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Violence Linked to Substance Use and Mental Health in BC Women With HIV
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1st International Workshop on HIV and Women, January 10-11, 2011, Washington, DC
Mark Mascolini
Enduring recent or lifetime violence was associated with drinking, illicit drug use, mental health problems, and unstable housing in a study of 249 HIV-positive women in British Columbia [1]. Recent violence more than doubled the risk of illicit drug use in these women.
Research has linked sexual or nonsexual violence to a higher risk of HIV infection, and violence can compromise HIV-related interventions and treatment outcomes. Violence-inspired fear may prevent HIV-positive women from seeking treatment or support or from adhering to antiretroviral therapy. To analyze the impact of lifetime and recent violence on HIV-positive women in British Columbia, researchers interviewed 249 women in the province-wide LISA cohort. All women were taking antiretrovirals and were 19 or older.
The investigators analyzed the impact of both recent violence (within the past 6 months) and any history of violence. They defined violence as being attacked, assaulted (including sexual assault), or suffering any kind of abuse.
Median age of the 249 study participants stood at 42 years (interquartile range [IQR] 35 to 46). Almost half of the women--116 (47%)--identified themselves as having aboriginal ancestry, and 118 (47%) had more than a high school education. Sixty-two women (25%) were in a relationship at the time of the interview. Only 154 women (62%) reported stable housing, and only 59 (24%) had a steady food supply. A large majority of women--216 (87%)--reported using illicit drugs at any time, and 131 (53%) were currently using drugs.
Two hundred and three women (82%) reported enduring violence at any time in their lives, and 44 (22% of 203) reported violence in the past 6 months. Most women--126 (51%)--experienced violence before the age of 16, and 139 women (56%) reported more than five episodes of violence. Women said strangers were the most frequent perpetrators, followed closely by husbands, acquaintances, and family members. The most frequent types of violence were verbal abuse, beating, rape, and emotional or physical abuse by a partner.
Multivariate statistical analysis found the following associations with lifetime experience of violence at the following adjusted odds ratios (AOR) (and 95% confidence intervals):
-- Reporting high stigma: AOR 2.18 (1.30 to 4.59)
-- Ever having a drinking problem: AOR 2.82 (1.28 to 6.23)
-- Ever receiving care for a mental health problem: AOR 2.42 (1.06 to 5.52)
Two factors were independently associated with violence in the past 6 months:
-- Current illicit drug use: AOR 2.60 (1.14 to 5.90)
-- Lack of current stable housing: AOR 2.75 (1.31 to 5.78)
The researchers note that women in this study have free health care, including free antiretroviral therapy, and all women were taking antiretrovirals; so results may not apply to women who do not have free access to care or who are not taking antiretrovirals. Study participants received an honorarium, so poorer women may have been oversampled. The study did not analyze the severity or context of violence, and the investigators could not determine women's possible involvement in sex trade. As in any cross-sectional study, this one could not determine the direction of causality (for example, does violence cause women to drink, or are women who drink more likely to be victims of violence?)
The researchers concluded that "these unacceptably high rates of violence demonstrate the need for improved access to targeted services." They argued that "the effects of such programs on the prevalence and outcomes of violence among HIV-positive women will not be optimized unless the broader social and structural contexts within which violence occurs, such as gender inequity and poverty, are also addressed."
Reference
1. Borwein AM, Chan K, Palmer AK, Miller CL, Montaner JSG, Hogg RS. Violence among a cohort of HIV-positive women on antiretroviral therapy in British Columbia, Canada. 1st International Workshop on HIV and Women. January 10-11, 2011. Washington, DC. Abstract O_11.
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