Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant Liberian women

Gender inequities place women at an increased risk for HIV acquisition, and this association may particularly disenfranchize young pregnant women. Intimate partner violence (IPV) and food insecurity may contribute to gender differences in power, thereby influencing HIV disparities between women and men. Factors influencing gender disparities in HIV are unique and country-specific within sub-Saharan Africa, yet these factors are understudied among women in Liberia. This paper sought to examine the unique contributions and intersections of intimate partner violence (IPV) and food insecurity with HIV-related risk factors among young pregnant women in Liberia. Between March 2016 and August 2016, cross-sectional data collected from 195 women aged 18–30, residing in Monrovia, Liberia who were receiving prenatal services were used to examine the independent and interaction effects of IPV and food insecurity on HIV-related risk factors (i.e., sexual partner concurrency, economically-motivated relationships). IPV (31.3%) and food insecurity (47.7%) were prevalent. Young women who experience IPV are more likely to report food insecurity (p?ps?ps?ps?>?0.05). IPV and food insecurity each uniquely heighten young Liberian women’s vulnerability to HIV. Intervention and policy efforts are need to promote and empower women’s sexual health through integrated sexual and reproductive health services, and reduce IPV and food insecurity among pregnant Liberian women.     

Evidence of increased STI/HIV-related risk behavior among male perpetrators of intimate partner violence in Guatemala: results from a national survey

Intimate partner violence (IPV) is a significant public health problem with a demonstrated link to increased sexually transmitted infection (STI)/HIV-related risk and vulnerability. While IPV is an important issue in Central America, the link to STI/HIV risk has not been explored in this region. In this study, the relationship between emotional and physical/sexual IPV and the STI/HIV-related risk behaviors of sex worker patronage and infidelity is assessed among male IPV perpetrators using data from a national survey conducted in 2009 in Guatemala (n = 4773 married/partnered men). Bivariate associations between background characteristics and emotional and physical IPV perpetration were explored. Logistic regression models were run to test associations between IPV for each sexual risk behavior. Perpetration of emotional and physical/sexual IPV was more common among married/partnered men who were older than 24, had more education, lived in urban areas, or were in common law versus married unions. Reports of past-year emotional IPV perpetration increased as wealth quintile increased. After adjusting for demographics and other characteristics, physical/sexual IPV perpetration was associated with past-year infidelity (AOR 1.9, 95% CI: 1.1–3.6). Lifetime emotional IPV (AOR 1.4, 95% CI: 1.1–1.7) and physical/sexual IPV 1.6 (95% CI 1.2–2.0) were positively associated with a history of sex worker patronage. Endorsement of traditional gender role norms showed a marginally positive association with past-year infidelity in the adjusted model (AOR 1.3, 95% CI 1.0–1.8). The study findings from Guatemala reinforce the growing evidence globally that male IPV perpetrators are more likely to engage in risky sexual behavior, including sex worker patronage and main partner infidelity. The concurrency of violence and increased STI/HIV risk may compound the health risks for female victims of IPV who also face injury and psychological trauma. Integration of prevention and screening of IPV and STI/HIV prevention services should be adopted in Guatemala and other similar contexts.     

Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda

Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15–24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06–1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25–2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in young women.     

A longitudinal study of the relationship between intimate partner violence and postpartum unsafe sex among newly diagnosed HIV-infected South African women

HIV-positive women who engage in postpartum unsafe sex are at risk for sexually transmitted infection (STI), unintended pregnancy, and secondary transmission of HIV to uninfected partners. One factor that may increase risk for postpartum unsafe sex among HIV-positive women is intimate partner violence (IPV) victimization; few studies, however, have examined this association. This longitudinal study examined whether patterns of psychological, physical, and sexual IPV, assessed during pregnancy, predicted unsafe sex at 14 weeks postpartum among South African women diagnosed as HIV-positive during pregnancy (n?=?561). In a latent class analysis, we identified three distinct patterns of IPV victimization: non-victims (74%), moderate IPV (20%), and multiform severe controlling IPV (5%). Compared to non-victims, victims of multiform severe controlling IPV were significantly more likely to engage in postpartum unsafe sex (p?=?.01), even after adjusting for potential confounding factors. Moderate IPV was not associated with postpartum unsafe sex. Findings support the need for targeted sexual risk reduction interventions for HIV-positive pregnant women who have experienced severe patterns of IPV.     

The intersection of intimate partner violence and HIV risk among women engaging in transactional sex in Ugandan fishing villages

Intimate partner violence (IPV) may increase risk for HIV/AIDS among women engaging in transactional sex in Ugandan fishing communities. In this cross-sectional study, 115 women reporting engaging in transactional sex in Lake Victoria fishing communities completed a computerized interview. We tested associations between IPV and other HIV risk factors, with unprotected sex and HIV status, and tested moderators of the IPV-HIV risk relationship. Women reporting recent sexual IPV reported 3.36 times more unprotected sex acts (AdjExp[B]?=?3.36, 95% CI?=?1.29–8.69, p?=?0.07). The effect of sexual IPV on sexual risk was significantly greater among alcohol and fish sellers compared to sex workers (interaction: Exp[B]?=?12.29, 95% CI?=?5.06–29.85, p?p?=?0.02). Integrated IPV and HIV interventions are needed in this context, especially among alcohol and fish sellers engaging in transactional sex.     

Intimate Partner Violence and PrEP Acceptability Among Low-Income,Young Black Women: Exploring the Mediating Role of Reproductive Coercion

A few studies suggest that women who experience intimate partner violence (IPV) are willing to use pre-exposure prophylaxis (PrEP), but no research has examined mediators of this relationship. The current study used path analysis to examine a phenomenon closely associated with IPV: reproductive coercion, or explicit male behaviors to promote pregnancy of a female partner without her knowledge or against her will. Birth control sabotage and pregnancy coercion—two subtypes of reproductive coercion behaviors—were examined as mediators of the relationship between IPV and PrEP acceptability among a cohort of 147 Black women 18–25 years of age recruited from community-based organizations in an urban city. IPV experiences were indirectly related to PrEP acceptability through birth control sabotage (indirect effect = 0.08; p < 0.05), but not to pregnancy coercion. Findings illustrate the importance of identifying and addressing reproductive coercion when assessing whether PrEP is clinically appropriate and a viable option to prevent HIV among women who experience IPV.     

The association between caffeinated alcoholic beverages and the perpetration of intimate partner violence

Background: Problematic alcohol use is a recognized risk factor for intimate partner violence (IPV) perpetration.Objective: The use of caffeinated alcoholic beverages (CAB) appears to be associated with high-risk drinking behavior but the relationship between CAB use and IPV has yet to be explored.Methods: Sixty male and 40 female married or dating participants responded to an online survey including measures of past-year alcohol use and partner violence.Results: Logistic regression analyses revealed that CAB users were significantly more likely to perpetrate physical assault and partner injury after controlling for age, sex, ethnicity, income, and heavy alcohol use. The relationship between CAB use and perpetration of sexual coercion was better accounted for by heavy alcohol use.Conclusion: Results from the current study suggest that there exists an independent link between CAB use and partner violence perpetration.     

Choice-Disability and HIV Infection: A Cross Sectional Study of HIV Status in Botswana, Namibia and Swaziland

Interpersonal power gradients may prevent people implementing HIV prevention decisions. Among 7,464 youth aged 15–29 years in Botswana, Namibia and Swaziland we documented indicators of choice-disability (low education, educational disparity with partner, experience of sexual violence, experience of intimate partner violence (IPV), poverty, partner income disparity, willingness to have sex without a condom despite believing partner at risk of HIV), and risk behaviours like inconsistent use of condoms and multiple partners. In Botswana, Namibia and Swaziland, 22.9, 9.1, and 26.1% women, and 8.3, 2.8, and 9.3% men, were HIV positive. Among both women and men, experience of IPV, IPV interacted with age, and partner income disparity interacted with age were associated with HIV positivity in multivariate analysis. Additional factors were low education (for women) and poverty (for men). Choice disability may be an important driver of the AIDS epidemic. New strategies are needed that favour the choice-disabled.     

Barriers to achieving the first 90%: gender norms and HIV testing among men in the Democratic Republic of the Congo

Gender inequality and gender norms are key social drivers of the HIV epidemic through their influences on sexual relationships, behavior, and risk taking. However, few empirical studies have measured the influence of gender norms on HIV sexual-risk behaviors and HIV testing among men in sub-Saharan Africa. We analyzed cross-sectional, survey data from 399 sexually active men (ages 18–39) in Democratic Republic of the Congo to examine the relationship between the men's support for inequitable gender norms and their HIV-risk behaviors. Logistic regression analyses revealed that moderate and strong levels of support for inequitable gender norms were significantly associated with never having been tested for HIV (AOR?=?2.92, p?p?相似文献   

Intimate partner violence as a factor associated with risky sexual behaviours and alcohol misuse amongst men in South Africa

Globally intimate partner violence (IPV) is a public health problem that can be perpetrated by both males and females, although males are more likely to inflict severe IPV-related injuries on their female partners. In low- and middle-income countries like South Africa, few studies have conducted research to determine whether IPV perpetration by men may be a risk factor for engaging in other risk behaviours. The aim of this study is to determine whether IPV perpetration by men is a risk factor for engaging in other risk behaviours with a particular focus on risky sexual behaviours and alcohol misuse. The data for this study were drawn from a multilevel intervention study, which addressed the nexus of alcohol abuse and HIV prevention among men in South Africa. Men were screened and recruited from informal drinking places within 12 communities situated in one of the oldest, predominantly Xhosa-speaking African townships in Cape Town. Univariate and multivariate logistic regression models were used to analyse the associations between IVP and potential explanatory variables. Of the 975 men included in the survey, 39.9% reported to have been involved in Intimate Partner Violence. IPV perpetration was significantly more likely among men who reported having a child [OR 1.51 (1.07–2.14) p?=?.019], having a casual sexual partner [OR 1.51 (1.11–2.05) p?=?.008], and those with possible alcohol dependence [OR 3.46 (1.17–10.20) p?=?.024]. IPV was significantly less likely among men with matric educational qualification than those with no education [OR 0.30 (95% CI: 0.09–1.02) p?=?.053] and among those who reported using a condom at last sex [OR 0.69 (0.50–0.97) p?=?.034]. We therefore recommend that interventions aimed at reducing IPV need to address risky sexual and drinking behaviours amongst men simultaneously, while also focusing on intimate relationship power dynamics and gendered norms amongst couples.     

Intimate partner violence is linked to less HIV testing uptake among high-risk,HIV-negative women in Atlanta

Increased risk of HIV acquisition among intimate partner violence (IPV) survivors underscores the need for regular HIV testing, but IPV-associated shame, stigma, and control may hinder uptake. Between March and November 2014, we conducted a cross-sectional study of 79 HIV-negative, high-risk women aged 18–50 in Atlanta, Georgia, to explore whether IPV experience was associated with less uptake of HIV testing, and fewer motivations and more reported barriers to HIV testing uptake. Psychological and physical and/or sexual abuse was significantly associated with less past-year HIV testing (p?=?.022 and p?=?.030, respectively), longer time since last HIV test (r?=?0.282, p?=?.012, and r?=?0.282, p?=?.012, respectively), and more reported barriers to HIV testing (r?=?0.406, p?=?.004, and r?=?0.389, p?=?.006). While requiring further validation, these preliminary findings suggest IPV survivors need additional support to access HIV testing services.     

Gender differences in unidirectional and bidirectional intimate partner violence in addictions

ABSTRACT

Background: Few studies have analyzed the specific characteristics related to uni/bidirectional intimate partner violence (IPV) in patients with addiction problems. Knowing the specific profiles of these patients would allow the development of effective tailored interventions.

Objective: This study assessed gender differences in unidirectional and bidirectional IPV among patients undergoing drug addiction treatment.

Method: We sampled 122 patients (91 male and 31 female) who sought treatment in an addiction treatment center, and collected cross-sectional self-reported data on violent behaviors (physical, sexual and psychological violence), sociodemographic factors, distorted thoughts about women and violence, impulsiveness, and anger.

Results: Ninety-one percent of participants reported experience of IPV (any type and any direction). Sixty-three percent of participants reported bidirectional violence, which was more common among women (83.9%) than men (56.1%). Unidirectional (perpetration only) IPV was reported in 28.7% of participants, and it was more common among men (34.1%) than women (12.9%). No one reported unidirectional (victimization-only) IPV. When only physical and/or sexual violence was considered, bidirectional violence affected 32.0% of the sample; 23.8% were only victims, and 3.3% were only perpetrators (all of them men). Participants who reported bidirectional violence had higher scores for impulsiveness, anger, and distorted thoughts.

Conclusions: Bidirectional IPV is commonly reported among patients seeking treatment for addiction, particularly among women, and should be considered in future research and clinical practice.     

Violence Inflicted on Latina Transgender Women Living with HIV: Rates and Associated Factors by Perpetrator Type

Many transgender individuals report violence directed against them. This study examined violence inflicted on transgender Latinas with HIV by primary partners, sexual partners and acquaintances/strangers. Logistic regression was used for analysis. 150 transgender Latinas were recruited. Rates of violence from different perpetrator types were 47–50%. For violence by primary partners, social support from cisgender people was associated with a lower likelihood of violence (AOR 0.56; CI 0.32, 0.98; p < 0.05). For violence by sexual partners, a history of childhood sexual abuse was associated with a higher likelihood of violence (AOR 2.64; CI 1.10, 6.34; p < 0.05). For violence by acquaintances/strangers, discrimination was associated with a higher likelihood of violence (AOR 2.84; CI 1.16, 6.94; p < 0.05) and social support from cisgender people with a lower likelihood (AOR 0.58; CI 0.37, 0.92; p < 0.05). Interventions are needed at individual, institutional and systemic levels to eradicate such violence.

     

Reported Physical and Sexual Abuse in Childhood and Adult HIV Risk Behaviour in Three African Countries: Findings from Project Accept (HPTN-043)

Childhood sexual and physical abuse have been linked to adolescent and adult risky sexual behaviors, including early sexual debut, an increased number of sexual partners, unprotected sex, alcohol and drug use during sex and sexual violence. This paper explores these relationships among both men and women who report histories of childhood abuse from representative samples of communities in three countries in southern and eastern Africa (South Africa, Zimbabwe and Tanzania). Data were collected as part of a 3-year randomized community trial to rapidly increase knowledge of HIV status and to promote community responses through mobilisation, mobile testing, provision of same-day HIV test results and post-test support for HIV. The results indicate that reported childhood sexual and physical abuse is high in all three settings, also among men, and shows strong relationships with a range of sexual risk behaviors, including age at first sex (OR ?0.6 (CI: ?0.9, ?0.4, p < 0.003)—among men, OR ?0.7 (CI: ?0.9, ?0.5, p < 0.001)—among women), alcohol (OR 1.43 (CI: 1.22, 1.68, p < 0.001)—men, OR 1.83 (CI: 1.50, 2.24, p < 0.001)—women) and drug use (OR 1.65 (CI: 1.38, 1.97, p < 0.001)—men, OR 3.14 (CI: 1.95, 5.05, p < 0.001)—women) and two forms of partner violence—recent forced sex (OR 2.22 (CI: 1.66, 2.95, p < 0.001)—men, OR 2.76 (CI: 2.09, 3.64, p < 0.001)—women) and ever being hurt by a partner (OR 3.88 (CI: 2.84, 5.29, p < 0.001)—men, OR 3.06 (CI: 2.48, 3.76, p < 0.001)—women). Individuals abused in childhood comprise between 6 and 29 % of young adult men and women living in these African settings and constitute a population at high risk of HIV infection.     

Gender equality and education: Increasing the uptake of HIV testing among married women in Kenya,Zambia and Zimbabwe

Gender equality and education are being promoted as strategies to combat the HIV epidemic in Africa, but few studies have looked at the role of gender equality and education in the uptake of a vital service – HIV testing. This study looks at the associations between education (a key input needed for gender equality) and key gender equality measures (financial decision making and attitudes toward violence) with ever tested for HIV and tested for HIV in the past year. The study focused on currently married women ages between15–24 and 25–34 in three countries – Kenya, Zambia, and Zimbabwe. The data came from the Demographic and Health Surveys. Logistic regression was used to study the role of gender equality and education on the HIV testing outcomes after controlling for both social and biological factors. Results indicated that education had a consistent positive relationship with testing for both age groups, and the associations were always significant for young women aged 15–24 years (p<0.01). The belief that gender-based violence is unacceptable was positively associated with testing for women aged 25–34 in all the three countries, although the associations were only significant in Kenya (among women reporting ever being tested: OR 1.58, p<0.00; among women reporting being tested in the past year: OR 1.34, p<0.05) and Zambia (among women reporting ever being tested: OR 1.24, p<0.10; among women reporting being tested in the past year: OR 1.29, p<0.05). High financial decision making was associated with testing for women aged 25–34 in Zimbabwe only (among women reporting ever being tested: OR 1.66, p<0.01). Overall, the findings indicate that the education and the promotion of gender equality are important strategies for increasing uptake of a vital HIV service, and thus are important tools for protecting girls and young women against HIV.     

Sexual Harassment, Sexual Coercion, and HIV Risk Among U.S. Adults 18-49 Years

Sexual harassment and sexual coercion have received considerable public attention. However, the extent of these problems nationally and the breadth of their health consequences are not fully understood. We estimated the national prevalence of sexual harassment and sexual coercion, and examined their relationship to HIV risk in the general U.S. population. Data came from a 1992 telephone survey of a random probability sample of 2,030 U.S. adults aged 18–49 years. Nationally, 16% of men and 33% of women reported having been sexually harassed, and 4% of men and 16% of women reported having been sexually coerced. Significantly higher HIV risk was observed among male victims of sexual harassment compared to nonvictims (32% vs. 22%), but not among women (17% vs. 14%). HIV risk for men did not differ by having experienced sexual coercion (31% vs. 23%), but female victims reported more risk behavior than nonvictims (26% vs. 13%). Greater HIV risk found among victims argues for prevention efforts that focus on their particular needs.     

Sexual Minority Status and Violence Among HIV Infected and At-Risk Women

IMPORTANCE

Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence.

OBJECTIVE

To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV.

DESIGN & PARTICIPANTS

Longitudinal study of 1,235 HIV infected and 508 uninfected women of the Women's Interagency HIV Study (WIHS) cohort, from New York City, NY, Chicago, IL, Washington D.C., and San Francisco, CA, 1994–2012.

MAIN MEASURES

Primary exposures are sexual identity (heterosexual, bisexual, lesbian/gay) and sexual behavior (male, female, or male & female partners). Primary outcomes are sexual abuse, intimate partner violence (IPV) and physical violence; high-risk sex and substance use were examined as mediators.

KEY RESULTS

Bisexual women were at increased odds for sexual abuse [aOR 1.56 (1.00, 2.44)], IPV [aOR 1.50 (1.08, 2.09)], and physical violence [aOR 1.77 (1.33, 2.37)] compared to heterosexual women. In a separate analysis, women who reported sex with men and women (WSMW) had increased odds for sexual abuse [aOR 1.65 (0.99, 2.77], IPV [aOR 1.50 (1.09, 2.06)] and physical violence [aOR 2.24 (1.69, 2.98)] compared to women having sex only with men (WSM). Using indirect effects, multiple sex partners, cocaine and marijuana were significant mediators for most forms of abuse. Transactional sex was only a mediator for bisexual women. Women who reported sex only with women (WSW) had lower odds of sexual abuse [aOR 0.23 (0.06, 0.89)] and physical violence [aOR 0.42 (0.21, 0.85)] compared to WSM.

CONCLUSIONS

Women who identify as bisexual or report both male and female sex partners are most vulnerable to violence; multiple recent sex partners, transactional sex and some types of substance use mediate this relationship. Acknowledging sexual identity and behavior, while addressing substance use and high-risk sex in clinical and psychosocial settings, may help reduce violence exposure among women with and at-risk for HIV.     

Forced Sexual Initiation, Sexual Intimate Partner Violence and HIV Risk in Women: A Global Review of the Literature

Coerced or forced sexual initiation and sexual intimate partner violence (sexual IPV) contribute significantly to a woman’s risk for HIV infection. This review systematically examines global research (n = 21 studies) published since 2000 on the role of coerced/forced sexual initiation and sexual IPV on HIV risk in women. In predominantly low- and middle-income countries, coerced/forced sexual initiation was associated with HIV/STIs, multiple and high-risk sex partners, and no condom use. Most studies using behaviorally specific terms for sexual IPV found strong associations between sexual IPV and HIV risk behaviors. In contrast, studies using less specific definitions often failed to find these significant associations. To develop more comprehensive HIV prevention programs, future efforts should integrate behaviorally specific terms into assessing prevalence of sexual IPV and its association with HIV risk, consider cultural differences, and identify causal pathways between coerced or forced sexual initiation, HIV risk behaviors and HIV/STI infection.     

Childhood Sexual Abuse and HIV Risk-Taking Behavior Among Gay and Bisexual Men

We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001). Perception of having been coerced was associated with greater sexual risk. Furthermore, childhood sexual abuse and level of coercion were associated with reported levels of HIV infection among gay and bisexual men. It is recommended that existing programs for those at risk for HIV be modified to deal with these issues, and that efforts to bring about behavior change will require approaches that go beyond simply increasing knowledge and awareness.     

Impact of intimate partner violence on clinic attendance,viral suppression and CD4 cell count of women living with HIV in an urban clinic setting

The substance abuse, violence and HIV/AIDS (SAVA) syndemic represents a complex set of social determinants of health that impacts the lives of women. Specifically, there is growing evidence that intimate partner violence (IPV) places women at risk for both HIV acquisition and poorer HIV-related outcomes. This study assessed prevalence of IPV in an HIV clinic setting, as well as the associations between IPV, symptoms of depression and PTSD on three HIV-related outcomes—CD4 count, viral load, and missed clinic visits. In total, 239 adult women attending an HIV-specialty clinic were included. Fifty-one percent (95% CI: 45%–58%) reported past year psychological, physical, or sexual intimate partner abuse. In unadjusted models, IPV was associated with having a CD4 count <200 (OR: 3.284, 95% CI: 1.251–8.619, p?=?0.016) and having a detectable viral load (OR: 1.842, 95% CI: 1.006–3.371, p?=?0.048). IPV was not associated with missing >33% of past year all type clinic visits (OR: 1.535, 95% CI: 0.920–2.560, p?=?0.101) or HIV specialty clinic visits (OR: 1.251, 95% CI: 0.732–2.140). In multivariable regression, controlling for substance use, mental health symptoms and demographic covariates, IPV remained associated with CD4 count <200 (OR: 3.536, 95% CI: 1.114–11.224, p?=?0.032), but not viral suppression. The association between IPV and lower CD4 counts, but not adherence markers such as viral suppression and missed visits, indicates a need to examine potential physiologic impacts of trauma that may alter the immune functioning of women living with HIV. Incorporating trauma-informed approaches into current HIV care settings is one opportunity that begins to address IPV in this patient population.