1. Collaborative Effort of HIV, Domestic Violence and Homeless Service Organizations to Develop Integrated Services as Strategy for HIV Risk Reduction for Women Zupenda M. Davis, MPH, CHES Susan B. Spencer, MSW, LCSW

2. Women and HIV/AIDS (Centers for Disease Control & Prevention, 2005) HIV/AIDS – Women represent 26% of all HIV cases – 5 th leading cause of death among all women aged 35-44 – 6 th leading cause of death among all women aged 25-34 – High-risk heterosexual contact primary source of HIV infection

3. Women and Domestic Violence (Centers for Disease Control & Prevention, 2006) Each year, women experience about 4.8 million intimate partner related physical assaults and rapes. Domestic Violence (DV) resulted in 1,544 deaths in 2004. Of these deaths, 25% were males and 75% were females. Many DV victims suffer from physical injuries and are harmed emotionally. Emotional abuse can lead to eating disorders, depression and thoughts of or committing suicide.

4. Women, HIV and Domestic Violence (Centers for Disease Control & Prevention, 2005; 2006) HIV+ women or Women at risk for HIV – Women’s attempts to negotiate condom use with male partners often result in threats of or actual violence – Disclosure of HIV status may result in violence from partner – Inequality in relationships & SES stresses experienced by HIV+ women are risk factors for DV Victims of Domestic Violence – Victims more likely to smoke, abuse alcohol, use drugs, & engage in risky sexual activity – Women experiencing powerlessness less likely to negotiate condom use – Sexual abuse increases likelihood of STIs & HIV infection

5. Homelessness and HIV (National Prevention Information Network, n.d.) ~ 3.5 million people are homeless over the course of a year HIV prevalence among various subpopulations of homeless estimated to be 8.5 - 62% Many of the homeless are street youth, women street sex workers and those with Mental Health issues – More prone to be Injection Drug Users and engage in high risk sex behaviors that lead to HIV infection Homeless have limited access to overall medical care, HIV prevention methods and medical treatment

6. Homelessness and DV (National Coalition for the Homeless, 2009) Victims of DV who leave their abusers often have no where to go 63% of homeless women and 28% of homeless families have experienced DV sometime in their lifetime Many female DV victims experience challenges getting an apartment due to – Poor credit scores – High unemployment rates – Leasing offices discomfort with renters who have restraining orders Many DV shelters filled to capacity

7. Prevention and Intervention AIDS-Related Services for Survivors of Domestic Violence Program funded by U. S. Department of Health & Human Services- Office on Women’s Health Cross Training of Philadelphia HIV & DV providers HIV & DV Update for Office of Supportive Housing Collaborative Approach Towards Systems Integration

8. Office of Supportive Housing Training Women Against Abuse (Domestic Violence Shelter) – HIV update – Sexual safety planning Kirkbride Center (Family Homeless Shelter) – HIV & DV updates – Sexual safety planning Red Shield Family Residence (Trauma-informed Shelter) – HIV update – Sexual safety planning extension

9. Multi-Systems Integration Approach Challenges – Office of Supportive Housing Sites Limited time with intake Mistrust of residents Comfort level to discuss violence and sexual history Solutions – HIV & DV providers informed homeless shelters Types of services/resources Who should be referred – Inclusion of questions about violence & sexual history in shelter intake form Opportunity for follow- up

10. Recommendations Educate all HIV, DV and homeless service providers about HIV & DV – Office of Supportive Housing (OSH) Include screening questions for DV ID resources to refer female consumers who need or may benefit from HIV & DV services AIDS Activities Coordinating Office – Integrate HIV prevention & OSH Effective integration of systems – Deliver to those who should provide services – Learn way to introduce consumers to site

11. Outcomes Consumers identified as HIV+ through testing Social worker asked relevant questions – People who were lost to care were found Shelter system talked about sexual safety, HIV & STIs Shelters learned where to refer consumers based on consumer need – Providers walked clients directly to clinics for services

12. References Centers for Disease Control and Prevention. (2005). HIV/AIDS among women (Fact sheet). Retrieved November 1, 2009, from http://www.cdc.gov/hiv/topics/women/ resources/factsheets/pdf/women.pdf Centers for Disease Control and Prevention. (2006). Understanding intimate partner violence (Fact sheet). Retrieved October 10, 2009, from http://www.cdc.gov/ violenceprevention/pdf/IPV-FactSheet.pdf National Coalition for the Homeless. (2009). Domestic violence and homelessness. Available at http://www.nationalhomeless.org

13. References National Prevention Information Network. (n.d.) The homeless. Retrieved November 1, 2009, from http://www.cdcnpin.org/scripts/population/homeless.asp