Approval Sheet Intimate partner violence among HIV+ crack cocaine users: where and why to intervene Público

Kalokhe, Ameeta Shivdas (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/pc289j16h?locale=es
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 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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