1. N ORTHWEST AIDS E DUCATION AND T RAINING C ENTER Relationship Abuse and HIV/STI: Addressing Risks, Offering Support Laura Avellaneda-Cruz, LMSW Alaska Native Tribal Health Consortium Alaska Native Epidemiology Center Presentation prepared by: Laura Avellaneda-Cruz Last Updated: March 25, 2015

2. Images and content created in part by: Rebecca Levenson, MA Linda Chamberlain, MPH, PhD

3. Describe how IPV/SV impact HIV/STI risk Describe how IPV/SV impact health of + patients Reduce risks & improve response Learning Objectives

4. Describe how IPV/SV impact HIV/STI risk

5. What is DV? IPV?

6. A pattern of behaviors Pattern of coercive and controlling behaviors that an adult or teen chooses to use against an intimate partner in order to intimidate and control the victim. For the CDC’s definition of DV, please refer to CDC’s website.

7. Intimate Partner Violence includes Physical violence (hitting, pushing, slapping, choking/strangulation) Emotional or psychological aggression (threatening, humiliating, controlling, isolating, coercive tactics, stalking) Sexual violence (coercive sex, sexual assault, sexual humiliation, control of reproductive or sexual health/ reproductive coercion)

8. What is sexual violence? Any kind of sexual contact without consent

10. What is reproductive coercion?

11. Reproductive Coercion (RC) may include: Explicit attempts to impregnate a partner against her wishes Controlling outcomes of a pregnancy Coercing a partner to have unprotected sex Interfering with birth control methods

12. Silverman et al., 2001 IPV  pregnancy Adolescent girls in physically abusive relationships were 6 times more likely to become pregnant than non-abused girls

13. Miller, et al., 2010 IPV  STIs Nearly half (47.8%) of adolescent girls tested for STI/HIV have experienced physical and/or sexual intimate partner violence.

14. HIV and IPV Among a small sample of HIV-positive men: 73% reported lifetime IPV 20% reported IPV from a current partner

15. IPV and Risk Behaviors Women who experienced past or current IPV are more likely to: Have multiple sexual partners Have a past or current sexually transmitted infection Have a partner with known HIV risk factors (including IDU) Report inconsistent use or nonuse of condoms Inject drugs Wu et al, 2007

16. Ralford et al, 2009 Knowledge isn’t enough Under high levels of fear for abuse, women with high STI knowledge were more likely to use condoms inconsistently than non-fearful women with low STI knowledge.

17. Wingood et al, 2001 2.8 times Girls who experienced physical dating violence were 2.8 times more likely to fear the perceived consequences of negotiating condom use than non-abused girls.

18. Dr. Vincent Felitti Adverse Childhood Experiences (ACEs)  Risk

20. Learning Objectives Describe how IPV/SV impacts health of + patients

21. “ Research shows us that violence is both a significant cause and a significant consequence of HIV infection among women. Judy Auerbach American Foundation for AIDS Research (AmfAR)

22. HIV  IPV Based on a study of 310 HIV-positive women: 45% experienced abuse after being diagnosed with HIV 4% experienced abuse as a direct consequence of disclosing their HIV status Gielen et al, 2000

23. HIV  IPV Based on a study of 56 HIV-positive men: 73% had experienced IPV 29% of those abused felt the abuse was related to their HIV status Gielen et al, 2000

24. Review study by Gielen et al, 2007 HIV and severity of IPV Women who are HIV- positive experience more severe IPV and more frequent abuse compared to HIV- negative women who are experiencing IPV.

25. Lang et al, 2007 HIV and consequences of IPV HIV-positive women who experienced recent IPV were more likely than those without IPV to report: inconsistent condom use abuse stemming from requests for condom use pregnancy Photo: Oscar Avellaneda-Cruz

26. Lichtenstein, 2006 IPV is an under- recognized barrier to obtaining regular care for HIV/AIDS.

27. Implications For Sexually Transmitted Infections/HIV Programs Partner notification may be dangerous for clients experiencing abuse. Clients may not be able to negotiate safe sex with an abusive partner. IPV may be a more immediate threat to a client than a sexually transmitted infection or HIV status. IPV may pose a barrier to visits and treatment

28. Part 2, on April 2nd The Safety Card Approach to Violence Prevention & Intervention Photo: Laura Avellaneda-Cruz, ANTHC