Mediators of the Relation Between Community Violence and Sexual Risk Behavior Among Adults Attending a Public Sexually Transmitted Infection Clinic

Abstract

Prior research shows that violence is associated with sexual risk behavior, but little is known about the relation between community violence (i.e., violence that is witnessed or experienced in one's neighborhood) and sexual risk behavior. To better understand contextual influences on HIV risk behavior, we asked 508 adult patients attending a publicly-funded STI clinic in the U.S. (54% male, Mage = 27.93, 68% African American) who were participating in a larger trial to complete a survey assessing exposure to community violence, sexual risk behavior, and potential mediators of the community violence-sexual risk behavior relation (i.e., mental health, substance use, and experiencing intimate partner violence). A separate sample of participants from the same trial completed measures of sexual behavior norms, which were aggregated to create measures of census tract sexual behavior norms. Data analyses controlling for socioeconomic status revealed that higher levels of community violence were associated with more sexual partners for men and with more episodes of unprotected sex with non-steady partners for women. For both men and women, substance use and mental health mediated the community violence-sexual risk behavior relation; in addition, for men only, experiencing intimate partner violence also mediated this relation. These results confirm that, for individuals living in communities with high levels of violence, sexual risk reduction interventions need to address intimate partner violence, substance use, and mental health to be optimally effective.

A need for trauma informed care in sexually transmitted disease clinics

“…Two studies in this review (Senn et al., 2016; Walsh et al., 2012) found participants who reported a history of CV, described as exposure to violence and/or crime in the participant's neighborhood, had higher rates of sexual behaviors, and reported history of STDs. Both studies used the City Stress Inventory (Ewart & Suchday, 2002) to measure incidence of CV.…”

“…Ten studies recruited only women. Three studies (Senn et al., 2006, 2010; Senn, Walsh, & Carey, 2016) recruited women and men. Study participants were recruited from STD clinics in cities from western (Bauer et al., 2002), southeastern (Raiford et al., 2009), and northeastern United States.…”

“…Study participants were recruited from STD clinics in cities from western (Bauer et al., 2002), southeastern (Raiford et al., 2009), and northeastern United States. Six studies (Mittal, Senn, & Carey, 2011, 2013; Senn et al, 2010; Senn, Carey, Vanable, Coury‐Doniger, & Urban, 2007; Senn et al., 2006; Senn et al, 2016) recruited participants from upstate New York STD clinics conducting ongoing randomized trials examining effectiveness of sexual risk reduction interventions.…”

“…Both studies used the City Stress Inventory (Ewart & Suchday, 2002) to measure incidence of CV. Participants who reported a history of CV reported greater numbers of lifetime sexual partners (Walsh et al., 2012) and greater numbers of sexual encounters without using condoms (Senn et al., 2016; Walsh et al., 2012). Mediating factors including mental health issues and alcohol or/or substance abuse, and a history of IPV were also higher among participants who reported a history of CV (Senn et al., 2016).…”

“…Education alone does not reduce STD risks (Raiford et al., 2009). Violence and co‐occurring health issues of alcohol and/or substance abuse, and poor mental health also contribute to increased sexual risk behaviors and must be addressed for effective STD prevention interventions (Senn et al., 2010, 2016).…”