Safer Sex and Partner Violence in a Sample of Women

Sexually transmitted infections (STIs), including HIV, continue to be associated with significant morbidity and mortality among women. Intimate partner violence (IPV), affecting approximately 25% of women, has been shown to be a risk factor for HIV and STIs. This study describes the relationship between sexual risk, safer sex, and partner violence in a sample of women. Women who experienced IPV reported greater coercive sexual risk behaviors and a decreased ability to practice some safer sex behaviors. Nurse practitioners should be aware of the relationship between IPV and sexual risk and screen all women during routine visits.     

The interrelationship between violence, HIV/AIDS, and drug use in incarcerated women.

The purpose of this study was to examine how violence co-occurs with drug use and HIV/AIDS high-risk behaviors among women incarcerated for drug use. This study was a supplement to a larger, experimental study designed to reduce HIV/AIDS high-risk behaviors among incarcerated female drug users. The women who participated (N = 170) reported that violence was a major part of their lives and affected many of their behaviors. Among these 170 women, 26.6% used condoms for oral sex, 46.4% for vaginal intercourse, and 65% were either sexually or physically abused. Intimate partner abuse was reported by 33.9% of the women. About 16% reported forced sexual activity, and 17.5% feared their partners. Women who refused to give oral sex to their male partners and those who insisted on condom use during oral sex prior to jail were more likely to be sexually or physically abused (chi 2 = 4.104; chi 2 = 3.886, p < .05, respectively). Although statistically significant interrelationships were not found among the three variables, significant bivariate relationships were found between intimate violence and HIV/AIDS high-risk behaviors.     

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

IntroductionUrban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.MethodsCross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants’ past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.ResultsRates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men’s at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.DiscussionBrief screening of patients’ at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.     

Hispanic women and AIDS: gendered risk factors and clinical implications

Current theory and research indicate that Hispanic women's increased risk for AIDS is due to sociocultural and psychological factors that are influenced by gender. Hispanic women's low social status limits their ability to negotiate safer sex behaviors for AIDS prevention. Female gender identity, based upon the desire for interpersonal attachment, places Hispanic women at risk for AIDS through a fear of abandonment by male sexual partners who perceive safer sex behaviors as unmasculine. Male sexual partners' beliefs, practices, and behaviors, such as bisexuality and the practice of anal intercourse, increase Hispanic women's AIDS risk. The experience of involuntary sexual encounters and the lack of power to determine sexual behaviors and practices within these encounters also place Hispanic women at risk for AIDS.     

A randomized clinical trial of an HIV-risk-reduction intervention among low-income Latina women

BACKGROUND: HIV infection has increased within the Latina community more than in any other ethnic or racial group within the United States. Latinas comprise only 13% of the U.S. population, yet they account for 20% of the cumulative reported cases of AIDS. OBJECTIVES: The purpose of the study was to evaluate a randomized culturally tailored intervention to prevent high-HIV-risk sexual behaviors for Latina women residing in urban areas. METHODS: Mexican and Puerto Rican women (18-44 years of age; N = 657) who were sexually active during the previous 3 months were recruited and randomized into intervention and control groups. The intervention, facilitated by bilingual, bicultural, trained Latina women, consisted of culturally tailored sessions on understanding their bodies, HIV/AIDS and sexually transmitted diseases, condoms (myths and use), negotiating safer sex practices, violence prevention, and partner communication. Bivariate and multivariate analyses assessed changes from baseline. RESULTS: The intervention improved HIV knowledge, partner communication, risk-reduction behavioral intentions, and condom use, and decreased perceived barriers to condom use. DISCUSSION: The efficacy of a culturally-sensitive intervention to reduce HIV/AIDS-risk behaviors in Latina women was demonstrated in the current study.     

Perception of HIV and safer sexual behaviors among lesbians.

There is little data on female-to-female transmission of HIV. Some women who have sex with women (WSW) have other high-risk behaviors that could lead to HIV infection. The belief that WSW are at no risk may lead to unsafe sexual practices. In this study, a convenience sample of 78 women was surveyed in order to explore the perception of HIV risk among lesbians, their sexual behaviors, and their sources of information about safer sex. Fifty-three percent reported they were at low risk for contracting HIV. Women reported knowledge of barrier methods (89% to 99%) and no sex during menstruation (92%). However, 35% to 40% reported no knowledge of less common safer sex practices. Women reported their source of knowledge as media (36%), workshops (22%), and friends (12%). Eighty-five percent stated that their health care provider knew they were lesbian, but only 15% reported receiving safer sex education. Nurses and nurse practitioners are aptly poised to provide critical HIV education and health care for this population.     

Toward an Understanding of the Context of Anal Sex Behavior in Ethnic Minority Adolescent Women

Understanding the context of anal sex behavior among ethnic minority adolescent women has public health implications for behavioral sexual health promotion and risk reduction interventions. African-American (n = 94) and Mexican-American (n = 465) women (14–18 years of age) enrolled in a clinical trial completed semi-structured interviews to assess psychosocial and situational factors and relationships to sexual risk behavior, substance use, sexually transmitted infection/HIV acquisition, and violence. Bivariate analyses with comparisons by anal sex experiences identified differences by ethnicity and higher self-reported histories of sexual risk behaviors, substance use, violence, and stressful psychosocial and situational factors among adolescent women experiencing anal sex. Predictors of anal sex identified through logistic regression included Mexican-American ethnicity, ecstasy use, methamphetamine use, childhood sexual molestation, oral sex, and sex with friends for benefits.     

Sex Work in Trucking Milieux: "Lot Lizards," Truckers, and Risk

Background: Long-haul truckers often engage in risk-laden sexual mixing and drug exchanges with female sex workers while on the road, which increase their vulnerability to sexually transmitted infections/blood borne infections (STI/BBI). Objective: An ethnoepidemiological study of STI/BBI in trucker-centered populations was conducted at four truckstops in the United States. This article reports findings from an analysis of the female sex worker data, which show how mobility and transience, as well as poverty, homelessness, and exposure to violence, have the potential to exacerbate the occupational health risks of female sex workers. Methods: Phase 1 involved nonparticipant observation of trucker risk network groups in public and semi-public settings at two Arizona truckstops. Phase 2 was a large-scale ethnoepidemiological study of STI/BBI risk among trucker networks at two Georgia truckstops. Ten sex workers in Phoenix and 29 in Atlanta were interviewed individually or in focus groups. Textual data were analyzed using QSR NVivo 8 and serological data collected from the Georgia sample were analyzed for STIs/HIV. Results: Infections occur within these populations, where the existence of multiple risks delivered via multiple channels within physical proximity maintains infection and transmission. Conclusions: Environmental-level interventions, such as better security at truck stops, and individual-level interventions, such as STI/BBI infection education and testing for FSWs and truckers, can contribute to safer settings for truckers, sex workers, and their sex and drug partners.     

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.     

Substance use,victimization, HIV/AIDS risk,and recidivism among females in a therapeutic justice program

This analysis examines the association between crack/cocaine use only and the SAVA syndemic (any substance use, being exposed to violence, having HIV/AIDS risk behaviors) at baseline and any felony, misdemeanor, or municipal violations by an 8-month follow-up. Data comes from 317 women recruited from a Municipal Drug Court System in the Midwest. Among the sample, 45% of the women had at least one felony, misdemeanor, or a municipal violation at the 8-month follow-up (felony: 20%; misdemeanor or municipal violation 25%). Multinomial regression revealed that crack/cocaine use and SAVA at baseline were associated specifically with misdemeanors OR 2.21 (95% CI: 1.21, 4.04) and OR 3.60 (95% CI: 1.23, 10.56), respectively, no increases in odds of felonies were evident. Women with a higher number of lifetime arrests were also significantly more likely to have a greater number of offenses postbaseline, while black women were considerably less likely to be charged with misdemeanors. Recent crack/cocaine use with or without the mutually reinforcing issues of victimization, and HIV/AIDS risk behaviors significantly increased the odds of a misdemeanors/municipal violation. However, significant increases in odds of more severe offenses (felonies) were not evident. Interventions aimed to reduce offenses should offer additional support for crack/cocaine users.     

Community-based research to explore safer sex behaviors among women: implications for CNS practice

PURPOSE/OBJECTIVES: This article illustrates how data from community-based surveys can be used to inform clinical nurse specialist (CNS) practice and ultimately influence patient care related to sex behaviors. BACKGROUND/RATIONALE: Clinical nurse specialists design, implement, and evaluate research to develop specific prevention and intervention strategies for populations. Much of this research is conducted in the tertiary setting although many of the interventions are carried out in the community setting. DESCRIPTION OF THE PROJECT: A sample of rural women (N = 578) participated in a community-based survey to determine characteristics which influence safer sex behaviors. OUTCOME: Results of the survey suggest that age, education, and relationship status influence safer sex behaviors. Women in the community tended to believe that safer sex behaviors were linked to pregnancy prevention and lacked understanding about the importance of safer sex behaviors to prevent sexually transmitted diseases including HIV/AIDS. INTERPRETATION/CONCLUSION: The findings of this study can inform CNSs about sex behaviors among women in a selected community, translating community-based research into evidence-based, patient-centered care. IMPLICATIONS FOR NURSING PRACTICE: Results from community-based research can be used to develop educational and prevention programs, and interventions for specialty populations.     

The lives of incarcerated women: violence, substance abuse, and at risk for HIV.

High rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) are seen in women prisoners. These high rates may be related to the nature of their lives, which may include violence, substance abuse, promiscuity, prostitution, and exchange of sex for drugs--all of which increase their risk for acquiring HIV. The purpose of this study was to examine the HIV-related risk behaviors and protective practices of women prisoners in a rural southern state and factors related to these behaviors. The sample included 57 women incarcerated in a medium-to-maximum security prison. Key findings included high rates of substance abuse, extensive past and current violent experiences including sexual abuse, high percentage of multiple partners, and low use of condoms. Additionally, women in this sample did not perceive themselves to be at risk for HIV infection. Practical suggestions for reducing the HIV risks of incarcerated women are offered.     

Predictors of sexual behaviors among Thai young adults.

To identify correlates of sexual behaviors among Thai young adults between 18 and 24 years, the authors used a cross-sectional survey of 405 young adults from eight randomly selected Thai urban and rural vocational schools. The young adults completed self-report questionnaires. Logistic regressions were used to determine the correlates between a Thai young adult's ever having had sexual intercourse and the correlates of the number of sexual partners and consistent condom use among those who were sexually active. The independent variables were age, gender, socioeconomic status, geographic residence, parental residence, parental-young adult communication, HIV knowledge, and negotiation for safer sex. The results showed that geographic residence and negotiation for safer sex were related to a young adult's ever having had sexual intercourse; gender, HIV knowledge, and negotiation for safer sex were related to the number of sexual partners; and geographic residence was related to condom use. HIV prevention programs should incorporate HIV knowledge and negotiation skills for both genders and for all geographical areas.     

Incidence and correlates of physical violence among HIV-infected women at risk for pregnancy in the southeastern United States.

To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIV-infected women 17 to 49 years of age (mean = 30.1 years). Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical or sexual abuse. Women reporting greater violence were more likely to disclose their HIV-seropositive status to their sex partner. Using logistic regression, greater intent to get pregnant (odds ratio [OR] = 0.933), decreased present life satisfaction (OR = 1.048), having three or more children (OR = 0.474), and history of drug use (OR = 0.794) significantly distinguished between women who reported physical and/or sexual violence and those who did not.     

Gay identity, interpersonal violence, and HIV risk behaviors: an empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men.

The highest absolute number of new HIV infections and AIDS cases still occur among men who have sex with men (MSM). Numerous theoretical approaches have been used to understand HIV risk behaviors among MSM; however, no theoretical model examines sexual risk behaviors in the context of gay identity and interpersonal violence. Using a model testing predictive correlational design, the theoretical relationships between childhood sexual abuse, adverse early life experiences, gay identity, substance use, battering, aversive emotions, HIV alienation, cue-to-action triggers, and HIV risk behaviors were empirically tested using confirmatory factor analysis and structural equation modeling. The relationships between these constructs are complex, yet childhood sexual abuse and gay identity were found to be theoretically associated with HIV risk behaviors. Also of importance, battering victimization was identified as a key mediating variable between childhood sexual abuse, gay identity, and adverse early life experiences and HIV risk behaviors among urban MSM.     

Association between intimate partner violence, migraine and probable migraine

(Headache 2011;51:208‐219) Objective.— Intimate partner violence (IPV) among women is a global public health problem. The association between childhood maltreatment and migraine is well established, but not the association between IPV and migraine. The aim of this cross‐sectional study was to evaluate the relationship between type and severity of IPV and migraine in a large cohort of Peruvian women. Methods.— Women who delivered singleton infants (n = 2066) at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during their postpartum hospital stay. Participants were queried about their lifetime experiences with headaches and migraine, and with physical and sexual violence. The International Classification of Headache Disorders (ICHD‐2) diagnostic criteria were used to classify participants according to their migraine status. Questions on physical and sexual violence were adapted from the protocol of Demographic Health Survey Questionnaires and Modules: Domestic Violence Module and the World Health Organization (WHO) Multi‐Country Study on Violence against Women. Depressive symptoms were assessed using a modified version of the Patient Health Questionnaire‐9. Logistic regression was used to estimate multivariate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results.— Compared with women without a history of violence, women with experiences of lifetime physical or sexual violence (aOR = 1.44, 95% CI 1.19‐1.75), physical violence only (aOR = 1.36, 95% CI 1.10‐1.68), sexual violence only (aOR = 1.76, 95% CI 0.97‐3.21), and both physical and sexual violence (aOR = 1.61, 95% CI 1.12‐2.31) had increased odds of any migraine after adjusting for maternal age, parity, and access to basic foods. There was no gradient of increased odds of any migraine with severity of physical violence. The relationship between IPV and any migraine was strongest among women with moderate to severe levels of depressive symptoms. The odds of any migraine was increased 2.25‐fold (95% CI 1.75‐2.28) among abused women who also had moderate to severe levels of depressive symptomology compared with women who were not abused and had none or mild levels of depressive symptomology. Associations from sensitivity analyze that segregated women according to probable migraine (ICHD‐2 category 1.6.1) and migraine (ICHD‐2 category 1.1) diagnoses were of similar magnitudes as those reported here for women with any migraine diagnoses. IPV, particularly sexual violence, appears to be a risk factor for migraine. Conclusion.— Our findings suggest the potential importance of considering a history of violence among migraineurs.     

Halting and reversing HIV epidemics in Asia by interrupting transmission in sex work: experience and outcomes from ten countries

HIV epidemics spread rapidly through Asian sex work networks two decades ago under conditions of high vulnerability, low condom use, intact male foreskins and ulcerative STIs. Experiences implementing interventions to prevent transmission in sex work in ten Asian countries were reviewed. All report increasing condom use trends in sex work. In the seven countries where condom use exceeds 80%, surveillance and other data indicate declining HIV trends or low and stable HIV prevalence with declining STI trends. All four countries with national-level HIV declines among sex workers have also documented significant HIV declines in the general population. While all interventions in sex work included outreach, condom programing and STI services, the largest declines were found in countries that implemented structural interventions on a large scale. Thailand and Cambodia, having controlled transmission early, are closest to providing universal access to HIV care, support and treatment and are exploring HIV elimination strategies.     

Reproductive health consequences of intimate partner violence. A nursing research review

Intimate partner violence is widespread and results in significant negative mental and physical health outcomes for women. This article is a review of nursing research on intimate partner violence and women's reproductive health and focuses on studies published since 1995, building on prior reviews. We begin with research on forced sex and the resulting physical and emotional trauma as well as implications for contraception, STD/HIV prevention, and condom use negotiation. We then discuss several approaches to the study of abuse during pregnancy, including several studies of nursing interventions. We conclude with the clinical implications of these studies.