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

Abstract

Intimate partner violence (IPV) is a risk factor for HIV infection. Little is known, however, about the prevalence, clinical associations, and impact of IPV among patients living with HIV. MethodsHIV-infected gay and bisexual men in Southern Alberta, Canada were screened for IPV between May 2009 and December 2011. The associations with IPV of sociodemographic factors, psychological factors, clinical status, and HIV-related and HIV-unrelated hospitalizations, data for which were obtained from a regional database, were evaluated using Poisson regression. ResultsOf 687 gay and bisexual patients, 22.4% had experienced one or several types of IPV. Patients disclosing IPV were more likely to be Aboriginal [adjusted prevalence ratio (APR) = 2.48; 95% confidence interval (CI) 1. 18-5.20], to be younger (APR/year = 0.97; 95% CI 0.95-0.99), to be victims of childhood abuse (APR = 4.27; 95% CI 2.84-6.41), to be smokers (APR = 2.53; 95% CI 1.59-4.00), to have had depression prior to HIV diagnosis (APR = 1.87; 95% CI 1.10-3.16), to use ongoing psychiatric resources (APR = 3.53; 95% CI 2.05-6.10), to have recently participated in unprotected sex (APR = 2.29; 95% CI 1.10-4.77), and to have poor or fair vs. very good or excellent health-related quality of life (APR = 2.91; 95% CI 1.57-5.39). IPV was also associated with a higher rate of clinically relevant interruptions in care (APR = 1.95; 95% CI 1.23-3.08), a higher incidence of AIDS among patients presenting early to care (CD4 count Ն 200 cells/mL; APR = 2.06; 95% CI 1. 15-3.69), and an increased rate of HIV-related hospitalizations [relative risk (RR) = 1.55; 95% CI 0.99-2.33], especially after HIV diagnosis was established (RR = 2.46; 95% CI 1.51-3.99). ConclusionsThe prevalence of IPV is high among HIV-infected gay and bisexual men and is associated with poor social, psychiatric, and medical outcomes. IPV is an under-recognized social determinant of health in this community that may be amenable to meaningful clinical interventions. [6,7]. IPV is a subset of domestic violence (DV; also known as 'family violence') and is defined as behaviour in an intimate relationship causing physical, psychological or sexual harm [8]. Manifestations of IPV include physical, sexual, emotional and financial abuse, in addition to isolation, neglect and intimidation. Screening for IPV among women is endorsed by the US Preventative Task Force, the Institute of Medicine, and professional organizations and may reduce IPV and improve outcomes in some populations [9]. Standardized screening is important because healthcare providers often fail to identify patients at risk of IPV and to discuss IPV appropriately when risk is identified [10].Interactions between IPV and HIV infection have usually been studied within the context of violence against women [1][2][3]11]. Among women, IPV can lead to HIV infection directly through forced sexual contact (rape) and reduced ability to negotiate safe sexual practices [3] The popular feminist theory of abuse (male perpetrators and female victims) by definiti...

Implementing an Intimate Partner Violence (IPV) Screening Protocol in HIV Care

“…[23][24][25][26][27] Not only are victims of IPV more vulnerable to acquiring HIV infection, but also the presence of IPV negatively impacts their HIV care by delaying access to diagnosis and subsequent engagement in care, missed clinical appointments, non-adherence to antiretroviral therapy, increased all cause hospitalizations, and progression to AIDS. [28][29][30][31] The presence of HIV infection may increase the risk of subsequent IPV within a relationship. 32,33 Identifying HIV patients, who have suffered or are suffering from the effects of IPV, offers the potential for mitigating its negative effects on both their general as well as HIV health.…”

“…Past research on IPV and HIV infection has primarily focused on understanding the synergistic interactions between violence and HIV, 34 determining the prevalence of IPV within different populations, 28,29,[35][36][37][38][39] expanding HIV prevention services to address IPV education, 40 and expanding IPV prevention services to address STI/HIV education. [41][42][43][44] However, the best practices for implementing a continuous universal IPV screening protocol within a HIV clinical care setting has not yet been fully developed.…”

History of Traumatic Events in HIV-Positive Individuals: Risk Behavior Implications in an Urban Clinic Setting

“…HIV-positive gay men in violent relationships had higher rates of HIV-related hospitalizations and lower CD4 counts than did who were not in violent relationships (Siemieniuk, Miller, Woodman, Ko, Krentz, & Gill, 2013). A history of interpersonal violence in men who have sex with men is associated with depression, substance abuse, unprotected anal sex, and an increased chance of HIV infection (Buller, Devries, Howard, & Bacchus, 2014).…”

Aborder les vecteurs sociaux et structurels du VIH au Canada

“…Les autres provinces ont également constaté que ces facteurs complexes ont une incidence sur les résultats en matière de santé. Par exemple, le Southern Alberta HIV Program a constaté une prévalence élevée de violence familiale et conjugale à l'échelle de tous les groupes à risque d'infection par le VIH, y compris les HARSAH, et a consigné ses effets négatifs sur la participation aux soins liés au VIH, la santé mentale et la stabilité sociale (9,10).…”