Anu Manchikanti Gomez

Testing the Cycle of Violence Hypothesis: Child Abuse and Adolescent Dating Violence as Predictors of Intimate Partner Violence in Young Adulthood:

Child abuse is an important determinant of future violence perpetration and victimization. Past research examining linkages between child abuse and adult intimate partner violence (IPV) has predominantly focused on married individuals and not considered adolescent dating violence. In the present study, data from three waves of the National Longitudinal Study of Adolescent Health are used to examine the impact of child abuse and adolescent dating violence on the likelihood of IPV victimization and perpetration in young adulthood. Child abuse and adolescent dating violence are common in this study population and are highly predictive of IPV. In regression models stratified by gender, child abuse and adolescent dating violence are significant predictors of IPV victimization and perpetration for both men and women, but the magnitude of these associations differs by gender. Although gender differences exist, it appears that experiencing violence during childhood and/ or adolescence is highly predictive of IPV in young adulthood.Child abuse is an important determinant of future violence perpetration and victimization. Past research examining linkages between child abuse and adult intimate partner violence (IPV) has predominantly focused on married individuals and not considered adolescent dating violence. In the present study, data from three waves of the National Longitudinal Study of Adolescent Health are used to examine the impact of child abuse and adolescent dating violence on the likelihood of IPV victimization and perpetration in young adulthood. Child abuse and adolescent dating violence are common in this study population and are highly predictive of IPV. In regression models stratified by gender, child abuse and adolescent dating violence are significant predictors of IPV victimization and perpetration for both men and women, but the magnitude of these associations differs by gender. Although gender differences exist, it appears that experiencing violence during childhood and/ or adolescence is highly predictive of IPV in young adulthood.

Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods.

In recent years, enthusiasm about long-acting reversible contraceptive (LARC) methods has skyrocketed among U.S. reproductive health care providers because of these methods’ potential to budge the rate of unintended pregnancy, which “stubbornly” persists at the same level despite efforts over many years to reduce it.1 For too long, LARC methods—IUDs and implants—have not been an option that women could easily choose, because of a range of barriers: lack of knowledge,2 providers’ low familiarity and lack of training,3–5 cost6,7 and unavailability in clinics.8 While we strongly believe that these barriers should be reduced so that LARC methods are an integral part of a comprehensive method mix, we also are concerned that unchecked enthusiasm for them can lead to the adoption of programs that, paradoxically, undermine women’s reproductive autonomy. Our concern is that when efforts move beyond ensuring access for all women to promoting use among “high-risk” populations through programs and contraceptive counseling aimed at increasing uptake of LARC methods, the effect is that the most vulnerable women may have their options restricted. To avoid this pitfall, it is vital that programs designed to promote LARC methods put the priorities, needs and preferences of individual women—not the promotion of specific technologies—first. While the possibility that LARC promotion efforts can undermine reproductive autonomy may seem remote in the face of the myriad barriers women face in using these methods, we believe that now is a pivotal time to engage in a critical discussion of this topic, given that use of LARC methods is on the rise,9 new clinical models are showing success in reducing and eliminating barriers to using them10,11 and many women have newfound access to contraceptives thanks to provisions of the Affordable Care Act.12 Such a discussion may illuminate the ways in which narrowing the scope of possibilities for family planning program innovation to promoting a particular class of technologies allows the widespread social inequalities that underlie unintended pregnancy to become invisible. It also may show how prioritizing method effectiveness above other contraceptive features may deny some women reproductive control.

Relationship dynamics as predictors of broken agreements about outside sexual partners: Implications for HIV prevention among gay couples

Agreements about sex with outside partners are common among gay couples, and breaks in these agreements can be indicative of HIV risk. Using longitudinal survey data from both partners in 263 HIV-negative and -discordant gay couples, we investigate whether relationship dynamics are associated with broken agreements. Twenty-three percent of respondents reported broken agreements. Partners with higher levels of trust, communication, commitment, and social support were significantly less likely to report breaking their agreement. Promoting positive relationship dynamics as part of HIV prevention interventions for gay couples provides the opportunity to minimize the occurrence of broken agreements and, ultimately, reduce HIV risk.

Factors Associated with the Prevalence and Incidence of Trichomonas vaginalis Infection among African American Women in New York City Who Use Drugs

BACKGROUND Trichomoniasis vaginalis, the most prevalent nonviral sexually transmitted infection, is associated with negative reproductive outcomes and increased HIV transmission and may be overrepresented among African Americans. METHODS A total of 135 African American women who used drugs were screened for Trichomonas vaginalis on > or =2 occasions between March 2003 and August 2005. Women were administered a structured questionnaire in a community-based research center, underwent serological testing for human immunodeficiency virus and herpes simplex virus type 2, and were screened for Neisseria gonorrhoeae and Chlamydia trachomatis. RESULTS Fifty-one women (38%) screened positive for T. vaginalis at baseline. Twenty-nine (31%) of 95 women with negative results of baseline tests became infected, for an incidence of 35.1 cases per 100 person-years at risk (95% confidence interval [CI], 23.5-49.0). Prevalent infection was associated with drug use in the past 30 days, and incident infection was associated with sexual behavior in the past 30 days, namely having >1 male sex partner. Women who reported having >1 partner were 4 times as likely as women with fewer partners to acquire T. vaginalis (hazard ratio, 4.3; 95% CI, 2.0-9.4). CONCLUSION T. vaginalis may be endemic in this community of African American women. A control strategy that includes T. vaginalis screening in nonclinical settings and rapid point-of-care testing could contribute to the disruption of transmission of this pathogen.

Linkages Between Gender Equity and Intimate Partner Violence Among Urban Brazilian Youth

PURPOSE Gender inequity is a risk factor for intimate partner violence (IPV), although there is little research on this relationship that focuses on youth or males. Using survey data collected from 240 male and 198 female youth aged 15-24 in Rio de Janeiro, Brazil, we explore the association between individual-level support for gender equity and IPV experiences in the past 6 months and describe responses to and motivations for IPV. METHODS Factor analysis was used to construct gender equity scales for males and females. Logistic and multinomial logistic regression models were used to examine the relationship between gender equity and IPV. RESULTS About half of female youth reported some form of recent IPV, including any victimization (32%), any perpetration (40%), and both victimization and perpetration (22%). A total of 18% of male youth reported recently perpetrating IPV. In logistic regression models, support for gender equity had a protective effect against any female IPV victimization and any male IPV perpetration and was not associated with female IPV perpetration. Female victims reported leaving the abusive partner, but later returning to him as the most frequent response to IPV. Male perpetrators said the most common response of their victims was to retaliate with violence. Jealousy was the most frequently reported motivation of females perpetrating IPV. CONCLUSION Gender equity is an important predictor of IPV among youth. Examining the gendered context of IPV will be useful in the development of targeted interventions to promote gender equity and healthy relationships and to help reduce IPV among youth.

The relationship between contraceptive features preferred by young women and interest in IUDs: An exploratory analysis

CONTEXT Little research has examined the relationship between womens preferences of contraceptive features and their interest in IUD use. Given high levels of contraceptive discontinuation and dissatisfaction, a better understanding of contraceptive preferences may support women in finding their optimal method and meeting their family planning goals. METHODS Data from 382 heterosexual women aged 18-29 were collected via a 2012 Internet survey. Chi-square tests and multivariate, multinomial logistic regression models were used to examine relationships between contraceptive features preferred by women and their interest in IUD use. RESULTS Forty-eight percent of women reported being unsure whether they would ever use an IUD; 20% were interested in using one, and 32% were not. In multivariate analyses, characteristics of a contraceptive method found positively associated with IUD interest were the methods not interfering with sexual pleasure (relative risk ratio, 3.4), being 99% effective without user action (2.5) and being effective for up to five years without any user action (3.8). Women who preferred a method that they could see or that would allow them to resume fertility immediately after discontinuation were less likely than those who did not to be interested in using rather than not using an IUD (0.4-0.5). CONCLUSIONS The findings of this exploratory analysis indicate that women value a multitude of contraceptive features, which may have implications for their interest in using an IUD. Future research should consider the ways that womens contraceptive preferences can be incorporated into contraceptive counseling.

Sexual Violence and Reproductive Health Among Youth in Port-au-Prince, Haiti

We examine sexual violence and reproductive health outcomes among sexually experienced youth in Port-au-Prince, Haiti, using the Priorities for Local AIDS Control methodology to identify participants in locations where sexual partnerships are formed. Our findings indicated that sexual violence is common and is significantly associated with condom use, pregnancy experience, and recent sexually transmitted infection symptoms.

Age differences at sexual debut and subsequent reproductive health: Is there a link?

BackgroundExperiences at sexual debut may be linked to reproductive health later in life. Additionally, young women with older sexual partners may be at greater risk for HIV and sexually transmitted infections. This study examines sexual debut with an older partner and subsequent reproductive health outcomes among 599 sexually experienced women aged 15–24 who utilized voluntary counseling and testing or reproductive health services in Port-au-Prince, Haiti.MethodsLogistic regression models, controlling for socioeconomic and demographic factors, examined whether age differences at first sex were significantly associated with STI diagnosis in the previous 12 months and family planning method use at last intercourse.ResultsSixty-five percent of women reported sexual initiation with a partner younger or less than 5 years older, 28% with a partner 5 to 10 years older, and 7% with a partner 10 or more years older. There was a trend towards decreased likelihood of recent use of family planning methods in women who had first sexual intercourse with a partner 5 to 9 years older compared to women with partners who were younger or less than 5 years older. Age differences were not linked to recent STI diagnosis.ConclusionPrograms focusing on delaying sexual debut should consider age and gender-based power differentials between younger women and older men. Future research should examine whether wide age differences at sexual debut are predictive of continued involvement in cross-generational relationships and risky sexual behaviors and explore the mechanisms by which cross-generational first sex and subsequent reproductive health may be connected.

Intersections Between Childhood Abuse and Adult Intimate Partner Violence Among Ecuadorian Women

Objectives Strong linkages exist between childhood abuse and adult intimate partner violence (IPV) among women in developed countries. Few studies examine this pattern in developing nations. This study explores the effect of childhood physical and/or psychological abuse on the likelihood of IPV among a national sample of Ecuadorian women of reproductive age. Methods Secondary data analysis was conducted on a subsample of 9,077 Ecuadorian women, utilizing the 2004 Encuesta Demografía y de Salud Materna e Infantil survey. Cross-tabulations and multivariate logistic regression models were utilized to assess whether women who report childhood abuse had a higher likelihood of reporting sexual, physical or psychological IPV during their lifetimes or within the past year. Results Levels of abuse were high. More than 30% of women reported childhood psychological or physical abuse, and 21% experienced both types of abuse. Forty percent of women reported sexual, physical or psychological IPV during their lifetimes, while 15% reported any form of IPV in the past year. The co-occurrence of childhood psychological and physical abuse was highly predictive of all forms of IPV, with less consistent associations for women who reported only physical or only psychological childhood abuse. Conclusions This study suggests that childhood abuse is an important risk factor for IPV victimization among Ecuadorian women. While this analysis supports findings from developed countries, more cross-cultural research about patterns of violence throughout the life course is needed to develop relevant prevention programs.

Sexual Violence as a Predictor of Unintended Pregnancy, Contraceptive Use, and Unmet Need Among Female Youth in Colombia

AIMS Violence against women is an important risk factor for unintended pregnancy and contraceptive use, although less is known about this relationship among youth. This study aims to investigate linkages between sexual violence and unintended pregnancy among Colombian female youth (aged 13-24). METHODS Using the nationally representative Colombian Demographic and Health Survey (2005), the association of sexual violence with unintended pregnancy, current modern contraceptive use, and unmet need for contraception is examined using Pearsons chi-square tests and logistic regression models. RESULTS Of female youth who have been pregnant in the past 5 years, 13% report experiencing sexual violence during their lifetimes, with 6% reporting sexual violence perpetrated by a spouse or partner and 8% by someone else. Among female youth at risk of unintended pregnancy, sexual violence is reported by 11%. About 5% of these female youth report sexual violence from a spouse or partner, and 7% report being forced to have sex with someone else. In cross-tabulations, female youth who have experienced sexual violence report significantly higher levels of unintended pregnancy and unmet need for contraception and lower levels of current modern contraceptive use compared to those who have not experienced sexual violence. In multivariate logistic regression models, sexual violence is associated with increased risk for unintended pregnancy (adjusted odds ratio [AOR] 1.4, 95% confidence interval [CI] 1.1-1.8), unmet need for contraception (AOR 1.5, 95% CI 1.1-2.0), and decreased likelihood of current contraceptive use (AOR 0.8, 95% CI 0.6-1.0). CONCLUSIONS This analysis indicates that sexual violence is pervasive in Colombia and is consistently linked to increased risk of unintended pregnancy among female youth. Because youth are particularly vulnerable to sexual violence and may have difficulty accessing services, preventive efforts and clinical responses should be specifically crafted to curb violence against young women as well as reduce the longitudinal impact of experiencing sexual violence.