Intimate Partner Violence and HIV Among Drug-Involved Women: Contexts Linking These Two Epidemics—Challenges and Implications for Prevention and Treatment

Abstract

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Keywords :

• HIV
• partner violence
• drug-involved women
• risk factors

THE AUTHORS

Dr. Nabila El-Bassel is a Professor at the Columbia University School of Social Work and Director of the Social Intervention Group (SIG), which was established in 1990 as a multidisciplinary research center on global health. Dr. El-Bassel is also the Director of the Columbia University Global Health Research Center in central Asia. The Center brings together leading multidisciplinary global health experts and creates crosscutting partnerships among governments, nongovernmental organizations, and academic institutions in central Asia. Dr. El-Bassel has been funded extensively by the National Institute of Mental Health and the National Institute on Drug Abuse. She has designed and tested HIV intervention and prevention models for women, men, and couples and has studied the intersecting epidemics of HIV and violence against women.

Louisa Gilbert, Ph.D., is the Codirector of the Global Health Research Center of central Asia and also the Codirector of the SIG at Columbia University School of Social Work. She has served as a Coinvestigator and Investigator on three National Institute of Mental Health (R01) studies and three National Institute on Drug Abuse (R01) studies. She has coauthored more than 50 articles with Dr. El- Bassel and has presented papers at several international and national conferences on HIV/AIDS and substance abuse. Her current area of research examines the relationship between IPV and HIV risk among drug-involved women, with a focus on designing gender-specific HIV prevention interventions that address IPV and other traumas.

Susan Witte, Ph.D., L.C.S.W., is an Associate Professor at the Columbia University School of Social Work and Associate Director of the Columbia University SIG. Witte's research at the SIG focuses on the development and testing of prevention and treatment interventions targeting the co-occurrence of HIV/AIDS risk behaviors, substance abuse, and interpersonal violence and the corresponding mental health consequences of these issues in vulnerable populations. Her current research is focused on the use of multimedia and Web-based technologies in the dissemination of HIV prevention and social-work-related programming, the promotion of female-initiated reproductive health technology including the female condom, and the utility of relationship- and family-based interventions, which move beyond the traditional target of individual behavior change to couples and families. Witte is principal investigator on a number of clinical trials funded by the National Institutes of Health and has presented her clinical and research findings at national and international social work, mental health, and public health conferences.

Elwin Wu, Ph.D., is an Assistant Professor at the Columbia University School of Social Work and an Associate Director at the SIG, where he and his colleagues conduct research targeting the intersection and overlap of HIV/ AIDS, substance abuse, and interpersonal violence. Dr. Wu's program of research covers a range of health services, prevention, and treatment research, all with an emphasis on marginalized populations. His current and recent research projects include an examination of the trajectories through the service system of drug-involved men who perpetrate IPV, identification of the key or active ingredients of alternative to incarceration programs in New York City, and adapting/developing novel behavioral HIV/STI preventive interventions for drug-involved men of color who have sex with men.

Mingway Chang, Ph.D., is a Sociologist and Statistician at the SIG. Dr. Chang has been developing and conducting quantitative analyses of data from observational studies and clinical trials focusing on behavioral intervention in the areas of HIV/AIDS, IPV, and substance abuse. His research interests include mathematical methods for theory building, dyadic data analysis, structural equation modeling, and social network analysis. Recently, Dr. Chang is working on examining discrepancies between partners’ responses in couple data and is developing an analytical approach to deal with measurement errors in couple data.

Notes

2 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.