Physical and Sexual Violence Predictors: 20 Years of the Women's Interagency HIV Study Cohort

Michele R Decker; Lorie Benning; Kathleen M Weber; Susan G Sherman; Adebola Adedimeji; Tracey E Wilson; Jennifer Cohen; Michael W Plankey; Mardge H Cohen; Elizabeth T Golub

doi:10.1016/j.amepre.2016.07.005

Physical and Sexual Violence Predictors: 20 Years of the Women's Interagency HIV Study Cohort

Am J Prev Med. 2016 Nov;51(5):731-742. doi: 10.1016/j.amepre.2016.07.005. Epub 2016 Aug 29.

Authors

Affiliations

¹ Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: mdecker@jhu.edu.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
³ The CORE Center, Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, Illinois.
⁴ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
⁵ Department of Community Health Sciences, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York.
⁶ Department of Clinical Pharmacy, University of California, San Francisco, California.
⁷ Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia.
⁸ Department of Medicine, Stroger Hospital, Chicago, Illinois.

Abstract

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 (AIRR_physical=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.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Female
Follow-Up Studies
Gender-Based Violence / statistics & numerical data*
HIV Infections / psychology
Humans
Sex Offenses
United States

Abstract

Publication types

MeSH terms

Grants and funding