Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.     

MINORITY ADOLESCENT WOMEN WITH SEXUALLY TRANSMITTED DISEASES AND A HISTORY OF SEXUAL OR PHYSICAL ABUSE

Life history methods were used to obtain a more in-depth understanding of the configuration of psychosocial and situational factors that are associated with high-risk sexual behavior among minority adolescent women with a history of sexual or physical abuse and sexually transmitted disease (STD), to facilitate development of behavioral risk-reduction interventions. Study participants ranged in age from 14 to 18 years; 19 were Mexican American and 11 were African American. Women were recruited from clinics in a metropolitan health district. Various constitutive patterns unfolded during interview analysis including “fearing,” “trusting,” and “being a woman.” The study revealed the perceptions of an extremely high-risk population of adolescent women regarding their STD risk, the context of their sexual relationships, sexual risk behaviors, contraception, and STD prevention, screening, and treatment practices. Intervention strategies based upon these findings are described.     

Abused women and risk for pelvic inflammatory disease

Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnoses of PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.     

Psychological distress among abused minority women with sexually transmitted diseases

PURPOSE: To describe psychological distress among abused minority women with sexually transmitted diseases (STDs) and to identify needs for psychotherapeutic intervention for reduction in abuse, sexual risk behavior and STD. DATA SOURCES: A controlled randomized trial of the effects of a behavioral intervention on STD recurrence. Eligibility was limited to English speaking Mexican-American and African-American women with a current non-viral STD confirmed by laboratory testing (gonorrhea, chlamydia, syphilis or trichomonas). All eligible women who could be contacted were recruited from public-health clinics in San Antonio. T-tests, Chi square and correlation were used to analyze the data. CONCLUSIONS: Women with STD and a history of abuse reported more symptoms of current psychological distress than nonabused women. This psychological distress was present in all dimensions of the SCL-90-R, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. Increased current psychological distress and correlation was found not only for women with reports of sexual abuse but also forms of physical or psychological abuse. The majority of abuse was reportedly experienced during a relationship with a boyfriend or friend/acquaintance. IMPLICATIONS FOR PRACTICE: Abused women with STD may benefit from the identification and assessment of abuse history and psychological distress so that appropriate psychological treatment can accompany medical treatment. The prevalence of woman abuse within a population of women with STD mandates the inclusion of violence in STD prevention programs.     

Risk and protective behaviours of bisexual minority women: a qualitative analysis

BACKGROUND: Public health messages urging women to seek health care services such as sexually transmitted diseases (STD) and cervical cancer screening or family planning services fail to address women who have sex with women (WSW). This negligence may have led to a false sense of security amongst WSW concerning sexual risk behaviour. Research has shown that WSW engaged in more high-risk sexual behaviours than heterosexual women. WSW has been identified as an important vector in the spread of STDs in all populations because of bisexuality. To prevent and reduce transmission of STDs amongst WSW, perceptions of risk for STD amongst WSW need to be understood so that effective interventions may be developed. AIM: To describe the relationship between sexual risk and protective behaviour and STD transmission amongst bisexual minority women with a history of STD. METHODS: Life history methods were used to interview 23 African-American bisexual women with a history of STD. FINDINGS: Various themes unfolded during analysis of the patient interviews, including bisexual women's perceptions of STD risk, the context of sexual relationships with women and STD prevention, screening, and treatment practices. CONCLUSIONS: The contexts of sexual relationships including multiple or concurrent partner relationships with both men and women placed these women at high risk for STD. Regardless of the type of relationship or belief it is possible to get an STD, protection was often not used. These circumstances identify an extremely high-risk population of women with need for more extensive research to identify strategies for health care interventions.     

Minority adolescent women with sexually transmitted diseases and a history of sexual or physical abuse

Life history methods were used to obtain a more in-depth understanding of the configuration of psychosocial and situational factors that are associated with high-risk sexual behavior among minority adolescent women with a history of sexual or physical abuse and sexually transmitted disease (STD), to facilitate development of behavioral risk-reduction interventions. Study participants ranged in age from 14 to 18 years; 19 were Mexican American and 11 were African American. Women were recruited from clinics in a metropolitan health district. Various constitutive patterns unfolded during interview analysis including "fearing," "trusting," and "being a woman." The study revealed the perceptions of an extremely high-risk population of adolescent women regarding their STD risk, the context of their sexual relationships, sexual risk behaviors, contraception, and STD prevention, screening, and treatment practices. Intervention strategies based upon these findings are described.     

RURAL WOMAN ABUSE AND SEXUALLY TRANSMITTED DISEASE: AN ETHICAL ANALYSIS OF CLINICAL DILEMMAS

Women who have experienced abuse are often offered individual and group psychotherapeutic interventions to help them overcome psychological aftereffects of abuse and avoid future abusive relationships. Clinical cases that are complicated by the existence of abuse and sexually transmitted diseases (STDs) often involve ethical issues concerning patient privacy and legitimate breaches of confidentiality that can potentially harm the individual. There is little known about the experiences of abused rural women with STDs, underscoring the need for modification of existing interventions for this patient population. This paper presents the application of an ethical framework to an actual case involving an abused rural woman with an STD that utilizes the concepts of casuistry, or case-based reasoning. A methodological tool for ethical analysis of the clinical dilemmas involving evidence-based psychotherapeutic interventions for abused rural women with STDs is used to apply the concepts of casuistry to the development of the taxonomy of cases for clinical practice.     

Women's self-efficacy and sexually transmitted disease preventive behaviors

Knowledge of sexually transmitted disease (STD) prevention, perceived risk for STDs, and self-efficacy for STD prevention were investigated as predictors of behavioral risk for STDs in 308 female college students. Perceived risk and self-efficacy predicted 19% of behavioral risk for STD; knowledge was not a predictor. Self-efficacy was highest for communicating about STD prevention and lowest for refusing sexual intercourse. Interventions that enhance both women's self-efficacy to prevent STDs and accurate risk appraisal are likely to be more effective than those that emphasize only knowledge of prevention techniques. © 1996 John Wiley & Sons, Inc.     

Rural woman abuse and sexually transmitted disease: an ethical analysis of clinical dilemmas

Women who have experienced abuse are often offered individual and group psychotherapeutic interventions to help them overcome psychological aftereffects of abuse and avoid future abusive relationships. Clinical cases that are complicated by the existence of abuse and sexually transmitted diseases (STDs) often involve ethical issues concerning patient privacy and legitimate breaches of confidentiality that can potentially harm the individual. There is little known about the experiences of abused rural women with STDs, underscoring the need for modification of existing interventions for this patient population. This paper presents the application of an ethical framework to an actual case involving an abused rural woman with an STD that utilizes the concepts of casuiStry, or case-based reasoning. A methodological tool for ethical analysis of the clinical dilemmas involving evidence-based psychotherapeutic interventions for abused rural women with STDs is used to apply the concepts of casuistry to the development of the taxonomy of cases for clinical practice.     

Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents

PURPOSE: Little is known about the relationship between minority adolescent's experiences of sexual or physical abuse and the pathology of gynecological symptoms that might have an impact on the diagnosis of sexually transmitted disease (STD) or risk for pelvic inflammatory disease (PID). The objective of this study was to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID among Mexican American and African American adolescent women with a current STD. METHODS: Mexican American and African American adolescent women (n = 373) with an STD underwent a targeted physical exam and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and risk behaviors known to be associated with PID to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID. RESULTS: Bivariate comparisons found that abused adolescents (n = 232) reported more behaviors associated with increased risk for PID, including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found that abused adolescents were more likely to report pathologic genitourinary symptomatology than those who were not abused. Clinicians reported more abnormal physical exams but did not make any more presumptive diagnoses of PID for abused than nonabused adolescents. CONCLUSIONS: Delayed treatment for PID dramatically worsens future fertility and chronic pelvic pain. These findings demonstrate that abused adolescent women are at high risk for PID. Because of its considerable impact on risk for PID, an assessment for abuse is essential in clinical management of adolescent women with STD and diagnosis of PID.     

Minority women with sexually transmitted diseases: sexual abuse and risk for pelvic inflammatory disease

Mexican American and African American women (N = 617) with a sexually transmitted disease (STD) underwent a targeted physical exam and questioning regarding sexual abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship between sexual abuse and risk for PID. Sexually abused women (n = 194) reported higher PID risk behaviors, including earlier coitus, more sex partners, higher STD recurrence, and a tendency toward delayed health-seeking behavior. They also reported more severe genitourinary symptomatology, confirmed by physical exam, and presumptive diagnoses of PID. These characteristics identify sexually abused women at high risk for PID. Because of its considerable impact on risk for PID, assessment for sexual abuse is essential in clinical management of women with STD and for diagnosis of PID.     

The relationship between abuse,sexually transmitted diseases, & group B streptococcus in childbearing women

PURPOSE: To examine the relationship between abuse, sexually transmitted diseases (STDs) and group B (GBS) infection among childbearing women using Selye's (1978) stress response theory. DESIGN AND METHODS: Retrospective chart review (n = 205) from two different clinical sites in Washington State, using the Childbearing Health Questionnaire to guide data collection. The women in the sample had an average age of 26.4 years and represented Anglo (81.4%), Hispanic (12%), Native American (3.9%), and African American (2.5%) ethnic groups. Thirty-eight percent ( = 78) reported experiencing physical and/or sexual abuse during their lifetimes and 31% had been diagnosed with an STD. RESULTS: Abuse was significantly related to STDs, and ethnicity emerged as a significant variable for the Hispanic women participating in this study. Findings indicated that infection with group B was also related to abuse status ( r=.60, p < or =.002) and to presence of herpes simplex virus-2 (r =.468, p相似文献   

Lifetime Physical and Sexual Abuse,Substance Abuse,Depression, and Suicide Attempts Among Native American Women

Although there is preliminary evidence that violence against women and children may be particularly prevalent in some Native American communities, associations between abuse and substance abuse, mental health problems, and suicide attempts have rarely been studied in this population. This study examined lifetime and current physical and sexual abuse among 30 Native American women. Nearly half had experienced physical and/or sexual abuse as children, over half were sexually abused at some time in their lives, and over three-fourths were abused by a partner. All but four women (87%) had experience physical or sexual abuse in their lifetime. Significant relationships were found among childhood abuse, substance abuse, and adult revictimization, and among cumulative lifetime abuse events, substance abuse, and depression. Further research is needed to examine abuse and relationships between abuse and health sequelae in Native American populations. An accelerated public health and community response is needed to address abuse issues in this community.     

Lifetime physical and sexual abuse,substance abuse,depression, and suicide attempts among Native American women

Although there is preliminary evidence that violence against women and children may be particularly prevalent in some Native American communities, associations between abuse and substance abuse, mental health problems, and suicide attempts have rarely been studied in this population. This study examined lifetime and current physical and sexual abuse among 30 Native American women. Nearly half had experienced physical and/or sexual abuse as children, over half were sexually abused at some time in their lives, and over three-fourths were abused by a partner. All but four women (87%) had experience physical or sexual abuse in their lifetime. Significant relationships were found among childhood abuse, substance abuse, and adult revictimization, and among cumulative lifetime abuse events, substance abuse, and depression. Further research is needed to examine abuse and relationships between abuse and health sequelae in Native American populations. An accelerated public health and community response is needed to address abuse issues in this community.     

Intimate Partner Violence in the Eastern Part of Iran: A Path Analysis of Risk Factors

Intimate partner violence against women is a widespread phenomenon that is the cause of many deleterious health and social consequences. This study examines the impact of some risk factors on partner violence in the eastern region of Iran, using path analysis. The study used a population-based cross sectional study design. In this study, 251 married women who were referred to the health centers were selected through a proportionally stratified and randomized sampling method. Domestic violence was measured using Conflict Tactics Scale and the socio-demographic variable was assessed by a self-report questionnaire. Bayesian Structural Equation Modeling was used for evaluating the overall path analysis and the direct and indirect p-value was estimated by Bootstrap method. AMOS and SPSS software were used to analyze data. The prevalence of overall violence was 78.1%, with 37.8% and 0.8% of women reporting minor and severe violence, respectively, and 39.8% reporting both severe and minor forms of violence. Psychological violence was the most common type of violence reported (66.5%). The model showed that husbands’ drug abuse and women's higher level of education compared to their husbands were the first and second most important factors that significantly and directly influenced the violence. The women's attitude, however, had the least effect on the violence. The findings indicated that higher educated women and women with addicted husbands were more likely to experience violence. Treating the drug abuse disorders, especially mental disorders, using behavioral couple's therapy, as well as modifying certain traditional and cultural biases against women's empowerment are suggested.     

PREVALENCE AND PATTERNS OF POSTTRAUMATIC STRESS DISORDER IN ABUSED AND POSTABUSED WOMEN

This study examined the prevalence and patterns of posttraumatic stress disorder (PTSD) symptomatology in abused and postabused women. A convenience sample of 160 abused, postabused, and nonabused women completed measures related to physical and emotional abuse by an intimate partner, risk of homicide, and PTSD. Results indicated that PTSD symptoms were present in both the abused and postabused women and were positively correlated with the severity of abuse and risk of homicide that the women experienced. The postabused women were out of the abusive relationship an average of nine years, yet continued to experience PTSD symptoms.     

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.