Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics

Abstract

Background/Objectives Adolescent and young adult women are at high risk for both STI/HIV and intimate partner violence (IPV). We evaluate the prevalence of IPV in the past three months and its associations with STI/HIV risk, STI, and related care-seeking over the same time period. Methods Female family planning clinic patients ages 16–29 (n=3,504) participated in a cross-sectional survey in 2011–2012 as a baseline assessment for an intervention study. We examined associations of recent IPV with sexual and drug-related STI/HIV risk behavior, self-reported STI, and STI-related clinical care seeking via logistic regression. Results Recent physical or sexual IPV (prevalence 11%) was associated with recent sexual and drug-related STI/HIV risk, specifically unprotected vaginal sex (AOR 1.93, 95% CI 1.52, 2.44), unprotected anal sex (AOR 2.22, 95% CI 1.51, 3.27) and injection drug use, both their own (AOR 3.39, 95% CI 1.47, 7.79) and their partner’s (AOR 3.85, 1.91, 7.75). IPV was also linked with coercive sexual risk: involuntary condom non-use (AOR 1.87, 95% CI 1.51, 2.33), and fears of requesting condoms (AOR 4.15, 95% CI 2.73, 6.30) and refusing sex (AOR 11.84, 95% CI 7.59, 18.45). STI-related care-seeking was also more common among those abused (AOR 2.49, 95% CI 1.87, 3.31). Conclusions Recent IPV is concurrent with sexual and drug-related STI/HIV risk, including coercive sexual risk, thus compromising women’s agency in STI/HIV risk reduction. Clinical risk assessments should broaden to include unprotected heterosexual anal sex, coercive sexual risk, and IPV, and should promote safety and harm reduction.

Sexual and Reproductive Health Indicators and Intimate Partner Violence Victimization Among Female Family Planning Clinic Patients Who Have Sex with Women and Men

“…Research on IPV, reproductive coercion, and reproductive health has illustrated the ways in which partner-perpetrated physical and sexual violence and coercion impact women's ability to negotiate condom use. 7,40,41 In the current analysis, IPV was an important confounder of the relationship between sexual minority status and health, which further illustrates how powerful IPV can be for women's sexual and reproductive health, regardless of the sex of women's sexual partners. However, the impact of abuse on women's health did differ with respect to lifetime history of an STI diagnosis.…”

The Potential of Pre-Exposure Prophylaxis for Women in Violent Relationships

“…11 Women in violent relationships are also less likely than nonabused women to refuse sex or use condoms during intercourse. [12][13][14] Women's reluctance to use condoms may stem from fear of physical or sexual violence. 12 In addition, the psychological sequelae of partner violence (e.g., depression, suicidal ideation) as well as substance abuse, which is associated with IPV victimization, have been shown to increase sexual risk taking and thus contribute to HIV infection.…”

“…15 When the co-occurring substance use involves injection drug use, women may additionally be at risk of HIV through shared needles. Studies have demonstrated that women experiencing partner violence are more likely to inject drugs than women who do not experience partner violence, 14 and women who inject drugs are more likely to engage in sex with partners who inject drugs.…”

Factors Associated to a Reactive Result of Rapid-HIV Test in Socio-culturally Adapted Services in Primary Care in Spain

“…In relation with drugs use, a higher risk of STI/HIV has been described associated to substance use, and attributable to unsafe sexual behaviors [17,18]. Although this association has been clearly established in MSM [35,36], those assisted by the Services had sexual intercourses under the drugs effect less frequently than in other studies [15,18], with data even lower than MSW, and there was no association with the detection of reactive results.…”

“…Different factors have been associated to this higher risk, like having suffered previous STI [13,14], or the use of drugs before or during sexual intercourse [15,17,18]. Among MSM the role of serodiscordant relationships in newly acquiring infection is well-recognised [15,19], and persistent unprotected anal intercourse with occasional partners is predictor of seroconversion [20].…”