Understanding intimate partner violence, HIV, and community based resources through a spatial lens among women in Atlanta, GA Open Access

Hariharan, Neetu (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/n296wz722?locale=en
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Abstract

Title: Understanding intimate partner violence, HIV, and community based resources through a spatial lens among women in Atlanta, GA

Author: Neetu Hariharan, MPH

Background: Current research suggests that women who experience intimate partner violence (IPV) are at higher risk of HIV infection. However, there have been limited investigations into the spatial relationship of both IPV severity and HIV prevalence. This study sought to evaluate the utility of spatial tools in exploring the geographic distribution and clustering of IPV and HIV. Additionally, we investigated the allocation of HIV resources to characterize the void of integrative HIV and IPV resources.

Methods: Past 12-month and lifetime IPV data obtained from a conveniently sampled cross-sectional study conducted from March through November 2014 of 85 HIV-negative high-risk women residing in metropolitan core Atlanta. AIDSVu provided Atlanta-based HIV data. Information regarding provision of mental health and violence screening was collected from HIV testing and counseling centers. Descriptive and various spatial statistics were performed using STATA 13.0, ArcGIS 10.2.2, Point Pattern Analysis (PPA) tool, and SaTScan 9.4.

Results: High HIV/AIDS prevalence areas were identified in two counties. Marginal IPV severity global clustering trends were found. Localized IPV severity was clustered in the area with high HIV prevalence (2 hot spots; z-score = 3.17 and α=0.05). IPV participants in high HIV prevalence areas were located outside the 1-mile buffer around IPV/mental health integrated resources (n= 38, outside; n=12, inside). However, all 9 of the integrative resources were located in high HIV prevalence areas with clusters of high IPV severity.

Conclusions: Our results suggest that geospatial mapping can be useful to identify regions of high IPV severity and high HIV overlap and to classify geographic gaps in allocation of HIV prevention and IPV community support services. Overall, this study serves as a platform to continue the exploration of spatial tools to address nontraditional socio-behavioral risk issues in research, and contribute to policy and resource discussions.

Table of Contents

Chapter 1: Introduction................................................................................................................................. 1 Goals, Aims & Objectives............................................................................................................................ 2 Study setting & population........................................................................................................................... 3 Chapter 2: Review of Literature.................................................................................................................... 4 HIV.............................................................................................................................................................. 4 HIV in the South........................................................................................................................................... 5 HIV and Women.......................................................................................................................................... 6 Intimate Partner Violence............................................................................................................................. 7 HIV and Intimate Partner Violence............................................................................................................... 8

HIV and Intimate Partner Violence prevention services: A need for integration......................................... 11

Geographic Information Systems................................................................................................................ 12 Spatial Relationship with HIV in Atlanta.................................................................................................... 13 GIS and IPV, and Gaps in Literature........................................................................................................... 14 Chapter 3: Manuscript................................................................................................................................ 16 Contribution of Student.............................................................................................................................. 16 Abstract...................................................................................................................................................... 17 Introduction................................................................................................................................................ 18 Methods...................................................................................................................................................... 20 Study Setting and Design............................................................................................................................ 20 Data sources............................................................................................................................................... 20 Intimate Partner Violence Data................................................................................................................... 20 HIV Surveillance Data................................................................................................................................ 22 Care and Counseling Resources.................................................................................................................. 22 Spatial Analysis.......................................................................................................................................... 23 Geocoding and Mapping............................................................................................................................. 23 Cluster Analysis.......................................................................................................................................... 24 Distance to Resources Analysis.................................................................................................................. 25 Results........................................................................................................................................................ 26 Demographics of Atlanta............................................................................................................................ 26 Results for Intimate Partner Violence Data................................................................................................. 26 Results for AIDSVu HIV Data.................................................................................................................... 27 Kernel Density and Weighted K-Function Estimates................................................................................... 27 Getis G-Ord* Estimates and Kulldroff's scan............................................................................................. 28

Geographic Gaps in the allocation of Integrative HIV & IPV Community Resources................................. 29

Discussion.................................................................................................................................................. 30 Limitations.................................................................................................................................................. 32 Conclusions................................................................................................................................................ 34 Manuscript References............................................................................................................................... 35 Appendices................................................................................................................................................. 39 Appendix A: Tables.................................................................................................................................... 39 Appendix B: Graphs................................................................................................................................... 42 Appendix C: Maps...................................................................................................................................... 44 Chapter 4: Implications and Recommendations.......................................................................................... 50 Introduction................................................................................................................................................ 50 Discussion and Limitations......................................................................................................................... 50 Implications and recommendations............................................................................................................ 51 References.................................................................................................................................................. 53

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