Jamila K. Stockman

The intersection of intimate partner violence against women and HIV/AIDS: a review

The objective of this study was to review original research on the intersection of violence against women by intimate partners and risk for HIV infection and highlight opportunities for new research and programme development. Seventy-one articles presenting original, peer-reviewed research conducted with females aged 12 years and older in heterosexual relationships during the past decade (1998–2007) were reviewed. Studies were eligible for inclusion if they addressed intimate partner violence (IPV) against women and HIV/AIDS as mutual risk factors. The prevalence of IPV and HIV infection among women varies globally, but females remain at elevated risk for both IPV and sexually transmitted/HIV infection, independently and concurrently. Comparisons between sero-negative and -positive women varied by geographic region; African HIV-positive women reported higher rates of victimisation while findings were inconsistent for HIV-positive women in the USA. Studies among various populations support the existence of a temporally and biologically complex relationship between HIV risk, lifetime exposure to violence and substance use, which are further complicated by gender and sexual decision-making norms. A possible link between violence-related post traumatic stress disorder and comorbid depression on immunity to HIV acquisition and HIV disease progression warrants further investigation. Sexual risk related to IPV works through both male and female behaviour, physiological consequences of violence and affects women across the lifespan. Further physiological and qualitative research is needed on the mechanisms of enhanced transmission; prospective studies are critical to address issues of causality and temporality. Prevention efforts should focus on the reduction of male-perpetrated IPV and male HIV risk behaviours in intimate partnerships.

Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions

Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.

Sexual Violence and HIV Risk Behaviors Among a Nationally Representative Sample of Heterosexual American Women: The Importance of Sexual Coercion

Objectives:Recent evidence suggests that it is important to consider behavioral specific sexual violence measures in assessing womens risk behaviors. This study investigated associations of history and types of sexual coercion on HIV risk behaviors in a nationally representative sample of heterosexually active American women. Methods:Analyses were based on 5857 women aged 18-44 participating in the 2002 National Survey of Family Growth. Types of lifetime sexual coercion included: victim given alcohol or drugs, verbally pressured, threatened with physical injury, and physically injured. Associations with HIV risk behaviors were assessed using logistic regression. Results:Of 5857 heterosexually active women, 16.4% reported multiple sex partners and 15.3% reported substance abuse. A coerced first sexual intercourse experience and coerced sex after sexual debut were independently associated with multiple sex partners and substance abuse; the highest risk was observed for women reporting a coerced first sexual intercourse experience. Among types of sexual coercion, alcohol or drug use at coerced sex was independently associated with multiple sex partners and substance abuse. Conclusions:Our findings suggest that public health strategies are needed to address the violent components of heterosexual relationships. Future research should utilize longitudinal and qualitative research to characterize the relationship between continuums of sexual coercion and HIV risk.

HIV Prevention fatigue among high-risk populations in San Francisco

To the Editor:Since the late 1990s, HIV-related risk behavior among men who have sex with men (MSM) has increased in San Francisco and other cities worldwide. 1–9 This increase in risk behavior is corroborated by rises in sexually transmitted diseases and, in some places, HIV incidence. 1,4 For exam

Forced Sex and HIV Risk in Violent Relationships

The intersecting epidemics of gender‐based violence, specifically forced sex, and HIV continue to affect women worldwide. Both in the United States and worldwide, women of African descent are disproportionately affected.

Targeting the SAVA (Substance Abuse, Violence, and AIDS) Syndemic Among Women and Girls: A Global Review of Epidemiology and Integrated Interventions.

Objectives:Multiple pathways link gender-based violence (GBV) to HIV and other sexually transmitted infections among women and girls who use or inject drugs. The aim of this article is to synthesize global literature that examines associations among the synergistic epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic. It also aims to identify a continuum of multilevel integrated interventions that target key SAVA syndemic mechanisms. Methods:We conducted a selective search strategy, prioritizing use of meta-analytic epidemiological and intervention studies that address different aspects of the SAVA syndemic among women and girls who use drugs worldwide from 2000 to 2015 using PubMed, MEDLINE, and Google Scholar. Results:Robust evidence from different countries suggests that GBV significantly increases the risk of HIV and other sexually transmitted infections among women and girls who use drugs. Multiple structural, biological, and behavioral mechanisms link GBV and HIV among women and girls. Emerging research has identified a continuum of brief and extended multilevel GBV prevention and treatment interventions that may be integrated into a continuum of HIV prevention, testing, and treatment interventions to target key SAVA syndemic mechanisms among women and girls who use drugs. Conclusions:There remain significant methodological and geographical gaps in epidemiological and intervention research on the SAVA syndemic, particularly in low- and middle-income countries. This global review underscores the need to advance a continuum of multilevel integrated interventions that target salient mechanisms of the SAVA syndemic, especially for adolescent girls, young women, and transgender women who use drugs.

Intimate Partner Violence, Depression, PTSD, and Use of Mental Health Resources Among Ethnically Diverse Black Women

This study examined exposure to violence and risk for lethality in intimate partner relationships as factors related to co-occurring MH problems and use of mental health (MH) resources among women of African descent. Black women with intimate partner violence (IPV) experiences (n = 431) were recruited from primary care, prenatal or family planning clinics in the United States and the U.S. Virgin Islands. Severity of IPV was significantly associated with co-occurring MH problems, but was not associated with the use of MH resources among African-American women. Risk for lethality and co-occurring problems were also not significantly related to the use of resources. African Caribbean women with severe physical abuse experiences were significantly less likely to use resources. In contrast, severity of physical abuse was positively associated with the use of resources among Black women with mixed ethnicity. Severe IPV experiences are risk factors for co-occurring MH problems, which in turn, increases the need for MH services. However, Black women may not seek help for MH problems. Thus, social work practitioners in health care settings must thoroughly assess women for their IPV experiences and develop tailored treatment plans that address their abuse histories and MH needs.

How does intimate partner violence affect condom and oral contraceptive Use in the United States?: A systematic review of the literature☆

INTRODUCTION Intimate partner violence (IPV) is estimated to affect 25% of adult women in the United States alone. IPV directly impacts womens ability to use contraception, resulting in many of unintended pregnancies and STIs. This review examines the relationship between IPV and condom and oral contraceptive use within the United States at two levels: the female victims perspective on barriers to condom and oral contraceptive use, in conjunction with experiencing IPV (Aim 1) and the male perpetrators perspective regarding condom and oral contraceptive use (Aim 2). STUDY DESIGN We systematically reviewed and synthesized all publications meeting the study criteria published since 1997. We aimed to categorize the results by emerging themes related to each study aim. RESULTS We identified 42 studies that met our inclusion criteria. We found 37 studies that addressed Aim 1. Within this we identified three themes: violence resulting in reduced condom or oral contraceptive use (n=15); condom or oral contraceptive use negotiation (n=15); which we further categorized as IPV due to condom or oral contraceptive request, perceived violence (or fear) of IPV resulting in decreased condom or oral contraceptive use, and sexual relationship power imbalances decreasing the ability to use condoms or oral contraceptives; and reproductive coercion (n=7). We found 5 studies that addressed Aim 2. Most studies were cross-sectional, limiting the ability to determine causality between IPV and condom or oral contraceptive use; however, most studies did find a positive relationship between IPV and decreased condom or oral contraceptive use. CONCLUSIONS Quantitative, qualitative, and mixed methods research has demonstrated the linkages between female IPV victimization/male IPV perpetration and condom or oral contraceptive use. However, additional qualitative and longitudinal research is needed to improve the understanding of dynamics in relationships with IPV and determine causality between IPV, intermediate variables (e.g., contraceptive use negotiation, sexual relationship power dynamics, reproductive coercion), and condom and oral contraceptive use. Assessing the relationship between IPV and reproductive coercion may elucidate barriers to contraceptive use as well as opportunities for interventions to increase contraceptive use (such as forms of contraception with less partner influence) and reduce IPV and reproductive coercion.

HIV among people who use drugs: a global perspective of populations at risk.

This article examines the epidemiology of HIV among selected subgroups of drug users around the world who are “most at risk”-men who have sex with men, female sex workers, prisoners, and mobile populations. The underlying determinants of HIV infection among these populations include stigma, physical and sexual violence, mental illness, social marginalization, and economic vulnerability. HIV interventions must reach beyond specific risk groups and individuals to address the micro-level and macro-level determinants that shape their risk environments. Public health interventions that focus on the physical, social, and health policy environments that influence HIV risk-taking in various settings are significantly more likely to impact the incidence of HIV and other blood-borne and sexually transmitted infections across larger population groups.

Prevalence and characteristics of abuse experiences and depression symptoms among injection drug-using female sex workers in Mexico

This mixed methods study examined the prevalence and characteristics of physical and sexual abuse and depression symptoms among 624 injection drug-using female sex workers (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico; a subset of 47 from Tijuana also underwent qualitative interviews. Linear regressions identified correlates of current depression symptoms. In the interviews, FSW-IDUs identified drug use as a method of coping with the trauma they experienced from abuse that occurred before and after age 18 and during the course of sex work. In a multivariate linear regression model, two factors—ever experiencing forced sex and forced sex in the context of sex work—were significantly associated with higher levels of depression symptoms. Our findings suggest the need for integrated mental health and drug abuse services for FSW-IDUs addressing history of trauma as well as for further research on violence revictimization in the context of sex work in Mexico.