Intimate Partner Violence: A Predictor of Worse HIV Outcomes and Engagement in Care

Abstract

For HIV-infected patients, experiencing multiple traumas is associated with AIDS-related and all-cause mortality, increased opportunistic infections, progression to AIDS, and decreased adherence to therapy. The impact of intimate partner violence (IPV) on adherence and HIV outcomes is unknown. HIV-infected patients recruited from a public HIV clinic participated in this observational cohort study (n = 251). Participants completed interviews evaluating IPV and covariates. CD4 count < 200 (CD4 < 200), detectable HIV viral load (VL), and engagement in care (''no show rate'' [NSR]) were the outcomes of interest. Medication adherence was not measured. Univariate and multivariate regression analyses were performed with covariates included if p < 0.3 in the univariate phase. Seventy-four percent of the participants were male, 55% Caucasian, and 52.2% selfidentified as ''men who have sex with men.'' IPV prevalence was 33.1% with no difference by gender or sexual orientation. In univariate analysis, IPV exposure predicted having a CD4 < 200 ( p = 0.005) and a detectable VL ( p = 0.04) but trended toward significance with a high NSR ( p = 0.077). Being threatened by a partner was associated with a CD4 < 200 ( p = 0.005), a detectable VL ( p = 0.011), and high NSR ( p = 0.019) in univariate analysis. In multivariate analysis, IPV predicted having a CD4 < 200 ( p = 0.005) and detectable VL ( p = 0.035). Being threatened by a partner predicted having a CD4 < 200 ( p = 0.020), a detectable VL ( p = 0.007), and a high NSR ( p = 0.020). Our results suggest IPV impacts biologic outcomes and engagement in care for HIV-infected patients. IPV alone predicts worse biologic outcomes, whereas the specific experience of being threatened by a partner was associated with all three outcomes in univariate and multivariate analyses.

Prevalence, clinical associations, and impact of intimate partner violence among HIV‐infected gay and bisexual men: a population‐based study

“…We wished to determine whether IPV, as a possible social determinant of health in HIV-infected individuals, had a measurable impact on the standard parameters of health used in HIV care. Although we did not find significant cross-sectional differences in viral load or CD4 count, as recently reported in a clinic study [36], progression of HIV disease to an AIDS-defining illness is probably of greater clinical importance. We found that the victims of IPV who presented early enough to avoid most AIDSdefining illnesses with appropriate care (CD4 Ն 200 cells/ mL) were still twice as likely to progress to AIDS, even after adjusting for confounders, when compared with patients who had not experienced IPV.…”

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

“…Previous research has found that intimate partner violence is associated with missed HIV appointments. 82 Financial difficulties were highlighted as one of the key barriers to attendance. Other barriers, including lack of child care and work responsibilities, were often raised and, although the effects of homelessness or immigration issues were less prevalent, they had a clear and direct impact on EIC for some people.…”

Strategies and Outcomes of HIV Status Disclosure in HIV-Positive Young Women with Abuse Histories

“…[1][2][3] HIV-positive women with childhood abuse histories, including both physical and sexual abuse in childhood, have been identified as a particularly vulnerable population, with higher rates of unprotected sex, greater numbers of partners, and additional health risk behaviors, such as substance use, and poorer adherence than their counterparts without abuse histories. [4][5][6][7][8][9] One potentially relevant mechanism linking abuse and engagement in unprotected sex is disclosure of HIV status. Women with childhood abuse histories report less assertive behavior, greater interpersonal distress, increased shame, and more difficulty with interpersonal communication.…”