High rates of lifetime and recent violence observed among harder-to-reach women living with HIV

Abstract

This study examined the prevalence and correlates associated with lifetime and recent violence among a sample of harder-to-reach human immunodeficiency virus (HIV)-positive women living in British Columbia (BC), Canada. Interviewer-led surveys with 1000 participants gathered quantitative data on social, economic, and structural characteristics such as housing status, relationship status, family structure, history of drug use, and sexual behavior. Logistic regression analysis modeled associations between independent variables and experiences of violence at baseline. Cox regression analyses with time-dependent covariates determined correlates of lifetime and recent violence among HIV-positive women. Of the 249 women in the study, an overwhelming proportion of women (81%) reported experiences of violence in their lifetime. Among those, 22% reported recent experiences of violence, and 56% of the women reported more than five violent episodes in their lifetime. Lifetime violence was independently associated with HIV-related stigma (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [CI] = 1.14–5.70), previous tobacco use (AOR = 2.79, 95% CI = 1.10–7.07), ever having a drinking problem (AOR = 2.82, 95% CI = 1.28–6.23), and ever having received care for a mental health condition (AOR = 2.42, 95% CI = 1.06–5.52). Recent violence was associated with the current illicit drug use (AOR = 2.60, 95% CI = 1.14–5.90), and currently residing in unstable housing (AOR = 2.75, 95% CI = 1.31–5.78). This study underscores the need to consider potential experiences of historical and current violence as part of comprehensive care for women living with HIV.

Keywords:

• HIV/AIDS
• women
• violence
• ART
• social determinants of health

Acknowledgments

The LISA Project is supported by the Canadian Institutes of Health Research (CIHR) and the British Columbia Centre for Excellence in HIV/AIDS. Dr. Montaner is a recipient of an Avant-Garde Award from the National Institute on Drug Abuse (NIDA) at the US National Institute of Health (NIH). We thank Eirikka K. Brandson for her contribution to early versions of the manuscript and data collection, and Erin Ding and Kimberly A. Fernandes for their help with statistical analyses. We are also grateful for the contributions of the co-investigators of the LISA project: Dr. Rolando Barrios, Dr. David Burdge, Dr. Marianne Harris, Dr. David Henderson, Dr. Thomas Kerr, Dr. Julio S.G. Montaner, Dr. Thomas Patterson, Dr. Eric Roth, Dr. Mark W. Tyndall, Dr. Brian Willoughby, and Dr. Evan Wood. The LISA research team is thankful for the cooperation of our various research sites. We are inspired by their amazing dedication to their clients and the communities they serve. We would especially like to thank the participants of the LISA study who trust us with sensitive and intimate information and share their stories in hopes of supporting research projects that will make a difference in their communities. We humbly listen and interpret their experiences and hope that we are doing them justice.

Dr. Julio Montaner has received grants from Abbott, Biolytical, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. He is also supported by the Ministry of Health Services and the Ministry of Healthy Living and Sport, from the Province of BC; through a Knowledge Translation Award from the CIHR; and through an Avant-Garde Award (No. 1DP1DA026182-01) from the National Institute of Drug Abuse, at the US National Institutes of Health. He has also received support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institute on Drug Abuse, National Institutes of Health Research Office of AIDS Research, National Institute of Allergy & Infectious Diseases, the United States President's Emergency Plan for AIDS Relief (PEPfAR), Bill & Melinda Gates Foundation, French National Agency for Research on AIDS & Viral Hepatitis (ANRS), Public Health Agency of Canada. He has academic partnerships with the University of British Columbia, Simon Fraser University, Providence Health Care, and Vancouver Coastal Health. Dr. Robert Hogg has held grant funding in the last 5 years from the NIH, CIHR, Health Canada, Merck, and Social Science and Humanities Research Council.