CATIE News

11 August 2020 

Intimate partner violence linked to poor health outcomes among women with HIV

  • A British Columbia study examined the impact of intimate partner violence on the health of women with HIV
  • Nearly 60% of women in the study said they had experienced intimate partner violence
  • Women were more likely to die of chronic health conditions if they experienced this violence

The widespread availability of potent HIV treatment (ART) has made HIV a chronic condition in Canada and other high-income countries. The power of ART is so immense that many ART users will have near-normal life expectancy

Despite the tremendous benefit of ART, not everyone who uses it experiences prolonged survival, likely due to socio-economic and structural issues. 

A team of researchers at the BC Centre for Excellence in HIV/AIDS has been studying the impact of intimate partner violence (IPV) on the survival of women living with HIV. The researchers found that HIV-positive women who experience severe IPV were twice as likely to subsequently die compared to HIV-positive women who did not experience severe IPV. The researchers proposed interventions to help prevent IPV and to help survivors. 

Study details

As part of a study on health services in B.C. called LISA, researchers recruited 1,000 HIV-positive people. There were 264 women, including nine transgender women. A total of 260 women chose to respond to survey questions about IPV and their data was used in the study. The survey was done at the point of enrollment. Key characteristics included the following:

  • age – 41 years
  • major ethno-racial groups: White – 49%; Indigenous – 45%
  • completed high school – 53%
  • currently injecting street drugs – 23%
  • previous imprisonment – 55%

The researchers accessed databases to find out if participants died and what was their likely cause of death.

On average, participants were monitored for about nine years.

According to the researchers, due to study advertisement and recruitment practices, “there was an over-representation of individuals marginalized by sociostructural inequities.” 

Results

Nearly 60% of women in this study disclosed that they had experienced some form of IPVphysical, emotional, sexualat some point in their lives.

Women who experienced any form of IPV, particularly if it was severe, were more likely to have experienced the following:

  • imprisonment
  • current or past depression
  • violence before the age of 16

Survival

Over the course of the study, 63 women (about 25%) died. There were no significant differences in the causes of death between women who had experienced or who did not experience IPV. However, researchers did notice one trend: Women who experienced severe IPV were more likely to have died from “a chronic disease or comorbidity.”

In addition, the researchers found that many HIV-positive women who experienced any form of IPV were also likely to have died from “alcohol-related or drug-related deaths.”

Women who experienced severe IPV “had the highest proportion of deaths (32%) and the highest age-adjusted mortality rate.”

The risk of death among women who experienced severe IPV was more than twofold greater than in women who had never experienced IPV. 

Women who experienced any degree of IPV were between three to five times more likely to die than the average HIV-negative woman in British Columbia.

IPV research

The study team noted that other research has found that “experiencing multiple forms of violence beginning at a young age cumulates to perpetuate a vicious cycle of poverty, abuse, lack of educational opportunities, substance use, and increased chronic diseases.”

Policy goals

According to the B.C. team, past research has found that “women are particularly vulnerable to IPV when they disclose their HIV status to their intimate partners.” Therefore, the team recommended that “strategies need to be developed and evaluated to support women to safely disclose their HIV status when they wish to. Currently, there is a lack of evidence-based approaches to achieve this.”

The researchers found that relatively few women were accessing support services for survivors of IPV. They recommended that “there is a need to use universal trauma-aware care. Providers should recognize experiences of trauma and supports should then be tailored to respond to syndemic effects of substance use, violence and HIV/AIDS.”

“As recommended by the WHO [World Health Organization], HIV care for [women] should be women-centred and integrated into sexual and reproductive health and rights services more broadly. Healthcare worker awareness, a supportive environment, and appropriate and timely responses are necessary to ensure that women living with HIV are not retraumatized by power imbalances within the professional-patient relationship.” The B.C. researchers cited a previous Alberta study that found that once care providers and patients had established a rapport, HIV-positive women appreciated being asked about “their experiences of violence.”

The study team underscored the need for much more research, particularly into finding “effective programs to prevent and respond to IPV” that involve trauma-aware care. 

The team also raised the need to do more research on IPV in general, “through prioritizing studies by, with, and for women living with HIV who have experienced or are at risk of experiencing IPV.”

Sean R. Hosein

RESOURCES:

 

REFERENCE:

Closson K, McLinden T, Parry R, et al. Severe intimate partner violence is associated with all-cause mortality among women living with HIV. AIDS. 2020;34(10):1549-1558.