma, expanding social networks, and educating SMM about dysfunctional relationship dynamics.
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Affiliation(s)
- David W Pantalone
- 1 University of Massachusetts, Boston, Massachusetts, USA
- 2 The Fenway Institute, Boston, Massachusetts, USA
| | | | | | | | - Jane M Simoni
- 6 University of Washington, Seattle, Washington, USA
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28
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Abstract
There is new hope that we can significantly reduce HIV rates. The United Nations AIDS organization, UNAIDS, has challenged all countries to strive for aggressive targets that could significantly bend the curve on HIV infections and deaths: 90% of people living with HIV diagnosed; 90% of people diagnosed on treatment; and 90% of people on treatment virally suppressed. This new optimism is largely driven by strong research findings that early and ongoing HIV treatment improves individual health outcomes and reduces people's viral load, making them less infectious. However, the risk of HIV infection is far from evenly distributed among populations most at risk. Those most at risk will find it hardest to reach these targets as they are caught in a syndemic (synergistic epidemic) of intertwining health and social issues. Our research, and that of others, shows that those who are in a syndemic of co-occurring mental health, addiction and social issues (e.g. homelessness, food insecurity) are significantly more likely to fall out of care, less likely to adhere to treatment and less likely to achieve/maintain an undetectable viral load. Intervention studies have found that a combination approach to HIV prevention and treatment that goes beyond primary care and mental health tools to include social and structural interventions has a protective effect, and can reduce risk and improve adherence. People living with and at risk of HIV need better access to social and mental health services as well as clinical treatment services that will help them achieve and maintain optimal health and well-being. We strongly encourage those in the HIV sector across the country to identify a common vision, with clear goals and targets. With concerted and targeted efforts, a focus on program and implementation science, and a willingness to see and treat HIV as a social as well as a biomedical problem-the fourth decade of HIV in Canada could well be the last.
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29
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Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis. AIDS 2015; 29:2183-94. [PMID: 26353027 DOI: 10.1097/qad.0000000000000842] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to estimate the odds of engagement in HIV care and treatment among HIV-positive women reporting intimate partner violence (IPV). DESIGN We systematically reviewed the literature on the association between IPV and engagement in care. Data sources included searches of electronic databases (PubMed, Web of Science, CINAHL and PsychoInfo), hand searches and citation tracking. METHODS Two reviewers screened 757 full-text articles, extracted data and independently appraised study quality. Included studies were peer-reviewed and assessed IPV alongside engagement in care outcomes: antiretroviral treatment (ART) use; self-reported ART adherence; viral suppression; retention in HIV care. Odds ratios (ORs) were pooled using random effects meta-analysis. RESULTS Thirteen cross-sectional studies among HIV-positive women were included. Measurement of IPV varied, with most studies defining a 'case' as any history of physical and/or sexual IPV. Meta-analysis of five studies showed IPV to be significantly associated with lower ART use [OR 0.79, 95% confidence interval (95% CI) 0.64-0.97]. IPV was associated with poorer self-reported ART adherence in six studies (OR 0.48, 95% CI 0.30-0.75) and lower odds of viral load suppression in seven studies (OR 0.64, 95% CI 0.46-0.90). Lack of longitudinal data and measurement considerations should temper interpretation of these results. CONCLUSION IPV is associated with lower ART use, half the odds of self-reported ART adherence and significantly worsened viral suppression among women. To ensure the health of HIV-positive women, it is essential for clinical programmes to address conditions that impact engagement in care and treatment. IPV is one such condition, and its association with declines in ART use and adherence requires urgent attention.
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30
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Williams JK, Wilton L, Magnus M, Wang L, Wang J, Dyer TP, Koblin BA, Hucks-Ortiz C, Fields SD, Shoptaw S, Stephenson R, O'Cleirigh C, Cummings V. Relation of Childhood Sexual Abuse, Intimate Partner Violence, and Depression to Risk Factors for HIV Among Black Men Who Have Sex With Men in 6 US Cities. Am J Public Health 2015; 105:2473-81. [PMID: 26469666 DOI: 10.2105/ajph.2015.302878] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the relation of childhood sexual abuse (CSA), intimate partner violence (IPV), and depression to HIV sexual risk behaviors among Black men who have sex with men (MSM). METHODS Participants were 1522 Black MSM recruited from 6 US cities between July 2009 and December 2011. Univariate and multivariable logistic regression models were used. RESULTS Participants reported sex before age 12 years with someone at least 5 years older (31.1%), unwanted sex when aged 12 to 16 years (30%), IPV (51.8%), and depression (43.8%). Experiencing CSA when aged 12 to 16 years was inversely associated with any receptive condomless anal sex with a male partner (adjusted odds ratio [AOR] = 0.50; 95% confidence interval [CI] = 0.29, 0.86). Pressured or forced sex was positively associated with any receptive anal sex (AOR = 2.24; 95% CI = 1.57, 3.20). Experiencing CSA when younger than 12 years, physical abuse, emotional abuse, having been stalked, and pressured or forced sex were positively associated with having more than 3 male partners in the past 6 months. Among HIV-positive MSM (n = 337), CSA between ages 12 and 16 years was positively associated with having more than 3 male partners in the past 6 months. CONCLUSIONS Rates of CSA, IPV, and depression were high, but associations with HIV sexual risk outcomes were modest.
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Affiliation(s)
- John K Williams
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Leo Wilton
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Manya Magnus
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lei Wang
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jing Wang
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Typhanye Penniman Dyer
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Beryl A Koblin
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christopher Hucks-Ortiz
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sheldon D Fields
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Steve Shoptaw
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rob Stephenson
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Conall O'Cleirigh
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Vanessa Cummings
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Raissi SE, Krentz HB, Siemieniuk RA, Gill MJ. Implementing an intimate partner violence (IPV) screening protocol in HIV care. AIDS Patient Care STDS 2015; 29:133-41. [PMID: 25585198 DOI: 10.1089/apc.2014.0306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV and intimate partner violence (IPV) epidemics propagate and interact in a syndemic fashion contributing to excess burden of disease and poorer health outcomes. In order to understand the impact of IPV on HIV disease management, a universal screening program was implemented in the Southern Alberta Clinic in May 2009. We evaluated our IPV screening protocol and made recommendations for its usage in HIV care. IPV data obtained from patients were evaluated, supplemented with responses from a subset of in-depth interviews. 35% of 1721 patients reported experiencing IPV. Prevalence was higher among females (46%), Aboriginal Canadians (67%), bisexual male/females (48%), and gay males (35%). Of 158 patients interviewed, only 22% had previously been asked about IPV in any health care setting. Patients were responsive to routine IPV screening emphasizing that referral services need to be easily accessible. 23% of patients disclosing IPV subsequently connected to additional IPV resources after screening. We recommend that universal IPV screening be incorporated within regular HIV clinic care. The IPV survey should be given after trust has been established with regular follow-up every 6-12 months. A referral process to local agencies dealing with IPV must be in place for patients disclosing abuses.
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Affiliation(s)
- Sadaf E. Raissi
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hartmut B. Krentz
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - M. John Gill
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Buller AM, Devries KM, Howard LM, Bacchus LJ. Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001609. [PMID: 24594975 PMCID: PMC3942318 DOI: 10.1371/journal.pmed.1001609] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/17/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) among men who have sex with men (MSM) is a significant problem. Little is known about the association between IPV and health for MSM. We aimed to estimate the association between experience and perpetration of IPV, and various health conditions and sexual risk behaviours among MSM. METHODS AND FINDINGS We searched 13 electronic databases up to 23 October 2013 to identify research studies reporting the odds of health conditions or sexual risk behaviours for MSM experiencing or perpetrating IPV. Nineteen studies with 13,797 participants were included in the review. Random effects meta-analyses were performed to estimate pooled odds ratios (ORs). Exposure to IPV as a victim was associated with increased odds of substance use (OR = 1.88, 95% CI(OR) 1.59-2.22, I² = 46.9%, 95% CI(I)² 0%-78%), being HIV positive (OR = 1.46, 95% CI(OR) 1.26-1.69, I² = 0.0%, 95% CI(I)² 0%-62%), reporting depressive symptoms (OR = 1.52, 95% CI(OR) 1.24-1.86, I² = 9.9%, 95% CI(I)² 0%-91%), and engagement in unprotected anal sex (OR = 1.72, 95% CI(OR) 1.44-2.05, I² = 0.0%, 95% CI(I)² 0%-68%). Perpetration of IPV was associated with increased odds of substance use (OR = 1.99, 95% CI(OR) 1.33-2.99, I² = 73.1%). These results should be interpreted with caution because of methodological weaknesses such as the lack of validated tools to measure IPV in this population and the diversity of recall periods and key outcomes in the identified studies. CONCLUSIONS MSM who are victims of IPV are more likely to engage in substance use, suffer from depressive symptoms, be HIV positive, and engage in unprotected anal sex. MSM who perpetrate IPV are more likely to engage in substance use. Our results highlight the need for research into effective interventions to prevent IPV in MSM, as well as the importance of providing health care professionals with training in how to address issues of IPV among MSM and the need to raise awareness of local and national support services.
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Affiliation(s)
- Ana Maria Buller
- Gender Violence and Health Centre, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Karen M. Devries
- Gender Violence and Health Centre, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise M. Howard
- Section of Women's Mental Health and King's Health Partners Women's Health Academic Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Loraine J. Bacchus
- Gender Violence and Health Centre, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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The clinical implications of high rates of intimate partner violence against HIV-positive women. J Acquir Immune Defic Syndr 2013; 64:32-8. [PMID: 23714742 DOI: 10.1097/qai.0b013e31829bb007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intimate partner violence (IPV) is associated with increased risk of HIV infection among women, however, whether IPV affects outcomes after HIV infection is uncertain. We assess the impact of IPV on HIV-positive women. METHODS All HIV-positive women who received outpatient HIV care in southern Alberta between March 2009 and January 2012 were screened for IPV. The associations with IPV of sociodemographic factors, health-related quality of life, clinical status, and hospitalizations were obtained from a regional database and evaluated with multivariable regression analysis. RESULTS Of 339 women screened, 137 (40.4%) reported experiencing IPV. Those disclosing IPV had higher rates of smoking [adjusted prevalence ratio (APR) = 5.07; 95% confidence interval (CI): 2.72 to 9.43]; illicit drug use (APR = 7.58; CI: 2.45 to 23.26); a history of incarceration (APR = 4.84, CI: 1.85 to 12.68); depression (APR = 2.50, CI: 1.15 to 5.46); and anxiety disorders (APR = 5.75, CI: 2.10 to 15.63). Health-related quality of life was diminished with IPV (APR = 2.94, CI: 1.40 to 6.16) for poor/fair versus very good/excellent. IPV-exposed women were hospitalized 256 times per 1000 patient-years compared to 166/1000 patient-years among IPV-unexposed (P < 0.001) women. The relative risk was increased for HIV-unrelated hospitalizations (APR = 1.42, CI: 1.16 to 1.73) and for HIV-related hospitalizations after outpatient HIV care was initiated (APR = 2.19, CI: 1.01 to 4.85). Modifiable contributors to the poor outcomes included decreased use of antiretroviral therapy (APR = 0.55, CI: 0.34 to 0.91) and additional interruptions in care longer than 1 year (APR = 1.90, CI: 1.07 to 3.39). CONCLUSIONS IPV is associated with deleterious HIV-related and HIV-unrelated health outcomes, of which, suboptimal engagement in care is a contributor. To improve outcomes, practitioners should aim to increase engagement in care of these women in particular.
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Sullivan PS, White D, Rosenberg ES, Barnes J, Jones J, Dasgupta S, O'Hara B, Scales L, Salazar LF, Wingood G, DiClemente R, Wall KM, Hoff C, Gratzer B, Allen S, Stephenson R. Safety and acceptability of couples HIV testing and counseling for US men who have sex with men: a randomized prevention study. J Int Assoc Provid AIDS Care 2013; 13:135-44. [PMID: 23995295 DOI: 10.1177/2325957413500534] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We tested a couples HIV testing and counseling (CHTC) intervention with male couples in Atlanta by randomizing eligible couples to receive either CHTC or separate individual voluntary HIV counseling and testing (iVCT). To evaluate the acceptability and safety of CHTC, main outcomes were satisfaction with the intervention and the proportions of couples reporting intimate partner violence (IPV) and relationship dissolution after the service. The results indicated that the service was very acceptable to men (median 7-item index of satisfaction was 34 for CHTC and 35 for iVCT, P = .4). There was no difference in either incident IPV (22% versus 17% for CHTC and iVCT, respectively, P = .6) or relationship dissolution (42% versus 51% for CHTC and iVCT, respectively, P = .5). Based on the preliminary data, CHTC is safe for male couples, and it is equally acceptable to iVCT for men who have main partners.
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