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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control.

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Presentation on theme: "To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control."— Presentation transcript:

1 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection HIV Determinants Webinar Series: Intimate Partner Violence and Sexual Abuse HIV Prevention Program HIV/AIDS and Hepatitis Section Florida Department of Health 1

2 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Learning Objectives Understand the intersection between intimate partner violence (IPV), sexual assault (SA) and HIV/AIDS Describe the incidence of IPV and SA in Florida and among our target populations Screening for clients who are risk of IPV and SA 10/11/20142

3 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Why are we talking about this? For us to be able to provide optimal support for people living with (or at risk for) HIV/AIDS, it is important to understand we will encounter individuals who are survivors of IPV and/or SA. Sex workers and victims of human trafficking are often victims of sexual assault.

4 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection The intersection of IPV, SA, and human trafficking/sex work Elements of power and control Victims are primarily women and children Victims are traumatized Abuse takes many forms (verbal, physical, emotional, sexual, economic)

5 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection The intersection of IPV, SA, and human trafficking/sex work continued Mistrust of law enforcement and/or other agencies Safety planning is critical Risk of HIV/AIDS and other STDs

6 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection IPV, SA and HIV/AIDS services providers are all… Accustomed to working with multiple systems Understanding of empowerment-based, survivor/client-centered advocacy and case management Savvy about issues of confidentiality Crisis responders

7 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Poll Question #1 Do you know or suspect you have encountered someone who has experienced IPV, SA, or human trafficking? 10/11/20147

8 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Statistics

9 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Florida’s DV Offenses (2012) Murder191 Manslaughter11 Forcible Rape981 Forcible Sodomy377 Forcible Fondling931 Aggravated Assault16,828 Aggravated Stalking192 Simple Assault85,929 Threat/Intimidation2,209 Stalking397 Total108,046 Source: 2009 Florida Uniform Crime Report. Florida Department of Law Enforcement. Available at Accessed December 9, 2013

10 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Florida’s SA offenses (2012) Rape by Force 4,960 Attempted Rape 2,94 Forcible Sodomy 1,375 Forcible Fondling 3,516 Total Forcible Sex Offenses 10,145 Source:Source: 2012 Florida Uniform Crime Report. Florida Department of Law Enforcement. Available at Accessed December 10, /11/201410

11 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Florida’s human trafficking offenses (2010) Of the 55 human trafficking victims served in Florida in 2010: 33 were male/22 were female 52 were adults/3 were children 50 were labor trafficking victims 5 were sex trafficking victims Source: Florida Human Trafficking Report. Florida Department of Children and Families. Available at Accessed December 10, /11/201411

12 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection One in every three women and one in ten men will experience IPV or sexual assault in his/her lifetime. Source: National Intimate Partner and Sexual Violence Survey – 2010 Summary Report,” National Center for Injury Prevention and Control Division of Violence Prevention (2010). Available at Accessed December 10, Sexual assault occurs in approximately 40-45% of relationships where IPV is present. Source: Campbell, et al. “Assessing Risk Factors for Intimate Partner Homicide.” National Institute of Justice Journal. Washington, D.C. U.S. Department of Justice (2003)

13 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Source: Sareen, et al. "Abusive Relationships Increase Women’s Risk Of HIV Infection." Center for Advancing Health. ScienceDaily 25 May Available at: Accessed April 15, 2010 Abused women are more than three times as likely to contract HIV as women who are not in violent relationships.

14 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection 23% of surveyed men who had lived with another man as a couple reported being raped, physically assaulted and/or stalked. Source: Allen, et al. “Lesbian, Gay, Bisexual and Trans (LGBT) Communities and Domestic Violence: Information and Resources.” National Resource Center on Domestic Violence. (2007). Available at: Full.pdf. Accessed April 6, /11/201414

15 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection A survey of transgender and intersex individuals found that 50% of respondents had been raped or assaulted by a romantic partner, though only 62% of these individuals (31% of the total) identified as survivors of IPV when asked. Source: Fountain and Skolnik. “Lesbian, Gay, Bisexual and Transgender Domestic Violence in 2006: A report of the National Coalition of Anti-Violence Programs.” National Coalition of Anti-Violence Programs. Available at: Accessed December 10, /11/201415

16 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Women who are trafficked for the purpose of sexual exploitation experience a tenfold risk for contracting HIV. Source: Hynes and Raymond (2002) via National Coalition Against Domestic Violence Available at Accessed December 10, /11/201416

17 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection 10/11/ Poll Question #2 A pattern of behavior that includes intimidation, violence, threatening, etc… within an intimate relationship are the major characteristics of?

18 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Working Definition of IPV The legal definition of IPV (domestic violence) is specific, the working definition refers to a much broader range of behaviors used by individuals to exert power and control over their partner.

19 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Specifically… IPV is a pattern of behavior used to establish power and control over another person through fear, intimidation, often including the threat or use of violence. IPV happens when one person believes they are entitled to control another.

20 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection The violence occurs in the context of intimate relationships. Occurs in homes regardless of age, income, race, ethnicity, religion, social background, or education level. Results in physical injury, psychological trauma, and sometimes death. Specifically… continued

21 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Specifically… continued Crosses generations and lasts a lifetime Is a subset within a larger societal problem of violence against women including oppression, sexual assault, incest, prostitution, sexual harassment, human trafficking, etc.

22 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Myth: Only women are victims of IPV. Fact: Approximately 85% of those who experience IPV are women; however, in some cases, women are the abusers and their male partners the victims. IPV also occurs in same gender relationships. Source: Bureau of Justice Statistics Crime Data Brief, Intimate Partner Violence, , February 2003.

23 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Myth: Abuse is about a loss of self control Fact: Abusers select their targets. They choose the circumstances of their violence, including the amount of injury inflicted by their acts. Abuse is about an attempt to control the behavior and/or emotional/intellectual life of the other person. They have learned that violence works to achieve this end.

24 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Myth: Alcohol or drug use causes IPV. Fact: Addictions are used as excuses to free the abuser from responsibility for the behavior. This myth does not explain why the abuser uses violence, why partners are targeted for abuse, or why s/he abuses when sober. The abuser will not necessarily stop abusing if s/he gains control over his addiction.

25 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Myth: Victims of IPV should just leave. Fact: The most dangerous time for someone who is being abused is when s/he tries to leave. There are times when it will be safer to stay.

26 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection IPV is… A choice A learned behavior Tacitly supported by society A behavior the survivor does not control A crime

27 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Power and Control Wheel The power and control wheel was developed to illustrate the various tactics an abuser uses on his partner. At the center of the wheel is the abuser’s need to get and keep power and control over the survivor’s life. Each spoke contains a tactic used to control the victim. Source: Domestic Abuse Intervention Programs, The Duluth Model. Power and Control Wheel. Available at: Accessed April 2, 2010

28 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection 10/11/

29 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Examples of Physical Violence Slapping Scratching Punching Hair pulling Biting Twisting limbs Pushing Kicking Harming pets Stabbing Strangulation Shooting

30 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Examples of Sexual Violence Forced exposure to pornography Forced sex Unwanted sexual acts, touching, advances Forced prostitution Forced pregnancy Forced sex with others Transmitting HIV or STDs

31 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection 10/11/

32 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Continuum of Abuse… Over time, the layering effect may adversely influence the survivor’s coping responses, confidence and self- esteem.

33 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection There is no “typical abuser” Most abusers choose to abuse because the choice is there to make and they believe they have the right.

34 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Which of the following HIV risk factors are common for survivors of IPV, SA and Human Trafficking? Choose one: 10/11/ Poll Question #3

35 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Risk of HIV/AIDS for Survivors of IPV Unfaithful partners Partners refuse to wear condoms Sexual assault Forced or coerced sex work Self-medication/IDU Lack of information & fear of seeking help

36 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection HIV/AIDS and IPV Partners prevent access to health care and/or withhold necessary medications Partners threaten to “out” survivor’s status Partners make other threats related to status Isolation from family, friends and the community

37 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Risk of HIV for survivors of SA Trauma is more likely (sexual, fight wounds, etc.) Possible multiple assailants Assailants refuse to use condoms Assailant may have multiple partners/victims; increases risk of other STDs Risk increases with multiple assaults Shame, embarrassment, blaming self, self medicating/IDU, etc. 10/11/201437

38 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection HIV/AIDS and SA SA is grossly under reported - survivors don’t receive treatment Emotional trauma can affect medication adherence Isolation from family, friends and the community 10/11/201438

39 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Risk of HIV/AIDS for Survivors of Human Trafficking and/or Sex Workers Sexual assault Forced or coerced sex work, specifically acts that are associated with increased risk No access to condoms IDU Lack of information & fear of seeking help

40 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection HIV/AIDS and sex work/human trafficking Sex workers/human trafficking victims are seen as expendable Less access to testing, health care, necessary medications, condoms, etc. Isolation from family, friends and the community

41 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Which of the following are common characteristics of a survivor of sexual assault, IPV and human trafficking seeking health care? Choose one: 10/11/ Poll Question #4

42 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection What Do You Do Now?

43 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection  Screen for indicators of IPV, sexual assualt and/or human trafficking  Safety Plan  Use an empowerment-based, survivor/client-centered approach  Educate yourself about potential remedies (domestic violence services providers, legal aid, local trafficking task force, etc.)  Provide linkage to community resources

44 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for Abuse Common injury sites: head, face, neck, areas usually covered by clothing- chest, breast, abdomen, etc. Common injury types: Contusions, abrasions, lacerations, fractures, sprains, eye or ear trauma, loose teeth

45 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for abuse continued Injury to multiple sites Injuries that don’t fit with provided explanations Injuries in various stages of healing Injuries during pregnancy

46 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for abuse continued Miscarriages and spontaneous or multiple abortions Pregnancy complications Frequent vaginal and urinary tract infections, pelvic pain

47 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for abuse continued Pain with no visible sign of injury Chronic pain/headaches Anxiety or PTSD Substance abuse/self-medication

48 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for Abuse continued Noncompliance with treatment regimens Partner limits access to medical care Missed appointments Failure to use condoms/birth control

49 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for abuse continued Reluctance to speak or disagree in front of partner Minimalizing extent of injuries Partner insists on attending appointments Overt displays of possessiveness by partner

50 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Screening for sex work/human trafficking Only very rarely will someone self-identify If your intuition tells you someone is trafficked, there are certain questions to ask Gentleness and sensitivity must be exercised when seeking information

51 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Who is Trafficked? Men, women and children (women and children most often) The most vulnerable The poor People with disabilities The very young or old People with low literacy skills or education Non-English speaking People from other countries People within the U.S. (for example, runaway and homeless youth)

52 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Trafficking happens in Florida Tourism = low wage, unskilled labor, sex labor Military bases = sex labor Both a transition and destination location 10/11/201452

53 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection What Do Trafficked Persons Do? Domestic servitude Restaurants, bars, etc. Hotels Service industries Cleaning services Mail order brides Food processing Factories Construction Migrant farm work Computers Begging Sex trade Drug trade

54 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Examples ‘Mail order brides’ forced into domestic servitude Women made to work in strip clubs Women forced into prostitution U.S. citizens trafficked into the sex trade

55 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Asking Questions Origins Status Employment Safety Community

56 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection A good client-centered approach is assuming someone is in crisis mode and/or incapable of making decisions, and you know what is best for him/her. True or False? 10/11/ Poll Question #5

57 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Safety Planning Inquire about safety generally, then specifically- use ‘if/then’ Remember that a safety plan is personalized A safety plan will change over time Consider partner notification

58 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection A client-centered approach is Recognizing one’s professional power in order not to impose it on the survivor Being honest, authentic and trustworthy Expecting and accepting ambivalence Remember that you may be an expert on HIV but the survivor is an expert on their experience

59 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection A client-centered approach is not Informing a survivor that you know what is best Assuming you know everything about a survivor’s experiences Assuming s/he is in a crisis mode and is incapable of making decisions Concentrating on challenges rather than focusing on strengths

60 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Factors influencing decisions Fear of the abuser Love Threats of personal harm, harm of loved ones or pets Threats of suicide Believing the abuser will take the children Traumatic Bonding Syndrome (Stockholm) 10/11/201460

61 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Factors influencing decisions continued Religious beliefs Believing the abuser will change Self-blame Limited financial options Believing that violence is normal Believing in the sanctity of marriage and the family 10/11/201461

62 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Factors influencing decisions continued Limited housing options Blaming abuse on alcohol, financial pressures, or other outside factors Low self-esteem Fear of the unknown, of change Isolation 10/11/201462

63 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Factors influencing decisions continued Embarrassment and shame Believing no one can help/will help Cultural beliefs Denial Pressure from friends and family to stay Believing the abuse will escalate, especially if abuser’s behavior becomes public 10/11/201463

64 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Poll Question #6 Do you know or suspect you have encountered someone who has experienced IPV, SA, or human trafficking? 10/11/201464

65 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Education and Resources: Florida Coalition Against Domestic Violence Domestic Violence Hotline (800) *2 Domestic Violence Legal Hotline (800) *3 Florida Council Against Sexual Violence Rape Crisis Hotline (888) Addressing the Intersection of HIV/AIDS, Violence against Women and Girls, & Gender-Related Health Disparities hiv_working_group_report_final_-_ pdf hiv_working_group_report_final_-_ pdf

66 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Education and Resources: National Coalition Against Domestic violence National Network to End Domestic Violence National Sexual Violence Resource Center CDC – Violence Prevention

67 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Education and Resources: Florida Coalition Against Human Trafficking Florida Dept. of Children and Families – Human Trafficking Program Abuse hotline: (800) Local task force directory: National Human Trafficking Resource Center: (888) hotline/the-nhtrc/overview

68 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Remember… No person wants to live with violence Don’t forget the stigma attached to labels Don’t assume that a person will identify as a victim Consider your own safety

69 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Contact Info HIV/AIDS and Hepatitis Section HIV Prevention Program Jenny Pace, Statewide Training Coordinator Yelitza Zubr, Interventions Specialist 10/11/201469


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