Elwin Wu

The Efficacy of a Relationship-Based HIV/STD Prevention Program for Heterosexual Couples

OBJECTIVES This study examined the efficacy of a relationship-based HIV/sexually transmitted disease prevention program for heterosexual couples and whether it is more effective when delivered to the couple or to the woman alone. METHODS Couples (n = 217) were recruited and randomized to (1) 6 sessions provided to couples together (n = 81), (2) the same intervention provided to the woman alone (n = 73), or (3) a 1-session control condition provided to the woman alone (n = 63). RESULTS The intervention was effective in reducing the proportion of unprotected and increasing the proportion of protected sexual acts. No significant differences in effects were observed between couples receiving the intervention together and those in which the woman received it alone. CONCLUSIONS This study demonstrates the efficacy of a relationship-based prevention program for couples at risk for HIV infection.

Relationship Between Drug Abuse and Intimate Partner Violence: A Longitudinal Study Among Women Receiving Methadone

OBJECTIVES We examined whether frequent drug use increases the likelihood of subsequent sexual or physical intimate partner violence (IPV) and whether IPV increases the likelihood of subsequent frequent drug use. METHODS A random sample of 416 women on methadone was assessed at baseline (wave 1) and at 6 months (wave 2), and 12 months (wave 3) following the initial assessment. Propensity score matching and multiple logistic regression were employed. RESULTS Women who reported frequent crack use at wave 2 were more likely than non-drug using women to report IPV at wave 3 (odds ratio [OR]=4.4; 95% confidence interval [CI]=2.1, 9.1; P<.01), and frequent marijuana users at wave 2 were more likely than non-drug users to report IPV at wave 3 (OR=4.5; 95% CI=2.4, 8.4; P<.01). In addition, women who reported IPV at wave 2 were more likely than women who did not report IPV to indicate frequent heroin use at wave 3 (OR=2.7; 95% CI=1.1, 6.5; P=.04). CONCLUSIONS Our findings suggest that the relationship between frequent drug use and IPV is bidirectional and varies by type of drug.

Intimate partner violence and HIV risk among urban minority women in primary health care settings

This study describes the associations between intimate partner violence (IPV) and HIV risk among urban, predominantly minority women. Interviews were conducted with 1,590 women, predominantly African American and Latina, attending hospital-based health care clinics. Approximately 1 in 5 women reported experiencing IPV in their current primary heterosexual relationships; about 1 in 8 women reported experiencing IPV in the preceding 6 months. Compared to women who reported no IPV in their primary relationships, women reporting past or current IPV perpetrated by their primary partners were more likely to report having multiple sexual partners, a past or current sexually transmitted infection (STI), inconsistent use or nonuse of condoms, and a partner with known HIV risk factors. These findings indicate that urban minority women experiencing IPV are at elevated risk for HIV infection, results that carry important implications in the efforts to improve HIV and IPV risk assessment protocols and intervention/prevention strategies for women in primary health care settings.

Long-Term Effects of an HIV/STI Sexual Risk Reduction Intervention for Heterosexual Couples

This randomized clinical trial examined the relative efficacy of a relationship-based HIV/STI prevention intervention for women and their regular male sexual partners at 12 months post-intervention. A total of 217 couples were randomized to (1) a six-session intervention provided to the woman and her sexual partner together (n = 81); (2) the same intervention provided to the woman alone (n = 73); or (3) a one-session health information education “control” provided to the woman alone (n = 63). Findings suggest the intervention was efficacious in reducing unprotected sex at 12 months post-intervention, compared with the education control group. No significant differences were observed when comparing whether couples received the intervention together or when the woman received it alone.

Intimate partner violence and substance abuse among minority women receiving care from an inner-city emergency department

UNLABELLED A womans drug and alcohol use has been found to increase her risk of experiencing intimate partner violence (IPV). OBJECTIVE The study describes the rates of lifetime and current IPV among women awaiting care in an emergency department and explores the association between IPV and having a drug abuse problem, and IPV and having an alcohol abuse problem, after controlling for demographic factors and history of childhood victimization. METHODS Face-to-face interviews were conducted with 143 low-level triaged women recruited from an inner-city emergency department. RESULTS Nearly one-half reported ever experiencing IPV, and over 18% reported IPV during the year before the interview. A higher proportion of abused women reported a history of regular crack, cocaine, or heroin use and visiting shooting galleries or crack houses. Participants who were physically abused by their partner during the past year (15%, n = 21) were more likely than nonabused women (85%, n = 122) to report higher scores on the Alcohol Use Disorders Identification Test (AUDIT) (4.9 vs. 2.4), a measure of alcohol-related problems, and the Drug Abuse Severity Test (DAST) (3.0 vs. 1.3), a measure of drug-related problems. Sexually abused women (6%, n = 9) were more likely than their counterparts (94%, n = 134) to have significantly higher AUDIT scores (6.4 vs. 2.5). The findings have implications for how the intersecting public health problems of IPV and substance abuse should be taken into consideration in research and patient care protocols in emergency departments.

Intimate Partner Violence and HIV Among Drug-Involved Women: Contexts Linking These Two Epidemics—Challenges and Implications for Prevention and Treatment

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Couple-based HIV prevention in the United States: advantages, gaps, and future directions.

This article presents an overview of couple-based HIV prevention research to date, advantages of using and core components of couple-based interventions, gaps in the current understanding of couple-based HIV prevention, status of dissemination research and the transportability of effective couple-based HIV prevention and treatment to real-world settings, and recommendations for future directions in couple-based prevention and treatment. Couple-based studies conducted among several populations-heterosexuals, men who have sex with men, and drug users-reported in the research literature were reviewed. Commonalities and limitations were noted in customary focus areas of the couple-based approaches: sexual and drug risk reduction, HIV testing behaviors, adherence to HIV treatment, and prevention of mother-to-child transmission. Couple-based intervention strategies have been rigorously tested and are a valuable addition to the arsenal of HIV prevention strategies. Immediate needs and opportunities include couple-based intervention strategies for prevention of HIV and other sexually transmitted infections among serodiscordant couples, couples who do not know their HIV status, and couples in whom both partners are HIV negative but at risk of HIV infection. There is a particular need to develop couple-based intervention strategies for men who have sex with men and for drug-involved couples.

Still a hard-to-reach population? Using social media to recruit latino gay couples for an HIV intervention adaptation study

Background Online social networking use has increased rapidly among African American and Latino men who have sex with men (MSM), making it important to understand how these technologies can be used to reach, retain, and maintain individuals in care and promote health wellness. In particular, the Internet is increasingly recognized as a platform for health communication and education. However, little is known about how primarily Spanish-speaking populations use and engage with each other through social media platforms. Objective We aimed to recruit eligible couples for a study to adapt “Connect ‘n Unite” (an HIV prevention intervention initially created for black gay couples) for Spanish-speaking Latino gay couples living in New York City. Methods In order to successfully design and implement an effective social media recruitment campaign to reach Spanish-speaking Latino gay couples for our ongoing “Latinos en Pareja” study, our community stakeholders and research team used McGuire’s communication/persuasion matrix. The matrix guided our research, specifically each marketing “channel”, targeted “message”, and target population or “receiver”. We developed a social media recruitment protocol and trained our research staff and stakeholders to conduct social media recruitment. Results As a result, in just 1 month, we recruited all of our subjects (N=14 couples, that is, N=28 participants) and reached more than 35,658 participants through different channels. One of the major successes of our social media recruitment campaign was to build a strong stakeholder base that became involved early on in all aspects of the research process—from pilot study writing and development to recruitment and retention. In addition, the variety of “messages” used across different social media platforms (including Facebook, the “Latinos en Pareja” study website, Craigslist, and various smartphone applications such as Grindr, SCRUFF, and Jack’d) helped recruit Latino gay couples. We also relied on a wide range of community-based organizations across New York City to promote the study and build in the social media components. Conclusions Our findings highlight the importance of incorporating communication technologies into the recruitment and engagement of participants in HIV interventions. Particularly, the success of our social media recruitment strategy with Spanish-speaking Latino MSM shows that this population is not particularly “hard to reach”, as it is often characterized within public health literature.

Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening

Objective: To examine (1) the prevalence of experiencing physical, injurious and sexual intimate partner violence (IPV) and (2) the associations between HIV risks and different types of IPV among women receiving care in an inner city emergency department (ED). Methods: A cross-sectional survey that elicited self-reported HIV risks and IPV among a random sample of 799 women receiving ED care. Multiple logistic regression was used to examine the associations between HIV risk and IPV, with covariance adjustment for potentially confounding sociodemographics. Results: 49.6% of the women reported a history of any form (ie, minor and severe type) of physical, injurious and/or sexual IPV, 15% severe sexual coercion (rape) over life time and 11.8% IPV in the past 6 months. Women who reported engaging in sex with a HIV-infected partner or an injecting drug user (IDU), having multiple partners in the past 12 months and injecting drugs were significantly more likely to have experienced any form of physical/injurious IPV, severe physical/injurious IPV and any form of sexual IPV in the past 6 months. In addition, women with multiple partners in the past 12 months and women who reported injecting drugs were significantly more likely to indicate having experienced a severe form of sexual IPV in the past 6 months. Conclusion: For many women receiving care in EDs, IPV and several HIV risk behaviours are frequent, co-occurring health problems. HIV testing and routine IPV inquiry in ED settings offer an important opportunity to identify women who are affected by these overlapping epidemics and refer them to appropriate treatment services.

An integrated relapse prevention and relationship safety intervention for women on methadone: testing short-term effects on intimate partner violence and substance use.

This study tests the feasibility, safety, and short-term preliminary effects of a relapse prevention and relationship safety (RPRS) intervention in reducing drug use and the experience of intimate partner violence (IPV) among women on methadone. For this randomized controlled trial, 34 women who met IPV and drug use criteria were randomly assigned to either the RPRS condition (n = 16) or a one-session informational control (IC) condition (n = 18). RPRS participants were more likely than IC participants to report a decrease in minor physical or sexual IPV (OR = 7.1, p = .05), minor psychological IPV (OR = 5.3, p = .03) and severe psychological IPV (OR = 6.07, p = .03) at the 3month follow-up. Data suggest that RPRS participants were also more likely than IC participants to report a decrease in any drug use at 3 months (OR = 3.3, p = .08). This study provides preliminary evidence that the RPRS intervention is effective in reducing IPV and drug use among women on methadone.