Frailty and life course violence: The international mobility in aging study

ObjectiveTo estimate the prevalence of frailty in older adults in the IMIAS population, to examine associations between lifelong domestic violence and frailty and possible pathways to explain these associations.MethodsA cross-sectional study with 2002 men and women in the International Mobility in Aging Study, aged between 65 and 74 years old living in five cities of Tirana (Albania), Natal (Brazil), Kingston and Saint-Hyacinthe (Canada), and Manizales (Colombia). Domestic physical and psychological violence by family and intimate partner was assessed by the Hurt, Insult, Threaten and Scream (HITS) scale. Fried’s phenotype was adopted to define frailty. Logistic regressions were fitted to estimate between frailty and lifelong violence. Mediation analyses using the Preacher and Hayes method was used to examine potential health pathways.ResultsFrailty prevalence varies across cities, being lowest in Saint-Hyacinthe and Kingston, and highest in women in Natal. Women had a higher prevalence in Tirana and Natal. Adjusting for age, sex, education and research city, those reporting childhood physical abuse (CPA) had higher odds of frailty (OR = 1.68; 95% CI: 1.01; 2.78); those who had been exposed to psychological violence by their intimate partner had also higher odds of frailty (OR = 2.07; 95% CI: 1.37; 3.12). CPA effect on frailty was totally mediated by chronic conditions and depression symptoms. Effects of psychological violence by intimate partner were partially mediated by chronic conditions and depression symptoms.ConclusionsChildhood physical abuse and psychological violence during adulthood leave marks on life trajectory, being conducive to adverse health outcomes and frailty in old age.     

Malaise, Motivation and Motherhood: Predictors of Engagement in Behavioral Interventions from a Randomized Controlled Trial for HIV+ Women in Drug Abuse Recovery

Drug abuse has serious consequences for the wellbeing of persons with HIV/AIDS but suboptimal rates of client engagement limit the efficacy of interventions. The present study examines and compares client characteristics that predicted engagement (defined as attendance at two or more sessions) in a family intervention (SET) and a group intervention within a randomized trial aimed at preventing relapse and improving medication adherence for 126 predominantly African American HIV+ women in drug abuse recovery. Intervention engagement (60% overall) was not significantly different across the two interventions. Fewer physical and mental symptoms (malaise) (P < 0.05), living independently (P < 0.05), living with children (P < 0.05), and readiness to change (P < 0.05) were associated with engagement across the two interventions. Results from this study can be used to inform outreach and engagement approaches for women dually affected by drug abuse and HIV/AIDS.     

Alcohol abuse,gender-based violence and HIV/AIDS in Botswana: establishing the link based on empirical evidence

The existence of gender-based violence has been a source of concern within the public and private sectors as well as civil society organisations in Botswana. The present study investigated the link between alcohol abuse, gender-based violence and HIV/AIDS. Further, it attempted to unravel the often unquestioned assumption that gender-based violence is perpetuated by cultural practices. Case study qualitative methodology was used to gather data for the study. A sample of 20 cases was selected purposively from five women's non-governmental organisations. In addition, in-depth interviews were conducted with agency coordinators, social workers, police commanders and police officers. The findings of the study revealed a relationship between alcohol abuse and gender-based violence, which makes victims vulnerable to HIV infection. From the findings, it is recommended that gender-based programmes be established to sensitise people about the link between alcohol abuse, genderbased violence and HIV/AIDS.     

Domestic violence screening: prevalence and outcomes in a Canadian HIV population

There is a strong association between domestic violence victimization and HIV infection. This may lead to poor health outcomes including mental health disorders and reduced access to care. A standardized domestic violence screening interview was incorporated into ongoing care in the large and diverse population living with HIV in Southern Alberta, Canada. Results from May through December 2009 are reported, including the prevalence and outcomes of abuse. Thirty-four percent of 853 patients screened reported abuse. Of these, 16% reported abuse in their current relationship, 58% in a previous relationship, and 57% reported a history of childhood abuse. High-risk groups for abuse included females (43%), gay/bisexual males (35%), and Aboriginals (61%). We found an association between a history of domestic violence and delayed access to care (p < 0.05), missed appointments (p < 0.001), and an increased use of clinic resources such as social work (p < 0.0001) and psychiatry (p < 0.001). Mental health conditions prior to HIV diagnosis, including depression (p < 0.0001), suicidal ideation (p < 0.0001), and anxiety disorder (p < 0.0001) were associated with abuse at any time, while a history of adjustment disorder was associated with childhood abuse (p < 0.05). A simple domestic violence screening tool was helpful for identifying patients experiencing abuse in our diverse HIV-infected population. This high prevalence of domestic violence among our HIV patients was associated with poor outcomes and an increased use of medical resources. HIV caregivers should be aware of domestic violence in order to optimize care and refer patients to appropriate support professionals as needed.     

Self-reported verbal abuse in 1300+ older women within a private,tertiary women’s health clinic

ObjectiveSeveral studies describe “elder abuse” among residents of nursing homes, but this issue is less well studied among independently functioning, community-based women. The current study was undertaken to report rates of self-reported intimate partner violence – with a focus on verbal abuse – among older women within a private tertiary women’s health clinic.MethodsThis study focused on women who completed a questionnaire on domestic abuse.ResultsA total of 1389 women with a median age of 55 years (range: 50, 90) are the focus of this report. Most 1102 (79%) were married. Within this group, 100 (7%) women reported verbal abuse within the last year. Rates of physical and sexual abuse were much lower with 9 women (1%) and 2 (<1%), respectively. In univariate analyses, being divorced, being an alcoholic, and having suffered prior abuse were associated with reported verbal abuse. In multivariate analyses, self-reported alcoholism and physical abuse were independently associated with reported verbal abuse.ConclusionThis study found a notable rate of patient-reported verbal abuse in older women within a private, tertiary women’s health clinic.ImplicationsThis observation should prompt healthcare providers to ask about intimate partner violence – and specifically verbal abuse – regardless of healthcare setting.     

Intimate Partner Violence, HIV Status, and Sexual Risk Reduction

This study describes the risk of intimate partner violence for women in a low-income, urban setting and the impact of violence on condom use. Partner-specific data were used to link partner characteristics with the measures of both abuse and condom use. Using the Revised Conflict Tactics Scales (CTS2), we determined annual rates, chronicity, and types of intimate partner violence among 188 HIV-positive and 257 HIV-negative women. Of the total sample, 62% reported experiencing psychological, physical, and/or sexual abuse; 44% experienced frequent abuse (13 events); and 29% suffered an injury. Rates did not differ by women's HIV status. Women who experienced frequent abuse were significantly less likely to have used condoms with their intimate partner. Partner characteristics significantly associated with experiencing frequent abuse were his HIV status and substance use. Findings can help inform the development of programs and policies that promote women's health through integrated approaches to intimate partner violence and HIV prevention.     

Racial Differences in Treatment Effect among Men in a Substance Abuse and Domestic Violence Program

Background: It isunclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs. Objectives: This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment. Methods: From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological). Results: African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse. Conclusions and Scientific Significance: At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.     

Social constructions of gender roles,gender-based violence and HIV/AIDS in two communities of the Western Cape,South Africa

The links between gender roles, gender-based violence and HIV/AIDS risk are complex and culturally specific. In this qualitative study we investigated how women and men in two black communities in the Western Cape, South Africa, constructed their gender identities and roles, how they understood gender-based violence, and what they believed about the links between gender relations and HIV risk. First we conducted 16 key informant interviews with members of relevant stakeholder organisations.Then we held eight focus group discussions with community members in single-sex groups. Key findings included the perception that although traditional gender roles were still very much in evidence, shifts in power between men and women were occurring. Also, genderbased violence was regarded as a major problem throughout communities, and was seen to be fuelled by unemployment, poverty and alcohol abuse. HIV/AIDS was regarded as particularly a problem of African communities, with strong themes of stigma, discrimination, and especially ‘othering’ evident. Developing effective HIV/AIDS interventions in these communities will require tackling the overlapping as well as divergent constructions of gender, gender violence and HIV which emerged in the study.     

Violence Among Women with or at Risk for HIV Infection

To estimate the prevalence and to identify correlates of physical and sexual assaults or abuse among women with or at risk for HIV infection, a cross-sectional survey was conducted within a longitudinal cohort study. A total of 765 HIV-seropositive and 367 HIV-seronegative women with a history of injection drug use (51%) or high-risk sex (49%) completed the interview. Both physical abuse and sexual abuse as a child were common for both HIV-seropositive (41.3%, 41.0%) and uninfected women (43.3%, 45.8%), respectively. Both physical abuse and sexual abuse as adults were even more common in both HIV-seropositive (66.4%, 45.7%) and HIV-seronegative women (69.2%, 48.8%), respectively. In the 6 months prior to interview, the most important predictors for being the victim of violence was age <30 years old, use of crack, use of marijuana, having multiple sex partners, and not having a steady sex partner. However, even after accounting for these other factors, HIV-infected women with low CD4 cell counts (<350/l) were less likely than the other women to experience recent violence. While the lower rate of recent violence among those with low CD4 cell count probably represents effects of HIV-related disability, women at high risk for HIV remain at high risk for violence. Both HIV prevention and treatment services need to recognize the background level of violence and incorporate appropriate counseling services.     

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.     

Causes of death among people living with HIV/AIDS in Brazil

BackgroundThe monitoring of the underlying causes of death in people living with HIV/AIDS is important so that actions to reduce morbidity and mortality can be taken.ObjectiveTo describe the temporal trends of underlying causes of death among people living with HIV/AIDS between 2000 and 2007 in Brazil and to identify factors associated with it.MethodsThe Mortality Information System data for deaths occurred in Brazil between 2000 and 2007 that contained reference to HIV/AIDS in any of the death certificate fields was analyzed. Temporal trends of the underlying cause of death were studied. Differences in the underlying cause of death according to gender, age, region of residence, level of education, certifying officer, race and year of death were verified.ResultsBetween 2000 and 2007 the percentage of deaths not related to HIV/AIDS among people living with HIV/AIDS increased from 2.5% to 7.0%. People with higher level of formal education, living in the South-East region of Brazil and aged under 13 or over 60 years old were more likely to have their underlying cause of death reported as not related to HIV/AIDS.ConclusionThe results suggest the importance of implementing actions aimed at improving the quality of life of PLWHA, and which could include behavioral changes, such as smoking and alcoholism cessation, early screening to detect neoplasms and the monitoring of chronic conditions, such as diabetes. That is to say, the need exists to integrate the actions of HIV/AIDS programs with other public health programs.     

Spousal Intimate Partner Violence is Associated with HIV and Other STIs Among Married Rwandan Women

HIV is a health problem in Rwanda, where the adult HIV prevalence is 3.1% (WHO 2008 in Online database of HIV/AIDS epidemiological data, found at: ); the majority of those infected are women (UNAIDS 2008 in ). Prior studies indicate that intimate partner violence is frequently associated with increased HIV risk in women, often because men who abuse their wives also exhibit riskier sexual behaviors (Silverman et al. in JAMA 300:703–710 2008. Population—based data from the 2005 Rwanda Demographic and Health Survey indicate that women with few, if any, other sexual risk factors who have experienced sexual, physical, or emotional abuse within their marriages are 1.61–3.46 times as likely to test positive for HIV, and 2.14–4.11 times more likely to report another STI. These findings confirm prior clinical studies that indicate that intimate partner violence is a correlate of HIV/STIs in Rwanda. Further research is needed to determine whether Rwandan men that abuse their wives have higher baseline rates of HIV/STI infection.     

Rural HIV/AIDS Services

Abstract

An exploratory study to investigate the needs of those living with HIV disease to determine related service challenges was conducted in 1997 and replicated in 1999. This study utilized qualitative and quantitative measures, surveyed both individuals who are living with HIV disease and HIV/AIDS service providers in predominately rural counties of a midwest -ern state with a low incidence of HIV infection. Respondents' perceptions were solicited regarding existing services in the areas of: (1) awareness; (2) satisfaction; and (3) gaps and barriers. Findings indicate: (1) the critical role AIDS service organizations have in rural service delivery; (2) service awareness is much stronger among those living with HIV disease than HIV/AIDS service providers; (3) satisfaction with available services is growing; and (4) there is a widening gap between important needs and available services.     

Screening for Domestic Violence Among Adult Women in the United States

Background Domestic violence is a problem frequently encountered in health care settings and a risk factor for physical and mental health problems. Objective To provide nationally representative estimates of rates of domestic violence screening among women, to identify predictors of screening, and to describe settings where women are screened. Design and Participants We examined 4,821 women over the age of 18 from the second wave of Healthcare for Communities, a nationally representative household telephone survey conducted in 2000–2001. Measurements Self-reports concerning whether the respondent was ever asked about domestic or family violence by any health care provider. Results Only 7% (95% CI, 6%–8%) of women reported they were ever asked about domestic violence or family violence by a health care professional. Of women who were asked about abuse, nearly half (46%) were asked in a primary care setting, and 24% were asked in a specialty mental health setting. Women with risk factors for domestic violence were more likely to report being asked about it by a health care professional, but rates were still low. Conclusions Self-reported rates of screening for domestic violence are low even among women at higher risk for abuse. These findings reinforce the importance of developing training and raising awareness of domestic violence and its health implications. This is especially true in primary care and mental health specialty settings.     

Faith,Spirituality, Fatalism and Hope

ABSTRACT

This study represents an illumination of the voices of Ghanaian women affected by HIV/AIDS. This phenomenological study provides meaningful insight into Ghanaian women's perspectives on living with HIV/AIDS. Emerging from the experiences of the 20 co-researchers is a construction of the phenomenon of living with HIV/AIDS. Core dimensions of this phenomenon include The Pre-Illness Experience, The Core Experience of Living with HIV/AIDS and The Transformation of Self. This article will focus on one of the prominent themes of the co-researchers' Core Experience of Living with HIV/AIDS, namely coping through faith, spirituality, fatalism and hope.     

Mitigating intimate partner violence among South African women testing HIV positive during mobile counseling and testing

South African women continue to suffer disproportionately from the interlinked epidemics of HIV and intimate partner violence (IPV). Effective strategies are needed to mitigate HIV-related IPV, which often creates barriers to successful engagement along the HIV continuum of care. More information is needed on how IPV impacts women’s safety following mobile HCT diagnosis, and the HIV IPV Risk Assessment &; Safety-planning (HIRS) protocol was developed to address several related gaps in knowledge. The sample included 255 black South African women experiencing IPV and testing HIV+ during mobile HCT in Gauteng province. Outcomes were compared between a standard of care (SOC) group and an Experimental group with two dosage levels (D1, D2). Of the total sample and in the last year, 99.2% had experienced non-violent control, 40.7% physical abuse, 44.8% sexual abuse, and 67.3% physical or sexual abuse. There were no significant differences in pre/post safety scores, or for satisfaction or acceptability items. The overall linkage rate was 45.8% (M?=?12.97 days), and the Experimental group had more links to care in certain age groups—the highest in those aged ≤23 years in D1 (70%). The lowest linkage rate was for those aged 33–43 years in the SOC (22.2%). Almost two thirds of participants reported using the safety plan (61.9%), with 80% reporting it was helpful, and 80% using ≥1 safety strategy. The Experimental group reported significantly less violence upon partner notification of serostatus, but all groups felt significantly less safe getting to medical appointments by post-test. Overall, the study indicates the HIRS protocol is safe and helpful, brief to administer, and may mitigate violence during partner notification of serostatus, but further investigation is needed before implementing it as a standard of care.     

When HIV-Prevention Messages and Gender Norms Clash: The Impact of Domestic Violence on Women's HIV Risk in Slums of Chennai, India

This paper examines how marital violence affects women's ability to protect themselves from HIV/AIDS. In-depth interviews (n = 48) and focus groups (n = 84, 3–7 per group) were conducted among men and women in two randomly selected slums of Chennai, India. The study showed that community gender norms tacitly sanction domestic violence that interferes with adopting HIV-preventive behaviors. Given the choice between the immediate threat of violence and the relatively hypothetical specter of HIV, women often resign themselves to sexual demands and indiscretions that may increase their risk of HIV acquisition. In conclusion, AIDS-prevention interventions must incorporate gender-related social contexts in settings where husbands strictly enforce their locus of control. HIV-prevention messages targeting men may effectively reduce women's exposure to HIV/AIDS.     

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.     

Adapting an evidence-based intervention for HIV to avail access to testing and risk-reduction counseling for female victims of sexual violence in post-earthquake Haiti

Haiti has the highest prevalence of HIV/AIDS in the Caribbean. Before the 2010 earthquake, Haitian women bore a disproportionate burden of HIV/AIDS, had lower HIV knowledge, less capacity to negotiate for safer sex, and limited access to HIV testing and risk-reduction (RR) counseling. Since 2010, there has been an increase in sexual violence against women, characterized by deliberate vaginal injuries by non-intimate partners, increasing victims’ risk of sexually transmitted infections including HIV/AIDS. Needed is an adaptation of evidence-based interventions for HIV that include HIV testing and counseling for this stigmatized population. We reviewed several features of Centers for Disease Control and Prevention's 103 evidence-based interventions for HIV (e.g., measures used, participant risk characteristics, theoretical framework, outcome variables, and evidence tier) in an attempt to seek a feasibly adaptable evidence-based intervention for HIV that could be used for victims of sexual violence (VOSV). RESPECT, one of the reviewed evidence-based HIV interventions, comprises of one-on-one, client-focused HIV prevention/RR counseling, and RAPID HIV testing. Adapting RESPECT can enhance access to testing for Haitian VOSV and can influence their perceptions of HIV risk, and establishment of RR goals for future consensual intimate relations. Adapting and implementing RESPECT can increase uptake of evidence-based HIV interventions among Haitians and positively affect a region with high HIV prevalence and increased rates of sexual violence.