Article2013

The Clinical Implications of High Rates of Intimate Partner Violence Against HIV-Positive Women

Reed Alexander Cunningham Siemieniuk · Hartmut B. Krentz · Patricia Miller · Kate Woodman · Karen Ko · Michael John Gill

75 citations0/0 files storedJAIDS Journal of Acquired Immune Deficiency Syndromes

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Intimate Partner and Family Violence HIV/AIDS Research and Interventions HIV, Drug Use, Sexual Risk

Abstract

INTRODUCTION: Intimate partner violence (IPV) is associated with increased risk of HIV infection among women, however, whether IPV affects outcomes after HIV infection is uncertain. We assess the impact of IPV on HIV-positive women. METHODS: All HIV-positive women who received outpatient HIV care in southern Alberta between March 2009 and January 2012 were screened for IPV. The associations with IPV of sociodemographic factors, health-related quality of life, clinical status, and hospitalizations were obtained from a regional database and evaluated with multivariable regression analysis. RESULTS: Of 339 women screened, 137 (40.4%) reported experiencing IPV. Those disclosing IPV had higher rates of smoking [adjusted prevalence ratio (APR) = 5.07; 95% confidence interval (CI): 2.72 to 9.43]; illicit drug use (APR = 7.58; CI: 2.45 to 23.26); a history of incarceration (APR = 4.84, CI: 1.85 to 12.68); depression (APR = 2.50, CI: 1.15 to 5.46); and anxiety disorders (APR = 5.75, CI: 2.10 to 15.63). Health-related quality of life was diminished with IPV (APR = 2.94, CI: 1.40 to 6.16) for poor/fair versus very good/excellent. IPV-exposed women were hospitalized 256 times per 1000 patient-years compared to 166/1000 patient-years among IPV-unexposed (P < 0.001) women. The relative risk was increased for HIV-unrelated hospitalizations (APR = 1.42, CI: 1.16 to 1.73) and for HIV-related hospitalizations after outpatient HIV care was initiated (APR = 2.19, CI: 1.01 to 4.85). Modifiable contributors to the poor outcomes included decreased use of antiretroviral therapy (APR = 0.55, CI: 0.34 to 0.91) and additional interruptions in care longer than 1 year (APR = 1.90, CI: 1.07 to 3.39). CONCLUSIONS: IPV is associated with deleterious HIV-related and HIV-unrelated health outcomes, of which, suboptimal engagement in care is a contributor. To improve outcomes, practitioners should aim to increase engagement in care of these women in particular.

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References

2000Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women 2010Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study 2006Conflict and Control 2012Experiences of Domestic Violence and Mental Disorders: A Systematic Review and Meta-Analysis 2002Should health professionals screen women for domestic violence? Systematic review 2008The intersection of intimate partner violence against women and HIV/AIDS: a review 2000Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV 2000Violence victimization after HIV infection in a US probability sample of adult patients in primary care

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2013Intimate Partner Violence and HIV: A Review 2015“Violence. Enough already”: findings from a global participatory survey among women living with HIV 2017Dating Violence Against HIV-Infected Youth in South Africa: Associations With Sexual Risk Behavior, Medication Adherence, and Mental Health 2019Intimate partner violence against HIV-positive Cameroonian women: Prevalence, associated factors and relationship with antiretroviral therapy discontinuity—results from the ANRS-12288 EVOLCam survey

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