Intersection between Intimate Partner Violence & HIV

By: Ranier Simons, ADAP Blog Guest Contributor

As with any chronic disease, quality of life and effective disease management requires consideration of the whole person, not just the disease. Regarding HIV, many different social determinants of health affect treatment, outcomes, and disease acquisition. The social, cultural, and physical environment of people living with HIV can be a crucial positive or negative factor. A recent study investigates the intersection of domestic violence and HIV. The Lancet published a retrospective study in December 2022 exploring the relationship between intimate partner violence (IPV) and women’s acquisition of HIV and experiences in the HIV treatment and care cascade (Stillman, 2023).

Photo Source: Fighter Law

Globally, more than one in four women experience IPV in their lifetime (McGill University, 2023). IPV is a subset of domestic violence and is not limited to physical abuse. Its forms include sexual, psychological, and even economic abuse. IPV is defined as violence that happens between people in an ongoing or former intimate or romantic relationship (Cerulli, 2022). Men experience it as well. Nearly one in ten men has experienced it in their lifetime. The Lancet study focuses on women in Sub-Saharan Africa, the regions of Africa south of the Sahara. This includes West Africa, East Africa, Central Africa, and Southern Africa (Wikipedia, 2022).

The study is a retrospective pooled analysis of cross-sectional surveys encompassing 280,259 women across 30 countries administered between January 1, 2000, and December 31, 2020. Ages ranged from 15-64 years old, and all the women were currently or formerly married or cohabitating. Sub-Saharan Africa was chosen because, in global comparison, the region has a very high prevalence of IPV and HIV (Cerulli, 2022). For the purposes of the study, IPV was limited to physical and sexual abuse. The study estimated the effects of past-year physical, sexual IPV, or a combination of both. Four outcomes were the focus of the study: recent HIV infection, HIV testing in the past year, antiretroviral regimen adherence, and viral load suppression (Kuchukhidze, 2022).

Photo Source: Loma Linda University 

Overall, 21.2% of the women self-reported having experienced physical or sexual IPV in the past year, and 29.1% had experienced it at some point in their lifetime. Self-reporting of HIV testing was very similar between the groups of women who did and did not experience past-year physical or sexual IPV, and more than a quarter of both groups had been tested in the past year. 

Regarding the women in the study who are living with HIV, there were differences in antiretroviral adherence. The ones who reported past-year physical or sexual IPV had lower uptake of ART (64.2%) than those who did not report any past-year IPV (71.3%) (Kuchukhidze, 2022).Those who had experienced physical or sexual IPV had missed 2-3 times as many pills in the past month as those who had not experienced past-year IPV. Additionally, women on antiretroviral therapy who had experienced past-year physical or sexual IPV were 5% less likely to be virally suppressed than those who had not. Regarding infection, women who had experienced physical or sexual IPV in the past year were 3.22 times as likely to acquire a recent HIV infection as those who had not experienced it in the past year (Kuchukhidze, 2022).

The mechanisms by which IPV can affect HIV acquisition are layered. One major pathway is infection through sexual violence, and another is the culture of the men who are abusers. Many may have multiple concurrent sexual partners coupled with a lack of condom use which would increase HIV transmission if they live with HIV. Knowledge of HIV status is an essential initial factor in reducing the adverse effects of IPV on HIV. Another barrier caused by IPV is antiretroviral adherence. Some women may fear being tested, dreading the possible reactions from their abusers if the test is positive. Treatment adherence is negatively impacted due to women not disclosing their status out of fear of abuse from their partners, making it hard to get them into consistent care.

Photo Source: Harvard Health Publishing

The study highlights the need for more research into the effects of IPV on HIV and systemic change to help the women involved. The researchers suggest that healthcare providers need to be trained on how to have patients safely disclose their instances of living with IPV. Additionally, there need to be innovative ways to safely deliver consistent antiretroviral and HIV care to those living with HIV in IPV situations. Creating patient-focused safe service delivery platforms, such as safe medication pick-up points, are policies to be considered (Kuchukhidze, 2022).

The Lancet study is further confirmation that there are many levels of barriers to overcome in the fight against HIV. Networks that span locally to globally are necessary to manipulate the mesh of life factors that complicate the transmission and treatment of HIV.

[1] Stillman, A. (2023, January 9). The link between HIV and domestic violence. Retrieved from https://news.yahoo.com/between-hiv-domestic-violence-213422389.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr

[2] McGill University. (2023, January 6). Women experiencing intimate partner violence three times more likely to contract HIV

[3] University of Rochester, Cerulli, C. (2022, March 23). What is intimate partner violence? It’s not just physical abuse. Retrieved from https://www.rochester.edu/newscenter/what-is-intimate-partner-violence-domestic-violence-516342/

[4] Sub-Saharan Africa. (2023, January 9). In Wikipedia. https://en.wikipedia.org/wiki/Sub-Saharan_Africa

[5] Kuchukhidze, S. et al. (2022, December 01). The effects of intimate partner violence on women's risk of HIV acquisition and engagement in the HIV treatment and care cascade: a pooled analysis of nationally representative surveys in sub-Saharan Africa. Lancet.Retrieved from https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(22)00305-8/fulltext DOI:https://doi.org/10.1016/S2352-3018(22)00305-8

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

Danger Zone: Intimate Partner Violence Among People Living with HIV

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The U.S. Centers for Disease Control & Prevention (CDC) recently reported what too many people living with HIV/AIDS (PLWHAs) in the United States had already known...they are at higher risk for intimate partner violence. According to the findings, which were published in the American Journal of Preventive Medicine, "26.3% reported having ever experienced intimate partner violence, and 4.4% reported having experienced intimate partner violence in the past 12 months."[1] Sadly, it means one in four PLWHAs are probably more worried about surviving physical abuse than battling their HIV diagnosis. 

Photo Credit: iStock (rights purchased)

Aside from the act of violence itself, what is equally troubling it how it impacts the emotional, mental and physical health of the survivors of domestic abuse and intimate partner violence. Among PLWHAs who experienced intimate partner violence during the previous year, CDC found they were:[2] 

• Less likely to maintain medication adherence. 
• Less likely to be engaged in routine HIV care.
• Less likely to have good HIV clinical outcomes.
• More likely to seek emergency care services.
• More likely to engage in risky behaviors, such as intravenous drug use.
• More likely to have unmet needs for supportive services. 

Gender and sexual orientation were both important factors for lifetime prevalence of intimate partner violence. Homelessness also was identified as a risk-factor, with 37.6% experiencing physical abuse from a partner with in the past twelve months.[3]

CDC's analysis used interview and medical record data from the 2015−2017 cycles of the Medical Monitoring Project,[4] which was prior to the ongoing Covid-19 pandemic. Unfortunately, all reports indicate that domestic abuse and intimate partner violence have increased over the last year during the Covid-19 isolation.[5] The ADAP Advocacy Association, in fact, worked closely last year with Simply Amazing You Are (SAYA) to highlight, COVID-19 is Exacerbating Existing Epidemics. 

SAYA, a Miami, Florida-based nonprofit organization, has been on the front lines battling this dual epidemic using empowerment focused intimate partner violence prevention and intervention. SAYA's programming includes direct assistance like escape planning and protective order assistance, as well as policy advocacy campaigns, referral for support services, and linkage to care and victim services navigation. SAYA currently relies on a word-of-mouth model in order to ensure the safety of their clients. Through the COVID pandemic, SAYA has also partnered with Panera Bread end night donations to provide to IPV survivors facing homelessness or the risk of homeless.

Connie Reese, SAYA's Founder & Executive Director, is survivor of intimate partner violence. "When is your enough...enough," Reese said upon urging survivors of intimate partner violence in South Florida to seek support. But according to Reese, Covid-19 has made it more difficult for people to seek help.

"For many women, even the fear of contracting the coronavirus is stopping them from seeking out medical care after experiencing physical abuse, in addition to being HIV-positive," said Reese. "SAYA, although in the process of applying for federal and local government funding, has provided unlimited services out-of-pocket to ten women who have experienced intimate partner violence in Miami-Dade County during Covid-19."

To that end, SAYA was instrumental in helping the ADAP Advocacy Association publish its infographic on the intersection between intimate partner violence and HIV. For anyone experiencing domestic abuse or intimate partner violence, please call the National Domestic Violence Hotline at 1-800-799-7233, or the Rape & Incest National Network (RAINN) National Sexual Assault Hotline at 1-800-656-4673.

[1] Ansley B. Lemons-Lyn, Amy R. Baugher, Sharoda Dasgupta, et al. (2021, March 31). Intimate Partner Violence Experienced by Adults With Diagnosed HIV in the U.S. American Journal of Preventive Medicine. Retrieved online at https://www.ajpmonline.org/article/S0749-3797(21)00079-9/fulltext.

[2] Ansley B. Lemons-Lyn, Amy R. Baugher, Sharoda Dasgupta, et al. (2021, March 31). Intimate Partner Violence Experienced by Adults With Diagnosed HIV in the U.S. American Journal of Preventive Medicine. Retrieved online at https://www.ajpmonline.org/article/S0749-3797(21)00079-9/fulltext.

[3] Lily Wakefield (2021, April 18). A quarter of HIV-positive Americans have experienced intimate partner violence. Retrieved online at https://www.pinknews.co.uk/2021/04/18/hiv-intimate-partner-violence-america-health-outcomes-cdc/. 

[4] Ansley B. Lemons-Lyn, Amy R. Baugher, Sharoda Dasgupta, et al. (2021, March 31). Intimate Partner Violence Experienced by Adults With Diagnosed HIV in the U.S. American Journal of Preventive Medicine. Retrieved online at https://www.ajpmonline.org/article/S0749-3797(21)00079-9/fulltext.

[5] Karen Nikos-Rose (2021, February 24). COVID-19 Isolation Linked to Increased Domestic Violence, Researchers Suggest. University of California, Davis. Retrieved online at https://www.ucdavis.edu/news/covid-19-isolation-linked-increased-domestic-violence-researchers-suggest.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

COVID-19 is Exacerbating Existing Epidemics

By: Connie Reese, Founder & Executive Director, Simply Amazing You Are

As a domestic violence survivor, and advocate for survivors of domestic violence and intimate partner violence ("DV/ IPV"), it is important to recognize that people are less likely (and less able) to seek help. Isolation by an abuser or shame often prevent it. The COVID19 public health crisis has left even some of the longest standing integrated courts, designed to deal with protection orders and victim assistance, scrambling to cope with modernizing, introducing technology and restructuring interpreter services. 

In unincorporated Miami-Dade, DV/IPV cases increased nearly 20 percent in April 2020, during the COVID "shelter-in-place" orders (The Women’s Fund Miami-Dade, 2020). While amazing local organizations, like the Women's Fund Miami-Dade, have focused awareness campaigns, it has been the experience of our organization, Simply Amazing You Are ("SAYA"), that these campaigns are most effective for those already connected to services with mandated reporters and close relationships with systems of justice. 

Photo Source: USC Suzanne Dworak-Peck School of Social Work

Due to lack of investment in stable, transitional housing (MiamiDade.gov lists only 2 transitional housing providers and 2 emergency shelters – of which congregate living risks in the time of COVID make them even less safe), much of the community needing the most help are at a loss or the system doesn't move fast enough to provide adequate interventions and in some cases are now no longer accessible at all due to victim/survivors' lack of broadband access. As much as some pundits bemoaned smartphones as a tool subsidized by anti-poverty programing, for many of my clients, those phones are the difference between life and death by way of a simple internet connection. 

Complicating considerations for at risk communities, the Center for Disease Control & Prevention ("CDC") recognizes "...studies suggest that IPV can be both a risk factor for HIV, and a consequence of HIV" (CDC, 2014). With Miami-Dade's historically high rate of new HIV diagnoses, reduced access for community-based HIV testing, and lack of investment in areas like Brownsville and Liberty City as a matter of geographic segregation and ghettoization, the area is poised to be an example of how public policy fails to address intersections of health.

Advocates and funders would do well to consider the most good can be achieved by making remarkable investments in local community-based organizations, rooted in neighborhood-oriented community outreach and "shoe leather" service provision. Much of the local community can't meaningfully enjoy the temporary flexibility for telehealth and linkage to care and services because the very entities providing these services were not prepared or supported in becoming prepared for such modernizations. And Miami is not unique.

Across the nation, deeply impoverished neighborhoods experience the same barriers to care.

We are quickly running out of time to change the inevitable course of increased domestic violence, deaths from domestic violence, more cases of COVID-19, more HIV diagnoses, less care, and less public trust in these entities meant to serve us and keep us safe. That's the core of this need, as our systems show just how fragile they are, as we see existing disparities become exacerbated, communities getting fewer of their needs met will ultimately come to trust us, all of us, less and less. The time to act, the time to make unprecedented, bold moves, is now.

About Simply Amazing Your Are. SAYA is an empowerment focused intimate partner violence prevention and intervention non-profit organization in Miami, FL. SAYA's programming includes direct assistance like escape planning and protective order assistance, as well as policy advocacy campaigns, referral for support services, and linkage to care and victim services navigation. SAYA currently relies on a word-of-mouth model in order to ensure the safety of our clients. Through the COVID pandemic, SAYA has also partnered with Panera Bread end night donations to provide to IPV survivors facing homelessness or the risk of homeless. Donate to Simply Amazing You Are.

References: 

• Centers for Disease Control & Prevention (February 2014). Intersection of Intimate Partner Violence and HIV in Women. U.S. Department of Health & Human Services. Retrieved online at https://www.cdc.gov/violenceprevention/pdf/ipv/13_243567_green_aag-a.pdf?response_type=embed#:~:text=Studies%20of%20HIV%2DPositive%20Women,and%20a%20consequence%20of%20HIV.
• Women’s Fund Miami-Dade (2020, July 17). The Women’s Fund Miami-Dade Launches Domestic Violence Awareness Campaign. PRWeb.com. Retrieved online at https://www.prweb.com/releases/the_womens_fund_miami_dade_launches_domestic_violence_awareness_campaign/prweb17265119.htm. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.