Marguerite B. Lucea

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.

Intimate partner violence, substance use, and adverse neonatal outcomes among urban women.

OBJECTIVE To assess the prevalence of intimate partner violence, substance use, and their co-occurrence during pregnancy and to examine their associations with adverse neonatal outcomes. STUDY DESIGN Between February 2009-February 2010, pregnant women receiving obstetrical care at 3 urban clinics were screened for intimate partner violence and substance use between 24-28 weeks gestation. A chart review was conducted upon delivery to assess for adverse neonatal outcomes of low birth weight, preterm birth, and small for gestational age (SGA). RESULTS Maternal and neonatal data were collected on 166 mothers and their neonates. Overall, 19% of the sample reported intimate partner violence during their pregnancies. Of the studys neonates, 41% had at least 1 adverse neonatal outcome. Nearly one-half of the mothers reported using at least 1 substance during pregnancy. Women experiencing intimate partner violence had a higher prevalence of marijuana use than their nonabused counterparts (P < .01). Experiencing intimate partner violence was associated with a 4-fold increase in having a SGA neonate (aOR = 4.00; 95% CI 1.58-9.97). Women who reported marijuana use had 5 times the odds of having a neonate classified as SGA (aOR = 5.16, 95% CI 2.24-11.89) or low birth weight (aOR 5.00; 95% CI 1.98-12.65). CONCLUSIONS The prevalence of intimate partner violence during pregnancy and substance use is high in urban mothers, the risks of which extend to their neonates. Pediatric providers are urged to routinely screen for both issues and recognize the impact of co-occurrence of these risk factors on poor neonatal and childhood outcomes.

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.

Factors Influencing Resource Use by African American and African Caribbean Women Disclosing Intimate Partner Violence

Many victims of intimate partner violence (IPV) do not access services. Education and severity of physical violence have previously been shown to predict resource utilization, but whether these hold true specifically among women of African descent is unknown. This article furthers our understanding of the relationship between IPV and resource use, considering sociodemographics and aspects of IPV by presenting results from a study conducted with African American and African Caribbean women in Baltimore, Maryland, and the U.S. Virgin Islands. Of the 545 women included in this analysis, 95 (18%) reported emotional abuse only, 274 (50%) reported experiencing physical abuse only, and 176 (32%) had experienced both physical and sexual abuse by an intimate partner. Resource utilization was relatively low among these women, with only 57% seeking any help. Among those who did, 13% sought medical, 18% DV, 37% community, and 41% criminal justice resources. Generalized linear model results indicated that older age and severe risk for lethality from IPV and PTSD were predictive of certain types of resource use, while education, insurance status, and depression had no influence. Perceived availability of police and shelter resources varied by site. Results suggest that systems that facilitate resource redress for all abused women are essential, particularly attending to younger clients who are less likely to seek help, while building awareness that women accessing resources may be at severe risk for lethality from the violence and may also be experiencing mental health complications. In addition, greater efforts should be made on the community level to raise awareness among women of available resources.

Intimate partner violence among African American and African Caribbean women: prevalence, risk factors, and the influence of cultural attitudes

Background Women of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories. Objective In this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse. Design Between 2009 and 2011, we recruited African American and African Caribbean women aged 18-55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis. Results Most of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas. Conclusions Variance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships.Background Women of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories. Objective In this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse. Design Between 2009 and 2011, we recruited African American and African Caribbean women aged 18–55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis. Results Most of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas. Conclusions Variance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships.

Intimate partner violence and HIV risk factors among African-American and African-Caribbean women in clinic-based settings

Abstract Despite progress against intimate partner violence (IPV) and HIV/AIDS in the past two decades, both epidemics remain major public health problems, particularly among women of color. The objective of this study was to assess the relationship between recent IPV and HIV risk factors (sexual and drug risk behaviors, sexually transmitted infections [STIs], condom use, and negotiation) among women of African descent. We conducted a comparative case–control study in womens health clinics in Baltimore, MD, USA and St. Thomas and St. Croix, US Virgin Islands (USVI). Women aged 18–55 years who experienced physical and/or sexual IPV in the past two years (Baltimore, n=107; USVI, n=235) were compared to women who never experienced any form of abuse (Baltimore, n=207; USVI, n=119). Logistic regression identified correlates of recent IPV by site. In both sites, having a partner with concurrent sex partners was independently associated with a history of recent IPV (Baltimore, AOR: 3.91, 95% CI: 1.79–8.55 and USVI, AOR: 2.25, 95% CI: 1.11–4.56). In Baltimore, factors independently associated with recent IPV were lifetime casual sex partners (AOR: 1.99, 95% CI: 1.11–3.57), exchange sex partners (AOR: 5.26, 95% CI: 1.92–14.42), infrequent condom use during vaginal sex (AOR: 0.24, 95% CI: 0.08–0.72), and infrequent condom use during anal sex (AOR: 0.29, 95% CI: 0.09–0.93). In contrast, in the USVI, having a concurrent sex partner (AOR: 3.33, 95% CI: 1.46–7.60), frequent condom use during vaginal sex (AOR: 1.97, 95% CI: 1.06–3.65), frequent condom use during anal sex (AOR: 6.29, 95% CI: 1.57–25.23), drug use (AOR: 3.16, 95% CI: 1.00–10.06), and a past-year STI (AOR: 2.68, 95% CI: 1.25–5.72) were associated with recent IPV history. The divergent results by site warrant further investigation into the potential influence of culture, norms, and intentions on the relationships examined. Nonetheless, study findings support a critical need to continue the development and implementation of culturally tailored screening for IPV within HIV prevention and treatment programs.

Perceptions of and Experience With System Responses to Female Same-Sex Intimate Partner Violence

Female same-sex intimate partner violence (FSSIPV) is a significant problem that affects the physical and mental health and the safety of sexual minority women. A mixed-methods study was conducted to (a) identify risk and protective factors for victimization and perpetration of repeat violence in abusive same-sex relationships and (b) examine participant experiences with system responses (by domestic violence services, criminal justice systems, and health care services) to FSSIPV. The purpose of the article is to report the findings from the qualitative component (e.g., focus groups and individual interviews) of the parent study that are specific to survivors’ perceptions of and experiences with domestic violence services, criminal justice systems, and health care services. The findings indicate a significant need across all systems for increased awareness, enhanced understanding, and provision of services specific to survivors of FSSIPV.

Disordered eating among African American and African Caribbean women: The influence of intimate partner violence, depression, and PTSD

We assessed the influence of intimate partner violence (IPV), depression and post-traumatic stress disorder (PTSD) on disordered eating patterns (DE) among women of African descent through a comparative case-control study (N = 790) in Baltimore, MD, and St. Thomas and St. Croix, US Virgin Islands, from 2009–2011. IPV, depression and PTSD were independent risk factors in the full sample. The relationship between IPV and DE was partially mediated by depression. The influence of risk for lethality from violence was fully mediated by depression. IPV should be considered in research and treatment of DE and both IPV and DE should be assessed when the other or depression is detected.

HIV Risk, Partner Violence, and Relationship Power Among Filipino Young Women: Testing a Structural Model

A persons ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15–31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women.

The context of condom use among young adults in the Philippines: Implications for HIV prevention

We examine current perceptions and constraints surrounding condom use among young adults in the Philippines to garner a deeper contextual understanding of this aspect of HIV prevention within Filipino society. Through thematic analysis of focus group data, we found three broad themes, all of which include societal and individual barriers to using condoms. The findings may provide insight for similar settings in which religion has a strong influence on society. To strengthen HIV prevention efforts in such settings, we suggest that the development of strategies to address these constraints and promote healthy sexuality in young adults is essential.