Approval Sheet Intimate partner violence among HIV+ crack cocaine users: where and why to intervene Open Access
Kalokhe, Ameeta Shivdas (2011)
Published
Abstract
Background: HIV+ crack cocaine users, collectively, are
at high-risk for disease progression and
transmitting HIV in that they encounter difficulty entering and
remaining in HIV care, taking
antiretroviral therapy (ART), and practicing safe sex. We
hypothesized that intimate partner
violence (IPV) occurs frequently in this cohort and contributes to
these shortcomings.
Methods: From December 2006-April 2010 we recruited HIV+ crack
cocaine users from
inpatient services at Grady Memorial Hospital (Atlanta, GA) and
Jackson Memorial Hospital
(Miami, FL). Participants were screened for IPV using a 5-item
validated survey, and IPV
survivors were questioned regarding use and barriers to use of
support services. Multivariate
analysis was conducted to evaluate the association between IPV and
unprotected intercourse or
STI diagnosis in the prior 6 months, use of HIV care in the past
year, and use of ART.
Results: 343 participants were enrolled. The majority were
African American (89%), had not
completed high school (52%), and earned <$10,000/year (91%).
Fifty-six percent reported
lifetime histories of IPV. After controlling for gender, frequency
of crack use, and sexuality, IPV
was associated with unprotected sex (PR 1.46, 95%CI=1.12-1.90).
After controlling for gender,
sexuality, and number of sexual partners, IPV was associated with
report of an STI diagnosis in
the prior 6 months (PR=2.43, 95%CI=1.11-5.36). While IPV was
associated with reduced
utilization of HIV care, this association was no longer
statistically significant after controlling for
frequency of crack use and homelessness. IPV survivors were less
likely to report ART use
(PR=0.57, 95%CI=0.41-0.80), however this negative association was
driven by men. While IPV
survivors most frequently used 911 services (31%) and the ED (27%),
over one-third used no
services. Barriers to resource utilization included unwillingness
to deal with the situation, fears of
partner notification and being judged, and perception of resources
as unhelpful.
Conclusion: IPV occurs frequently in HIV+ crack cocaine users
and is associated with high-risk
sexual behaviors and less use of HIV care. IPV screening should
become routine in this
population, and resources directed toward emergency/911 services.
Clinicians should focus on
increasing awareness of IPV services and improving patient comfort
and sense of confidentiality
in discussing IPV.
Table of Contents
TABLE OF CONTENTS
Table Title
Page
Introduction
1
Background
4
Methods
7
Results
13
Discussion
21
References
26
Table 1: Characteristics of 343 study participants by gender
29
Table 2: Intimate partner violence spectrum of severity
29
Table 3: Intimate partner violence by sexuality
29
Table 4: Frequency of intimate partner violence by gender
30
Table 5a: Frequency of exposure variables among those who did and
did not report
30
unprotected sexual intercourse in the prior 6 months
Table 5b: Frequency of varying degrees of IPV severity among
those who did and did
31
not report unprotected sexual intercourse in the prior 6 months
Table 5c: Assessing potential confounding: association
between IPV and other
31
covariates
Table 6: Assessing interaction and
confounding by stratification: the association
32
between IPV and unprotected sexual intercourse/6 months
Table 7a: Exposure variable frequency among participants tested
for an STI in the prior 32
6 months who did and did not report being diagnosed with a STI/6
months
Table 7b: Exposure variable frequency among participants with and
without an STI
33
diagnosis/6 months
Table 7c: Assessing interaction and
confounding: the association between IPV and
33
STI/6 months (among those tested)
Table 7d: Assessing
interaction and confounding: the association between IPV and
34
STI/6 months (all participants)
Table 8a: Exposure
variable frequency among who did/did not report HIV care in
the
34
prior 12 months
Table 8b: Exposure variable frequency among who did/did not report
IPV: potential
35
confounders
Table 8c: Assessing interaction and confounding: the association
between IPV and use
35
of HIV care/12 months
Table 9a: Exposure variable frequency among who are/are not
currently on
36
antiretroviral therapy
Table 9b: Assessing interaction and confounding: the association
between IPV and use
36
of ART
Figure 1a: Causal diagrams depicting the potential association
between IPV and 37
unprotected sexual intercourse in the prior 6 months
Figure 1b: Causal diagrams depicting the potential association
between IPV and 38
STI diagnosis in the prior 6 months
Figure 1c: Causal diagrams depicting the potential
association between IPV and 38
HIV care in the past 12 months
Figure 1d: Causal diagrams depicting the potential association
between IPV and 39
current use of ART
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