Transcript The Intersection of Domestic Violence and HIV

The Intersection of
Intimate Partner Violence and HIV
Jennifer Marshall, Assistant Director
Memphis Center for Reproductive Health
August 2011
Special Thank You to…
This presentation has been adapted from an
original presentation by:
ManChui Leung
HIV Program Director
Asian & Pacific Islander American Health Forum
March 2008
This presentation was made possible by the
.
Objectives
• After this session, participants will:
– Understand how intimate partner violence
can increase a person’s risk for being
infected with HIV
– Understand how being infected with HIV
may increase a person’s risk for
experiencing intimate partner violence
– Have tools to screen for intimate partner
violence among people living with HIV
– Know about local intimate partner violence
resources
Intimate partner
violence can
happen to anyone
anywhere.
What is intimate partner violence?
• Intimate partner violence occurs when a
person you are dating, living with, or married
to physically, sexually, or emotionally injures
you.
• Intimate partner violence is often used to
establish and keep control.
• Intimate partner violence happens to women,
men, adolescents, same sex partners- anyone.
What is intimate partner violence?
• Mild physical harm– like pulling hair or
twisting flesh
• Verbal abuse (using words to make someone
feel bad), threats or constant blame
• Violent actions that leave marks – like hitting,
slapping, or beating
• Extreme violence using knives or guns
• Rape or sexual assault
How prevalent is IPV?
• Each year,
– women experience about 4.8 million intimate
partner related physical assaults and rapes.
– Men are the victims of about 2.9 million intimate
partner related physical assaults.
• 2,340 deaths in 2007. Of these deaths,
– 70% were females, and
– 30% were males.
Understanding Intimate Partner Violence Fact Sheet. Centers for Disease Control and Detection Division of
Violence Prevention. 2011. http://www.cdc.gov/ViolencePrevention/pdf/IPV_factsheet-a.pdf
How prevalent is IPV?
• A national study found that 29% of women
and 23% of men had experienced intimate
partner violence during their lifetime.
• A review of representative samples found that
between 9-28% of women have experienced
child sexual abuse.
(Coker et al., 2002).
(Vogeltanz et al., 1999)
Coker AL, Davis KE, Arias I, Desai S, Sanderson M, Brandt HM, et al. Physical and mental health effects of intimate partner
violence for men and women. American Journal of Preventive Medicine 2002;23(4):260.
Vogeltanz, N.D., et al., Prevalence and risk factors for childhood sexual abuse in women: National survey findings., in Child
Abuse & Neglect. 1999, Elsevier Science. p. 579-592.
How prevalent is IPV among PLWHAs?
• Prevalence of violence among women living
with HIV or at risk for HIV may be as high as
67%.
(Cohen et al., 2000)
– DISPROPORTIONATED IMPACT: Compared to 29%
of women overall.
• Prevalence of child sexual abuse among
women living with HIV ranges from 31%-53%.
(Koenig & Clark, 2004)
– DISPROPORTIONATED IMPACT: Compared to 928% of women overall.
Cohen, M. et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV.
American Journal of Public Health. 2000 April; 90(4): 560-565.
Koenig LJ, Clark H. Sexual abuse of girls and HIV infection among women: Are they related? In: Koenig LJ, Doll LS,
O’Leary A, Pequegnat W, editors. From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention.
American Psychological Association; Washington, DC: 2004. pp. 69–92.
INTERSECTION of Violence and HIV
VIOLENCE CAN BE A
BARRIER TO ENGAGING IN
HIV RISK REDUCTION BEHAVIORS
Violence limits a person’s ability to access
and engage in HIV preventative behaviors,
such as condom-use, monogamy, and
pregnancy planning and prevention
Violence & Risk Reduction
Women in abusive relationships:
• Are more likely to never use a condom (Hamburger et al., 2004)
• Report escalation of abuse when asking their
partner to use a condom (Crosby, et al., 2002)
• Experience depression, anxiety, substance use,
suicide ideation (Tjaden and Thoennes, 2000)
Hamburger, ME, et al. Persistence of inconsistent condom use: relation to abuse history and HIV serostatus. AIDS Behavior.
2004 Sep; 8(3): 333-344.
Crosby, RA, et al. HIV/STD prevention benefits of living in supportive families: A prospective analysis of high risk AfricanAmerican female teens. American Journal of Health Promotion. 2002 Jan-Feb; 16(3): 142-145.
Tjaden, P. and Thoennes, N. Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the
National Violence Against Women Survey. US Department of Justice. 2000 Nov.
INTERSECTION of Violence and HIV
PARTNERS WITH
HIGHER RISK OF HIV
INFECTION
Women who experience violence are more
likely to be in partnerships with men who are
at high risk for HIV from substance use and
multiple partners.
Violence & Higher Risk Partners
• Women with a history of abuse are 4 times more
likely to engage in sex with a high risk partner (Beadnell et al.,
2000).
• Women, even in high risk and violent relationships,
are often unable to label sexual abuse as rape (El-Bassel et al.,
2000).
Beadnell, B., et al. HIV/STD Risk Factors for Women with Violent Male Partners. Sex Roles. 2000 April: 42(7-8), 661-689.
El-Bassel, N., et al. Fear and Violence: Raising the HIV Stakes. AIDS Education and Prevention. 2000 April: 12(2), 154-170.
INTERSECTION of Violence and HIV
VIOLENCE CAN BE A
BARRIER TO ACCESSING
HIV TESTING AND CARE SERVICES
Fear of violence and other negative
outcomes are controlling factors that serve
as a barrier to a woman’s ability to access
HIV testing and other health and human
services.
Violence & HIV Testing and Care
• Women in violent relationships often have limited
decision making authority with regard to accessing
healthcare for themselves and their children (Tjaden &
Thoennes, 2000).
• Most common barriers to disclosure are fear of
abandonment, rejection, further violence from
partner and family (Gielen, et al., 1997).
• Women living with HIV in violent relationships report
a reluctance to keep appointments because of fear,
depression and feeling “worn down”.
– Abusive partners can also sabotage efforts to keep
appointments or take medications (Lichtenstein, 2006).
Tjaden, P. and Thoennes, N. Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the
National Violence Against Women Survey. US Department of Justice. 2000 Nov.
Gielen, AC, et al. Women’s disclosure of HIV status: experiences of mistreatment and violence in an urban setting. Women
Health. 1997; 25(3): 19-31.
Lichtenstein, B. AIDS Patient Care and STDs. February 2006, 20(2): 122-132.
INTERSECTION of Violence and HIV
EXPERIENCE OF EARLY
SEXUAL ABUSE
The experience of early sexual abuse as a
child or adolescent correlates with high risk
behaviors and a limited ability to engage in
risk reduction strategies
HIV, Child Sexual Abuse
& High Risk Behaviors
Women with a history of sexual abuse and violence:
• Have a 7-fold increase of HIV risk behaviors and
other markers of risk (Wyatt, 2000).
• Are 14 times more likely to report an STD (Wingood & DiClemente,
1997).
• Tend to have more partners (Cohen et al., 2000), and high risk
partners (Beadnell et al., 2000).
Wyatt, GE, et al. Examining Patterns of Vulnerability to Domestic Violence Among African American Women. Violence Against
Women. 2000 July; 6(5), 495-514.
Wingood, GM and DiClemente, RJ. The effects of an abusive primary partner on the condom use and sexual negotation
practices of African-American women. American Journal of Public Health. 1997; 87(6): 1016-1018.
Cohen, M. et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. American
Journal of Public Health. 2000 April; 90(4): 560-565.
Beadnell, B., et al. HIV/STD Risk Factors for Women with Violent Male Partners. Sex Roles. 2000 April: 42(7-8), 661-689.
HIV, Child Sexual Abuse
& High Risk Behaviors
• Substance use
• Victims of child sexual abuse are more likely to
be re-victimized as adults
• Men of color compared to white men, and
gay/bisexual men compared to heterosexual
men have a higher prevalence of child sexual
abuse
(Wilsnack, 2003)
(Wyatt, 2000).
(Koenig, et al., 2003).
Wilsnack, SC, et al. Child sexual abuse and alcohol use among women: Setting the stage for risky sexual behavior. In L. J.
Koenig, L. S. Doll, A. O’Leary, & W. Pequegnat (Eds.), Child sexual abuse to adult sexual risk: Trauma, revictimization, and
intervention (pp. 181–200). 2003.
Wyatt, GE, et al. Examining Patterns of Vulnerability to Domestic Violence Among African American Women. Violence Against
Women. 2000 July; 6(5), 495-514.
Koenig, LS, et al. Child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention. 2003
DISCUSSION
Why might routine screening for violence
be important for people living with HIV?
Would you feel comfortable screening your
patients/clients for violence?
Tools to Screen for Violence
Intimate Partner Violence and Sexual
Violence Victimization Assessment
Instruments for Use in Healthcare
Settings
http://www.cdc.gov/NCIPC/pubres/images/IPVandSVscreening.pdf
Tools to Screen for Violence
• Have you ever been emotionally or
physically abused by your partner or
someone important to you?
• Within the last year, have you been hit,
slapped, kicked or otherwise physically
hurt by someone?
• Within the last year, has anyone forced
you to have sexual activities?
Local Resources
• YWCA of Greater Memphis Abused Women’s
Services 901-725-4277
• Shelby County Sexual Assault Resource Center
901-222-9960
• LGBTQ Resource?
• Resource for Men?
Upcoming Lunch & Learns
• Clinic and Community Partner Updates
October 20th
• Parenting Options for HIV Positive Men
November 17th
• Integrating Reproductive Health & HIV Testing
January 12th
• Microbicides and other Special Topics
February 16th