[Viva] Fwd: CATIE News - Implementing a screening program for domestic abuse

Fri Apr 17 06:32:33 PDT 2015

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From: CATIE <mailer at catie.ca>
Date: Thu, Apr 16, 2015 at 6:20 PM
Subject: CATIE News - Implementing a screening program for domestic abuse
To: dbecker106 at gmail.com

     CATIE News - Bite-sized HIV and hepatitis C news bulletins
       CATIE News - Implementing a screening program for domestic abuse

Thanks to the availability of potent combination anti-HIV therapy (commonly
called ART or HAART), many people with HIV are living longer in high-income
countries such as Canada. As a result, researchers in the HIV field are
able to explore a range of different issues in the lives of this
population. One such issue is intimate partner violence (IPV), which a team
of researchers in Calgary, Alberta, has defined as follows (based on a
report by the World Health Organization):

“Violence committed by a current or former intimate partner involving the
threat, attempt, or completion of physical, sexual or psychological
violence.” Included in this are issues such as “neglect, isolation,
intimidation and financial abuse.”

IPV is also known as interpersonal violence, battering or domestic abuse.
 IPV and its relation to health and HIV

IPV can have a broad range of negative effects on a person’s health and
quality of life.

The Calgary researchers state: “Not only are [people who experience] IPV
more vulnerable to acquiring HIV infection, but also the presence of IPV
negatively impacts their care by delaying access to [HIV] diagnosis and
subsequent engagement in care, missed clinical appointments, non-adherence
to antiretroviral therapy, increased hospitalizations, and [increasing the
risk for developing AIDS].”

This statement is based on findings from studies conducted in Alberta and
elsewhere.

The Calgary team notes that other researchers have found that “the presence
of HIV infection may increase the risk of subsequent IPV within a
relationship.” Therefore, they say that identifying HIV-positive people who
have experienced or are experiencing IPV “offers the potential for
mitigating its negative effects on both their general and HIV health.”
 Past and present

Several years ago the Southern Alberta Clinic (SAC) began implementing a
program to screen HIV-positive patients for IPV. The Calgary team recently
conducted a study to assess the program. They found that IPV was
common—overall, 35% of 1,721 participants disclosed this problem. However,
IPV was even more common among some subgroups. Researchers conducted
detailed interviews with a subset of 158 participants. This latter group
reported appreciation for the screening program and gave feedback that the
researchers used to make recommendations for other clinics implementing an
IPV screening program.
 Results

Of the 1,721 participants screened for IPV, a total of 605 (35%) reported
at least one of the following issues:

   - They were currently experiencing IPV.
   - They had experienced IPV in a previous relationship.
   - They had experienced abuse as a child.

 IPV and demographic information

Participants who were diagnosed with HIV when they were younger than 30
years old were more likely to disclose IPV than participants who were
diagnosed with HIV in their later years.

Other findings by the Calgary team included the following:

   - IPV was more common in women (46%) than in men (32%)
   - 67% of Aboriginal people reported experiences of IPV
   - participants whose risk factor for HIV infection was injecting street
   drugs were more likely to disclose IPV than participants whose HIV risk
   factor was condomless sex with men or condomless sex with men and women
   - bisexual men and women reported high rates of IPV (48%)
   - gay men reported more IPV (35%) than straight men (25%)
   - straight women reported high rates of IPV (44%)

 Findings from interviews

In June and July 2014, the research team interviewed 158 people—a subset of
the larger study of 1,721 participants—to hear their views about IPV
screening in the clinic. The main findings are as follows:

   - Prior to being a patient at the SAC, only 22% of participants had been
   screened about IPV. The Calgary team found this surprising, as they said
   that many participants belonged to “demographic groups well known to be at
   increased risk for IPV.”
   - The researchers reported that 73% of participants suggested that “IPV
   screening should be routinely discussed [as part of regular HIV care].”
   - However, 53% of participants said that routine screening for IPV
   should be delayed until after several clinic visits had occurred. This
   delay provided time for patients to develop a trusting relationship with
   clinic staff. This trusting relationship was revealed by both participants
   and researchers to be a critical factor for successful participation in IPV
   screening.
   - Participants did not express any clear preference for the type of
   specialist—doctor, nurse, social worker—who should perform IPV screening.
   - In general, participants did not express a preference for the gender
   of the healthcare worker who would perform IPV screening. However, the
   researchers stated that among those who did state a preference “most
   preferred females to ask questions.”
   - According to the researchers, about half of the participants
   recommended that “a clear and precise definition of IPV must be included in
   any questioning about partner violence.”
   - Participants felt that questions about IPV should be asked routinely
   in the clinic (41%) or every six months (31%).

 In context

The latest results from the Calgary researchers confirm their earlier
findings and conclusions—that “IPV is common, ongoing and a pervasive issue
across all of our different communities living with HIV in southern
Alberta.”

Furthermore, the researchers stated that “screening and providing proper
follow-up and referral for IPV can and should be incorporated effectively
in the HIV clinic setting.”
 Recommendations for clinics

Based on their experience of screening for IPV for at least five years in
southern Alberta, the researchers made the following recommendations for
other clinics that provide care for HIV-positive people:

   - IPV screening can and should be incorporated into regular HIV care.
   - A trusting relationship with the patient should be established prior
   to asking about IPV.
   - Any healthcare provider with an established trust relationship can
   enquire about IPV.
   - A clear and understandable definition of abuse must be included when
   asking about IPV.
   - A protocol and referral process must be in place for people who
   disclose IPV.
   - Patients disclosing abuse in a current relationship must have close
   follow-up and be asked about abuse at subsequent routine appointments.
   - All patients should be asked about their IPV status at least annually,
   even if they have not previously disclosed IPV.

 Although the present study was done in southern Alberta, IPV knows no
boundaries, so HIV clinics in other regions can hopefully learn from the
experience of the Calgary research team.

*—Sean R. Hosein*

REFERENCES:

   1. World Health Organization. Global and regional estimates of violence
   against women: Prevalence and health effects of intimate partner violence
   and non-partner sexual violence. *Report*. 2013. Available at:
   apps.who.int/iris/bitstream/10665/85239/1/9789241564625_eng.pdf
   2. Raissi SE, Krentz HB, Siemieniuk RA, et al. Implementing an intimate
   partner violence (IPV) screening protocol in HIV care. *AIDS Patient
   Care and STDs*. 2015 Mar;29(3):133-41.

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