Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women

Conroy, Amy A.; Jain, Jennifer; Sheira, Lila A; Frongillo, Edward A.; Neilands, Torsten B.; Cohen, Mardge H.; Wilson, Tracey E.; Chandran, Aruna; Adimora, Adaora A.; Kassaye, Seble; Sheth, Anandi N.; Fischl, Margaret A.; Adedimeji, Adebola; Turan, Janet M.; Tien, Phyllis C.; Weiser, Sheri D.

doi:10.1097/qai.0000000000002848

Cited by 4 publications

(4 citation statements)

References 55 publications

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“…To test whether substance use mediated the association between GBV and suboptimal adherence and the association between GBV and poor engagement in care, we employed a mediation method previously used in the WIHS [19,35,36]. We fit a series of fully adjusted regression models to estimate the total effect of GBV on each outcome (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Among WLHIV in the US, 55% reported ever experiencing intimate partner violence, a common type of GBV, which is more than twice the rate among the general population of women in the US [17]. Further, a history of experiencing GBV and high levels of traumarelated sequelae such as posttraumatic stress disorder, depression, and anxiety are associated with poor HIV treatment and care outcomes, including suboptimal adherence to ART and viral nonsuppression among WLHIV in the US [18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States

Jain¹,

Sheira

Frongillo

et al. 2022

Aids

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Objective:To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US).Design:We analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS).Methods:From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (<95%) adherence and at least one missed HIV care appointment without rescheduling in the past 6 months. Mediation analyses were performed to test whether heavy drinking and illicit drug use mediated the associations between GBV and the two HIV outcomes.Results:The mean age was 47 (standard deviation = 9), 5% reported experiencing GBV, 17% reported suboptimal adherence and 15% reported at least one missed appointment in the past 6 months. Women who experienced GBV had a significantly higher odds of suboptimal adherence [adjusted odds ratio (aOR) = 1.99; 95% confidence interval (CI) = 1.40–2.83] and missed appointments (aOR = 1.92, 95% CI = 1.32–2.33). Heavy drinking and illicit drug use mediated 36 and 73% of the association between GBV and suboptimal adherence and 29 and 65% of the association between GBV and missed appointments, respectively.Conclusions:Substance use is an underlying mechanism through which GBV affects outcomes along the HIV care continuum among WLHIV in the US. To optimize HIV treatment and care among women, interventions should address the combined epidemics of substance use, violence, and HIV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States

Jain¹,

Sheira

Frongillo

et al. 2022

Aids

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“…Research that further delineates the mechanisms by which violence is associated with structural factors remains critical to inform development and implementation of programs and supports (Conroy et al, 2022). The lack of research with gender minority women living with HIV on violence and needed supports should be addressed, and programs should integrate gender-inclusive and gender-competent services for all cis and gender minority women living with HIV (Poteat et al, 2016).…”

Section: Study Implications and Recommendationsmentioning

confidence: 99%

“…TVI principles may be integrated into healthcare practices through curriculum, training, and continuing education; further research to understand how these skills may be applied and what impact this has on clinical care outcomes remains a priority (Desilets et al, 2020). Research that further delineates the mechanisms by which violence is associated with structural factors remains critical to inform development and implementation of programs and supports (Conroy et al, 2022). The lack of research with gender minority women living with HIV on violence and needed supports should be addressed, and programs should integrate gender-inclusive and gender-competent services for all cis and gender minority women living with HIV (Poteat et al, 2016).…”

Section: Study Implications and Recommendationsmentioning

confidence: 99%

Prevalence and Social-Structural Correlates of Gender-Based Violence Against Women Living With HIV in Metro Vancouver, Canada

Ohtsuka

Shannon

Zucchet

et al. 2022

J Interpers Violence

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Violence experienced by cisgender (cis) and gender minority women living with HIV is known to be high. More work is needed to better understand how to support women living with HIV who have experienced violence. The objectives of this study are therefore to identify the prevalence and correlates of violence by any perpetrator among women living with HIV in a Canadian setting. Data were drawn from 9 years (January, 2010 to February, 2019) of a longitudinal community-based open cohort study of 350+ cis and trans women living with HIV who were living and/or accessed care in Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment “SHAWNA”). Participants completed baseline and biannual follow-up interviews. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify correlates of recent (last 6 months) violence (physical and/or sexual) by any perpetrator. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CIs) are presented. At baseline, prevalence of violence was high: 95.5% (recent = 19.4%) of participants reported lifetime physical and/or sexual violence, 94.8% (recent = 17.9%) reported lifetime physical violence, and 84.5% (recent = 5.7%) reported lifetime sexual violence. In multivariable logistic regression with GEE, the following variables were associated with higher odds of recent physical/sexual violence: youth (<30 years) (AOR: 1.60, 95% CI [1.15, 2.22]), recent unstable housing/homelessness (AOR: 1.96, 95% CI [1.30, 2.97]), recent food insecurity (AOR: 1.57, 95% CI [1.13, 2.17]), recent incarceration (AOR: 1.85, 95% CI [1.18, 2.91]), recent opioid use (AOR: 1.38, 95% CI [1.04, 1.82]), recent stimulant use (AOR: 2.48, 95% CI [1.72, 3.56]), and lifetime HIV status disclosure without consent (AOR: 1.59, 95% CI [1.13, 2.24]). Trauma- and violence-informed (TVI) policies that include a focus on confidentiality and safe disclosure practices should be integrated into existing housing, incarceration, and harm reduction programs, and HIV care and practice for women living with HIV. Programs and policies that address high levels of violence remain critical.

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Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil

de Sousa Mascena Veras,

Menezes,

Mocello

et al. 2024

BMC Public Health

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Background Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. Methods A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. Results A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). Conclusion Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. Trial registration ClinicalTrials.gov Identifier: NCT03525340.

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Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women

Cited by 4 publications

References 55 publications

Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States

Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States

Prevalence and Social-Structural Correlates of Gender-Based Violence Against Women Living With HIV in Metro Vancouver, Canada

Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil

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