Physical and sexual violence and health care utilization in HIV-infected persons with alcohol problems

Abstract

We examined interpersonal violence and its association with health care utilization and substance use severity among a cohort of 349 HIV-infected men and women with histories of alcohol problems assessed biannually up to 36 months. Data included demographics, lifetime interpersonal violence histories, age at first violence exposure, recent violence (prior six months), substance use severity and health care utilization (ambulatory visits, Emergency Department (ED) visits, hospitalizations) and adherence to HIV medication. Kaplan-Meier survival curves estimated the proportion of subjects experiencing recent violence. Generalized estimating equation regression models evaluated the relationship between recent violence, utilization and substance use severity over time, controlling for demographics, CD4 counts and depressive symptoms. Subject characteristics included: 79% male; mean age 41 years; 44% black, 33% white and 23% other. Eighty percent of subjects reported lifetime interpersonal violence: 40% physical violence alone, and 40% sexual violence with or without physical violence. First violence occurred prior to age 13 in 46%. Twenty-four (41%) of subjects reported recent violence by 24 and 36 months, respectively. In multivariate analyses, recent violence was associated with more ambulatory visits, ED visits and hospitalizations and worse substance use severity, but not medication adherence. Due to the high incidence and associated increased health care services utilization, violence prevention interventions should be considered for HIV-infected patients with a history of alcohol problems.

Acknowledgments

Support for this study came from the following grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA): RO1-AA13766 (Clinical Impact of HCV and Alcohol in HIV-Infected Persons); RO1-AA11785 (Medication Adherence in Alcohol Abusing HIV Patients); RO1-AA10870 (Enhanced Linkage of Alcohol Abusers to Primary Care). This research was conducted in part in the General Clinical Research Center at Boston University School of Medicine, USPHS grant M01 RR00533. Jane Liebschutz, MD, MPH, was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar during this study.

The authors wish to thank Seville Meli for asssistance in all aspects of the study, and Nicole Tibbets and the staff at DM-Stat for data management and statistical support.

The authors appreciate the contributions of the clinical staff of the HIV Diagnostic Evaluation Unit at Boston Medical Center, including Colleen LaBelle, RN, and Jennifer Doyle, LICSW as well as research assistance provided by: Jacqueline Savetsky, MPH, Jessica Garcia, Laura Weinstein, Sharon Phillips, Vera Doljanskaia, MPH, Kathleen Doyle and Katie Schoolwerth. The authors likewise appreciate the contributions of Howard Libman MD, and the clinical staff at the Beth Israel Deaconess Medical Center.