# Presentation: 703994

## Domestic Violence and HIV

- Linda Koenig, Ph.D.
- Division of HIV/AIDS Prevention
- Centers for Disease Control and Prevention
- Perinatal HIV Prevention Grantee Meeting
- Roundtable Presentation
- February 2002

## Prevalence of violence/abuse during pregnancy: Findings from the Perinatal Guidelines Evaluation Project (PGEP)

- Participants: Pregnant women receiving prenatal care (336 HIV+, 298 HIV- matched for sexual transmission risk behavior) in Connecticut; North Carolina; Brooklyn, NY; Miami, FL
- Method: Interviewed at _>_ 24 weeks gestation
- Measures:
- Physical or sexual violence during the past 6 months
- Main male partner who is physically or emotionally/verbally abusive

## Prevalence of violence/abuse during pregnancy: Findings from PGEP

- 8.9% of women reported recent violence
*	*
- 21.5% of women with a main male partner described him as abusive (5.5% physically, 16.0% verbally/emotionally)
- Recent violence was highest among those with a physically abusive partner but almost 3⁄4 of the women who experienced recent violence were not currently in a relationship with a physically abusive partner

## Recent violence and HIV serostatus

- Recent violence was not associated with serostatus
- However, one woman was physically assaulted by her partner when he learned her positive serostatus
- Women receiving an HIV diagnosis during prenatal care were not at increased risk for violence

## Predictors of violence during pregnancy (PGEP)

- Bivariate predictors include:
- Low income
- Frequent moves
- Recent drug use (marijuana, crack/cocaine)
- Multiple sex partners
- Bartering sex for money

## Predictors of violence during pregnancy (PGEP)

- Independent predictors from multivariate model include:
**Moved more frequently** in prior year (OR=1.6, CI=1.0, 2.4)
**Less** likely to receive **financial support from partners or family** (OR= 0.4, CI=.2,.8)
- More likely to have **recently bartered sex** for money (OR = 12.6, CI=1.9,77.3)

## Implications for programs

- Violence and HIV coexist within common environ-mental and behavioral risk contexts. Consequently, risk for violence is high among all women who access HIV services.
- Violence screening and referral should be integrated into all HIV-related services (C&T, prenatal testing, exposed infant care, HIV treatment)
- Prenatal care setting, with its multiple scheduled provider contacts, may be well-suited to identification and referral; HIV treatment and infant follow-up involve multiple visits too

## What kind of training or services are needed?

- DV screening is endorsed by many professional associations (e.g., ACOG, AMA, Peds) yet often not done. Providers experience many barriers.
- Some states (e.g, CA, NY) have integrated domestic violence training into HIV C & T training, but not typical.
- HIV infected women can have unique periods of risk related to disclosure. Individuals who conduct post-test counseling and partner notification must be particularly aware of risks faced by HIV+ women.

## PAPERS/RESOURCES

- Koenig, LJ, Whitaker, D., Royce, R., Wilson, T.E., Callahan, M., and Fernandez, M.I. for the Perinatal Guidelines Evaluation Project Group. (2002) Violence during pregnancy among women with or at risk for HIV infection. _American Journal of Public Health, 92 (3)._
- Koenig, LJ., and Moore, J.  (2000).  Women, Violence, and HIV:  A Critical Evaluation With Implications for HIV Services.  _Maternal and Child Health Journal_, _4_ (2), 103-109.
- Spitz, A., Goodwin, M.M., Koenig, LJ,** **Saltzman, L, Ramsey, T., and Marks, J. (Eds.) (2000). Violence and Reproductive Health. Special Issue of the _Maternal and Child Health Journal_, _4_, (2).  (Contains articles relevant to HIV disclosure, physician screening practices, violence against women and role of reproductive health care services.
- NYSDOH Guidelines for Integrating Domestic Violence Screening into HIV Counseling, Testing, Referral and Partner Notivfication. _[http://](http://www.health.state.ny.us/nysdoh/rfa/hiv/guide.htm)__[www.health.state.ny.us/nysdoh/rfa/hiv/guide.htm](http://www.health.state.ny.us/nysdoh/rfa/hiv/guide.htm)_
- NYSDOH Protocol – Domestic Violence Screening in Relation to HIV Counseling, Testing, Referral & Partner Notification. _[http://](http://www.health.state.ny.us/nysdoh/rfa/hiv/protocol.htm)__[www.health.state.ny.us/nysdoh/rfa/hiv/protocol.htm](http://www.health.state.ny.us/nysdoh/rfa/hiv/protocol.htm)_
- U.S. Department of Health and Human Services, Centers for Disease Control and prevention. HIV Partner Counseling and Referral Services *Guidance, *December 30, 1998. _[http://](http://www.cdc.gov/hiv/resources/guidelines/pcrs/index.htm)__[www.cdc.gov/hiv/pubs/pcrs.htm](http://www.cdc.gov/hiv/resources/guidelines/pcrs/index.htm)_
- Centers for Disease Control and Prevention. Revised Guidelines for HIV Counseling, Testing and Referral. MMWR, 2001, 50(RR19), 1-58. _[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a1.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a1.htm)_.