Relationship Abuse and HIV/STI: Addressing Risks, Offering - PowerPoint Presentation

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Relationship Abuse and HIV/STI: Addressing Risks, Offering Support

Laura Avellaneda-Cruz, LMSWAlaska Native Tribal Health ConsortiumAlaska Native Epidemiology Center

Presentation prepared by:

Laura Avellaneda-Cruz

Last Updated:

March 25, 2015Slide2

Images and content created in part by:

Rebecca Levenson, MA

Linda Chamberlain, MPH, PhDSlide3

Describe

how IPV/SV impact HIV/STI riskDescribe how IPV/SV impact health of + patients

Reduce risks &

i

mprove response

Learning

ObjectivesSlide4

Learning

ObjectivesDescribe how IPV/SV impact HIV/STI riskSlide5

What is DV? IPV

?Slide6

A pattern of behaviors

Pattern of coercive and controlling behaviors that an adult or teen chooses to use against an intimate partner in order to intimidate and control the victim.For the CDC’s definition of DV, please refer to CDC’s website. Slide7

Intimate Partner Violence includes

Physical violence (hitting, pushing, slapping, choking/strangulation)Emotional or psychological aggression (threatening, humiliating, controlling, isolating, coercive tactics, stalking)Sexual violence (coercive sex, sexual assault, sexual humiliation, control of reproductive or sexual health/ reproductive coercion)Slide8

What is sexual violence?

Any kind of sexual contact without consentSlide9
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What is reproductive

coercion?Slide11

Reproductive Coercion (RC) may include:

Explicit attempts to impregnate a partner against her wishesControlling outcomes of a pregnancyCoercing a partner to have unprotected sex Interfering with birth control methodsSlide12

Silverman et al., 2001

IPV  pregnancy

Adolescent girls in physically abusive relationships were

6 times more likely

to become pregnant than non-abused girlsSlide13

Miller, et al., 2010

IPV  STIs

Nearly half (47.8

%)

of adolescent girls tested for STI/HIV have experienced physical and/or sexual intimate partner violence.

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HIV and IPV

Among a small sample of HIV-positive

men:

73%

reported

lifetime IPV

20%

reported

IPV from a current partner

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IPV and

Risk BehaviorsWomen who experienced past or current IPV are more likely to:Have multiple sexual partnersHave a past or current sexually transmitted infectionHave a partner with known HIV risk factors (including IDU)Report inconsistent use or nonuse of

condoms

Inject drugs

Wu et al,

2007Slide16

Ralford et al,

2009Knowledge isn’t enough

Under high levels of fear for abuse, women with high STI knowledge were

more likely to use condoms inconsistently

than non-fearful women with low STI knowledge. Slide17

Wingood et al,

2001

Girls who experienced physical dating violence were

2.8 times

more likely

to fear the perceived consequences of negotiating condom use than non-abused girls. Slide18

Dr. Vincent Felitti

Adverse Childhood Experiences (ACEs)  RiskSlide19

Adverse Childhood Experiences (ACEs)

 RiskSlide20

Learning

ObjectivesDescribe how IPV/SV impacts health of + patientsSlide21

“

Research shows us that violence is both a significant cause and a significant consequence of HIV infection among women.

Judy

Auerbach

American Foundation for AIDS Research (

AmfAR

)Slide22

HIV 

IPVBased on a study of 310 HIV-positive women:45% experienced abuse after being diagnosed with HIV 4% experienced abuse as a direct consequence of disclosing their HIV statusGielen et al, 2000Slide23

HIV 

IPVBased on a study of 56 HIV-positive men:73% had experienced IPV 29% of those abused felt the abuse was related to their HIV statusGielen et al, 2000Slide24

Review study by Gielen

et al, 2007HIV and severity of IPV

Women who are HIV-positive experience more severe IPV and more frequent abuse compared to HIV-negative women who are experiencing IPV.Slide25

Lang et al, 2007

HIV and consequences of IPV

HIV-positive women who experienced recent IPV were more likely

than those without IPV to

report:

inconsistent condom

use

abuse

stemming from

requests for

condom use

pregnancy

Photo: Oscar Avellaneda-Cruz Slide26

Lichtenstein, 2006

IPV is an under-recognized barrier to obtaining regular care for HIV/AIDS. Slide27

Implications For Sexually Transmitted

Infections/HIV ProgramsPartner notification may be dangerous for clients experiencing abuse.Clients may not be able to negotiate safe sex with an abusive partner.IPV may be a more immediate threat to a client than a sexually transmitted infection or HIV status.IPV may pose a barrier to visits and treatmentSlide28

Part 2, on April 2nd

The Safety Card Approach to Violence

Prevention & Intervention

Photo:

Laura

Avellaneda-Cruz, ANTHC