Posted on November 01, 2016
Source: American Journal of Preventive Medicine
Michele R. Decker ScD, MPH, Lorie Benning, MS, Kathleen M. Weber, RN, BSN, Susan G. Sherman, PhD, Adebola Adedimeji, PhD, Tracey E. Wilson, PhD, Jennifer Cohen, MPA, Michael W. Plankey, PhD, Mardge H. Cohen, MD, and Elizabeth T. Golub, PhD
Introduction
Gender-based violence (GBV) threatens women’s health and safety. Few prospective studies examine physical and sexual violence predictors. Baseline/index GBV history and polyvictimization (intimate partner violence, non-partner sexual assault, and childhood sexual abuse) were characterized. Predictors of physical and sexual violence were evaluated over follow-up.
Methods
HIV-infected and uninfected participants ( n =2,838) in the Women’s Interagency HIV Study provided GBV history; 2,669 participants contributed 26,363 person years of follow-up from 1994 to 2014. In 2015–2016, multivariate log-binomial/Poisson regression models examined violence predictors, including GBV history, substance use, HIV status, and transactional sex.
Results
Overall, 61% reported index GBV history; over follow-up, 10% reported sexual and 21% reported physical violence. Having experienced all three forms of past GBV posed the greatest risk (adjusted incidence rate ratio [AIRR] physical =2.23, 95% CI=1.57, 3.19; AIRR sexual =3.17, 95% CI=1.89, 5.31). Time-varying risk factors included recent transactional sex (AIRR physical =1.29, 95% CI=1.03, 1.61; AIRR sexual =2.98, 95% CI=2.12, 4.19), low income (AIRR physical =1.22, 95% CI=1.01, 1.45; AIRR sexual =1.38, 95% CI=1.03, 1.85), and marijuana use (AIRRphysical =1.43, 95% CI=1.22, 1.68; AIRR sexual =1.57, 95% CI=1.19, 2.08). For physical violence, time-varying risk factors additionally included housing instability (AIRR=1.37, 95% CI=1.15, 1.62); unemployment (AIRR=1.38, 95% CI=1.14, 1.67); exceeding seven drinks/week (AIRR=1.44, 95% CI=1.21, 1.71); and use of crack, cocaine, or heroin (AIRR=1.76, 95% CI=1.46, 2.11).
Conclusions
Urban women living with HIV and their uninfected counterparts face sustained GBV risk. Past experiences of violence create sustained risk. Trauma-informed care, and addressing polyvictimization, structural inequality, transactional sex, and substance use treatment, can improve women’s safety.
