[Viva] Fwd: CATIE News - Domestic violence against HIV-positive women and its impact on their health

Tue Sep 3 20:26:45 PDT 2013

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From: CATIE <mailer at newsletter.catie.ca>
Date: Tue, Sep 3, 2013 at 2:30 PM
Subject: CATIE News - Domestic violence against HIV-positive women and its
impact on their health
To: dbecker106 at gmail.com

**
    CATIE News - Bite-sized HIV/AIDS news bulletins
       CATIE News - Domestic violence against HIV-positive women and its
impact on their health

Several terms are used by researchers who study violence against women
committed by men who are their partners. Examples of such terms include the
following:

   - domestic violence
   - gender-based violence
   - intimate partner violence (IPV)

 The United States Institute of Medicine (IOM) now recommends that
healthcare professionals screen and counsel all women for IPV.

Past research in sub-Saharan Africa, India and the U.S. has found that IPV
is a risk factor for women acquiring HIV. However, little research has been
done to explore the impact of IPV on the health of HIV-positive women.

Now researchers in Calgary, Alberta, have conducted a study to assess the
presence of IPV among HIV-positive women as well as its impact on their
health. Their findings are distressing—IPV is common, reported by 40% of
HIV-positive women in the region’s major clinic. Furthermore, HIV-positive
women who disclosed IPV had worse health and quality of life compared to
other HIV-positive women who did not report IPV. Indeed, HIV-positive women
who reported IPV were more likely to have been hospitalized even after
initiating care for HIV.

The present study has uncovered a high rate of IPV among HIV-positive women
and documented a link to increased hospitalization in affected women.
Hospital stays arising from any cause, including IPV, are costly for the
healthcare system. These factors should encourage policy planners and
regional health departments to intensify programs to help prevent IPV and
treat women, particularly those with HIV, affected by abuse. By building a
trusting relationship with HIV-positive women, healthcare providers can
help engage these women into care and improve the women’s overall health
and well-being.
 Study details

The Alberta research team noted that there are several types of abuse that
can be directed at people, including the following:

   - physical abuse
   - sexual abuse
   - emotional abuse
   - financial abuse
   - isolation
   - neglect
   - intimidation

 As part of their study, the research team screened HIV-positive women for
these types of abuse during the course of routine clinic visits between May
2009 and Jan 2012. Any woman who disclosed abuse was offered further care
with a social worker who had expertise dealing with IPV among HIV-positive
people.
 Results

Nearly 80% (339 women) of women receiving HIV care in Southern Alberta were
screened for abuse during the study. The main findings were as follows:

   - 40% (137) of women reported a history of IPV
   - among the 137 women who disclosed a history of abuse, 20% reported
   that abuse occurred in their current relationship
   - 8% (11) of women who experienced abuse disclosed that abuse occurred
   both in their past and current relationships
   - 22% of the 137 women who reported a history of IPV also disclosed a
   history of childhood abuse

 Common forms of abuse included the following:

   - emotional
   - physical
   - sexual

 However, the researchers stated that most women (72%) disclosed that they
“experienced multiple types of abuse."
 Race and ethnicity

The research team found that Aboriginal and white women reported high rates
of IPV as follows:

   - Aboriginal women – 65%
   - white women – 61%

 In contrast, black women, most of whom were immigrants from sub-Saharan
Africa, reported a lower rate of IPV (22%).
 IPV, substance use and imprisonment

The researchers found that women who had a history of IPV were
significantly more likely to do the following:

   - use street drugs
   - use tobacco or have a history of smoking

 The research team found that IPV did not predict the “excessive” use of
alcohol.

The study was mostly cross-sectional in nature; this is akin to taking a
snapshot of a group of people at one time and studying the data captured,
rather than conducting a longer and more expensive study that monitors
participants for many years. As a result of the nature of the study, the
timing of substance use in relation to abuse is not clear. However, it is
likely that substance use occurred after IPV as women sought temporary
refuge from the psychological burden imposed by abuse.

The researchers found it noteworthy that 19 out of 25 women who had a
history of being imprisoned reported IPV.
 Mental health

In reviewing the medical records of the women in the study, researchers
found that women who experienced IPV had high rates of depression prior to
their HIV diagnosis. In general, the intensity of depression was severe and
many affected women required prescription medicines to cope.

Women who had IPV also had an increased risk for previously being diagnosed
with an anxiety-related disorder. Furthermore, women with IPV were more
likely to have attempted to commit suicide before having been diagnosed
with HIV.
 Quality of life

Women who reported IPV had greatly reduced health-related quality of life.
 General health

Women who disclosed IPV were generally diagnosed with HIV relatively early
in the course of infection, with CD4+ counts greater than 500 cells. Also,
women who disclosed IPV were less likely to use antiretroviral therapy
(commonly called ART or HAART); if they did use it, they did so
irregularly. Moreover, women who experienced IPV found it difficult to stay
engaged with regular clinic visits and other care. Over the long term, such
interruptions in care could affect their survival.

Rates of hospitalization were greater for women with IPV than women who did
not have IPV.
 Key findings

The Alberta study has found a high overall rate—40%—of IPV among
HIV-positive women. According to the researchers, it is possible that the
actual rate of IPV is even greater: “Many women experiencing IPV do not
interpret their experiences as IPV, often minimizing the situation.”

The researchers also found that substance use and a history of smoking were
relatively common among women who disclosed IPV. They stated that “helping
patients address IPV in a constructive manner may also [reduce the illness
and death that can arise from] substance use and smoking.”

Another finding noted by researchers was that women who faced IPV
“experience multiple barriers to care, such as the immediate threats to the
safety of themselves and their dependents, which in turn requires less
imminent threats, such as HIV infection, to fall in priority.”

The researchers stated that many women “may also experience IPV as a
consequence of HIV infection and its disclosure [to their partner]. As
such, these women may be risking violent repercussions by engaging in care.
Our study supports this [idea], as women who experienced IPV found it more
difficult to remain engaged in HIV care.”

In this context it is not surprising that many women with IPV had poor
health and quality of life, in part due to severe stress and no or
intermittent use of ART. So the Alberta team proposes that by “directly
addressing IPV, we may support adherence to care and thereby improve [their
health and well-being].”
 Advice for care teams

Women who disclosed IPV were less likely to be using ART; this may have at
least partially accounted for their increased risk for hospitalization.
Therefore, the researchers encourage medical and social teams caring for
HIV-positive women to help develop safe and trustworthy relationships so
that care teams can address IPV and its psychological consequences. As a
result, affected women should improve psychologically and be able to take
ART exactly as directed, which would lead to them experiencing better
health and quality of life. Physicians, nurses, pharmacists and other
healthcare providers can begin to help women with IPV by “appropriate
referrals to specialized agencies and other health professionals” who are
trained and experienced in dealing with IPV.

The Alberta study is a good first step in tackling the horror of IPV among
HIV-positive women. Further research is needed to study the long-term
outcomes on the health of affected HIV-positive women who have been able to
disclose and escape IPV. As well, more effort needs to be made by regional
health authorities everywhere to educate and screen all women about IPV.

*—Sean R. Hosein*

REFERENCES:

   1. Siemieniuk RA, Krentz HB, Miller P, et al. The clinical implications
   of high rates of intimate partner violence against HIV-positive
women. *Journal
   of Acquired Immune Deficiency Syndromes*. 2013 Sep 1;64(1):32-8.
   2. Siemieniuk RA, Krentz HB, Gill MJ. Intimate partner violence and HIV:
   a review. *Current HIV/AIDS Reports.* 2013; *in press*.

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