Transcript relationship_abuse_a..

NORTHWEST AIDS EDUCATION AND TRAINING CENTER
Relationship Abuse and HIV/STI: Addressing
Risks, Offering Support
Laura Avellaneda-Cruz, LMSW
Alaska Native Tribal Health Consortium
Alaska Native Epidemiology Center
Presentation prepared by:
Laura Avellaneda-Cruz
Last Updated: 3/31/15
Learning Objectives, Part 1
Describe
how IPV/SV
impact
HIV/STI risk
Describe
how
IPV/SV
impact
health of +
patients
Learning Objectives, Part 2
Reduce
risks &
improve
response
Assess for IPV
Routinely
Educate Clients
Recognize
elevated risk of
partner notification
Identify most
effective treatment
options
“Success is measured by our
efforts to reduce isolation and to
improve options for safety.”
- Futures Without Violence
Safe Environment +
Education, Assessment, Response
Safe Environment: Privacy
We respect our patients’ privacy.
We always see patients alone at
some point in their visit
Safe Environment: Send positive messages
We respect our patients’ privacy.
We always see patients alone at
some point in their visit
Reviewing Confidentiality
• Builds trust
• Removes fear re.
gossip, reporting of
drug use, etc.
• Avoids feelings of
betrayal, coercion,
taking away control
The Safety Card Approach to
Violence Prevention & Intervention
www.anthctoday.org/epicenter/healthyfamilies
Normalizing
Lets patient know:
• Not being singled out or judged
• This is a major health issue
• Pt. is not alone
• Why to read the card
Remember: Terms can be barriers
Visit-specific questions
Because it happens to so many girls and women,
we ask every patient who needs emergency
contraception if someone has been trying to get
them pregnant when they didn’t want to be.
Any time patients come in for STI/HIV testing, we
ask if they feel comfortable talking with their
partners about using condoms, or if their partners
will get mad. Are you able to talk with your partner
about using condoms without feeling afraid?
Resources
Resources
Responding
Keep the door open
Validate and support
Validate and support
I’m sorry this is happening in your life. You
don’t deserve this.
It’s not your fault.
That sounds really stressful.
Thank you for telling me. That was a brave
thing to do.
Offer information and concern:
You have the right to require
that your partner uses a
condom every time.
I’m concerned about how this
is affecting your health.
Sometimes the stress from
relationships can lead to some
of the symptoms you are
describing.
Health & Safety Issues to Consider: LARCs
Health & Safety Issues to Consider
Long-lasting, reversible contraception (LARCs):
• Does partner monitor menstruation?
• Can patient return to clinic for shots?
• IUD strings? Nexplanon?
Health & Safety Issues to Consider
Long-lasting, reversible contraception (LARCs):
• Does partner monitor menstruation?
• Can patient return to clinic for shots?
• IUD strings? Nexplanon?
Emergency Contraception:
• In an unidentifiable envelope
Health & Safety Issues to Consider
Long-lasting, reversible contraception (LARCs):
• Does partner monitor menstruation?
• Can patient return to clinic for shots?
• IUD strings? Nexplanon?
Emergency Contraception:
• In an unidentifiable envelope
STI treatment & partner notification:
• Ask if it’s safe to tell & treat partner
• Anonymous call from health dept. about “one of your partners in the
last few years”
• Safety plan around partner notification
• Identify safest treatment options
Health & Safety Issues to Consider
Long-lasting, reversible contraception (LARCs):
• Does partner monitor menstruation?
• Can patient return to clinic for shots?
• IUD strings? Nexplanon?
Emergency Contraception:
• In an unidentifiable envelope
STI treatment & partner notification:
• Ask if it’s safe to tell & treat partner
• Anonymous call from health dept. about “one of your partners in the
last few years”
• Safety plan around partner notification
• Identify safest treatment options
Is abuse affecting chronic conditions?
Is abusive partner denying patient medication or treatment?
Include needed treatments, medications, etc. in safety planning
Providing a warm referral
If it’s okay with you, we could use the phone here in the
clinic to call my colleague, [name] who is an expert in
helping people who are in difficult relationships. She can
help you think about and plan some ways to stay safe.
Would you like me to call her for you?
Photo: Laura Avellaneda-Cruz, ANTHC
Thank you
Quyana
Gunalchéesh
Háw’aa
Quyanaq
Taikuu
Mahsi' choo
Ana baasee'
Qaĝaasakung
Way dankoo
Laura Avellaneda-Cruz, LMSW
[email protected]
(907) 729-2489
www.anthctoday.org/epicenter/healthyfamilies
References (in order of use)
Chamberlain, L., & Levenson, R. (2013). Addressing Intimate Partner Violence, Reproductive and
Sexual Coercion: A Guide for Obstetric, Gynecologic, Reproductive Health Care Settings (3 rd Ed).
San Francisco: Futures Without Violence.
Miller, E., Levenson, R., Monasterio, E., & Duplessis, V. (2014). Hanging Out or Hooking Up: An
Integrated Approach to Prevention And Intervention. A Train the Trainers Curriculum On
Responding to Adolescent Relationship Abuse. San Francisco: Futures Without Violence.
Silverman JG, Raj A, Mucci LA, & Hathaway JE. (2001). Dating Violence Against Adolescent Girls
And Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy,
And Suicidality. JAMA. 286(5):572-579.
Miller, E., Decker, M., Raj A., Reed E., Marable, D., & Silverman, J.(2010). Intimate Partner
Violence And Health Care-Seeking Patterns Among Female Users Of Urban Adolescent Clinics.
Maternal Child Health Journal, 14:910–917
Ramachandran, S., Yonas, M. A., Silvestre, A. J., & Burke, J. G. (2010). Intimate Partner Violence
among HIV Positive Persons in an Urban Clinic.AIDS Care, 22(12), 1536–1543.
doi:10.1080/09540121.2010.482199
El‐Bassel, N., Gilbert, L., Wu, E., Chang, M., Gomes, C., Vinocur, D., & Spevack, T. (2007).
Intimate partner violence prevalence and HIV risks among women receiving care in emergency
departments: implications for IPV and HIV screening. Emergency Medicine Journal : EMJ, 24(4),
255–259. doi:10.1136/emj.2006.041541
References
Raiford, J., DiClemente, R., & Wingood, G. (2009). Effects of Fear of Abuse and Possible STI
Acquisition on the Sexual Behavior of Young African American Women. American Journal of Public
Health: 99(6), 1067-1071. doi 0.2105/AJPH.2007.131482
Wingood, G., DiClemente, R., McCree, D., Harrington, K, & Davies, S. (2001). Dating violence and
the sexual health of black adolescent females. Pediatrics. 107(5):E72.
Gielen, A., McDonnell, K., Burke, Jessica, & O’Campo, P. (2000). Women’s Lives After an HIVPositive Diagnosis: Disclosure and Violence. Maternal and Child Health Journal, 4(2).
Gielen, A., Ghandour, R., McDonnell, K., Burke, Jessica, & O’Campo, P. (2000). HIV/AIDS and
Intimate Partner Violence: Intersecting Women's Health Issues in the United States. Trauma,
Violence, Abuse, 8(2), 178-198. doi: 10.1177/1524838007301476
Lang, D., Salazar, L., Wingood, G., DiClemente, R., & Mikhail, I. (2007). Associations Between
Recent Gender-Based Violence and Pregnancy, Sexually Transmitted Infections, Condom Use
Practices, and Negotiation of Sexual Practices among HIV-Positive Women. Journal of Acquired
Immune Deficiency Syndrome. 1;46(2), 216-21.
Lichtenstein, B. (2006). Domestic violence in barriers to health care for HIV-positive women. AIDS,
Patient Care, STDS. 20(2), 122-32.