Prevalence and Social-Structural Correlates of Gender-Based Violence Against Women Living With HIV in Metro Vancouver, Canada

Violence experienced by cisgender (cis) and gender minority women living with HIV is known to be high. More work is needed to better understand how to support women living with HIV who have experienced violence. The objectives of this study are therefore to identify the prevalence and correlates of violence by any perpetrator among women living with HIV in a Canadian setting. Data were drawn from 9 years (January, 2010 to February, 2019) of a longitudinal community-based open cohort study of 350+ cis and trans women living with HIV who were living and/or accessed care in Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment “SHAWNA”). Participants completed baseline and biannual follow-up interviews. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify correlates of recent (last 6 months) violence (physical and/or sexual) by any perpetrator. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CIs) are presented. At baseline, prevalence of violence was high: 95.5% (recent = 19.4%) of participants reported lifetime physical and/or sexual violence, 94.8% (recent = 17.9%) reported lifetime physical violence, and 84.5% (recent = 5.7%) reported lifetime sexual violence. In multivariable logistic regression with GEE, the following variables were associated with higher odds of recent physical/sexual violence: youth (<30 years) (AOR: 1.60, 95% CI [1.15, 2.22]), recent unstable housing/homelessness (AOR: 1.96, 95% CI [1.30, 2.97]), recent food insecurity (AOR: 1.57, 95% CI [1.13, 2.17]), recent incarceration (AOR: 1.85, 95% CI [1.18, 2.91]), recent opioid use (AOR: 1.38, 95% CI [1.04, 1.82]), recent stimulant use (AOR: 2.48, 95% CI [1.72, 3.56]), and lifetime HIV status disclosure without consent (AOR: 1.59, 95% CI [1.13, 2.24]). Trauma- and violence-informed (TVI) policies that include a focus on confidentiality and safe disclosure practices should be integrated into existing housing, incarceration, and harm reduction programs, and HIV care and practice for women living with HIV. Programs and policies that address high levels of violence remain critical.

[1]  Amy A. Conroy,et al.  Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women , 2021, Journal of acquired immune deficiency syndromes.

[2]  J. Shoveller,et al.  In the midst of plenty: Experiences of food insecurity amongst women living with HIV in Vancouver, Canada. , 2021, Health & social care in the community.

[3]  S. Lees,et al.  Exploring the feasibility and acceptability of integrating screening for gender-based violence into HIV counselling and testing for adolescent girls and young women in Tanzania and South Africa , 2021, BMC Public Health.

[4]  K. Hampanda,et al.  Weaponizing HIV: Qualitative interviews with pregnant Zambian women depicting a unique typology of HIV-specific intimate partner violence. , 2021, European journal of obstetrics, gynecology, and reproductive biology.

[5]  M. Bellis,et al.  Cycles of violence in England and Wales: the contribution of childhood abuse to risk of violence revictimisation in adulthood , 2020, BMC Medicine.

[6]  Maureen E. Farrell,et al.  A Pandemic within a Pandemic - Intimate Partner Violence during Covid-19. , 2020, The New England journal of medicine.

[7]  P. Schneider,et al.  Health care practitioners’ responsibility to address intimate partner violence related to the COVID-19 pandemic , 2020, Canadian Medical Association Journal.

[8]  K. Sodeinde,et al.  Intimate Partner Violence Among Women Accessing HIV-Care Services at Tertiary Hospitals in Ogun State, Nigeria: Implications for Policy and Practice , 2020, Journal of interpersonal violence.

[9]  Mylène Fernet,et al.  Trauma-Informed Practices to Address Intersections Between HIV and Intimate Partner Violence Among Women: Perspective of Community Service Providers. , 2020, The Journal of the Association of Nurses in AIDS Care : JANAC.

[10]  N. Pick,et al.  Violence and other social structural factors linked to incarceration for women living with HIV in Metro Vancouver: need for trauma-informed HIV care in prisons and post-Release , 2020, AIDS care.

[11]  Sonja J. Ellis,et al.  Gender Minority Stress: A Critical Review , 2020, Journal of homosexuality.

[12]  R. Labonté,et al.  “Everything Is Perfect, and We Have No Problems”: Detecting and Limiting Social Desirability Bias in Qualitative Research , 2019, Qualitative health research.

[13]  S. Trottier,et al.  Social Determinants of Health and Retention in HIV Care Among Recently Incarcerated Women Living with HIV in Canada , 2019, AIDS and Behavior.

[14]  E. Wiewel,et al.  A Randomized Controlled Trial of a Rapid Re-housing Intervention for Homeless Persons Living with HIV/AIDS: Impact on Housing and HIV Medical Outcomes , 2019, AIDS and Behavior.

[15]  M. Loutfy,et al.  A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study , 2019, Journal of the International AIDS Society.

[16]  C. Varcoe,et al.  Partnering with Indigenous Elders in primary care improves mental health outcomes of inner-city Indigenous patients: Prospective cohort study. , 2019, Canadian family physician Medecin de famille canadien.

[17]  Rebecca J. Macy,et al.  Housing Interventions for Intimate Partner Violence Survivors: A Systematic Review , 2019, Trauma, violence & abuse.

[18]  Amy A. Conroy,et al.  Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S. , 2019, PloS one.

[19]  A. Mcclelland.  “Lock This Whore Up”: Legal Violence and Flows of Information Precipitating Personal Violence against People Criminalised for HIV-Related Crimes in Canada , 2019, European Journal of Risk Regulation.

[20]  D. Operario,et al.  The missing trans women of science, medicine, and global health , 2019, The Lancet.

[21]  S. Greene,et al.  How women living with HIV react and respond to learning about Canadian law that criminalises HIV non-disclosure: ‘how do you prove that you told?’ , 2019, Culture, health & sexuality.

[22]  Mardge H. Cohen,et al.  The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach. , 2018, Social science & medicine.

[23]  T. Kerr,et al.  Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada , 2018, Addiction.

[24]  Jeffrey N. Martin,et al.  Prevalence and correlates of physical and sexual intimate partner violence among women living with HIV in Uganda , 2018, PloS one.

[25]  A. Krüsi,et al.  Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study , 2018, PloS one.

[26]  S. Kirkpatrick,et al.  Food Insecurity and Mental Health among Females in High-Income Countries , 2018, International journal of environmental research and public health.

[27]  Maya I. Ragavan,et al.  The Health of Women and Children After Surviving Intimate Partner Violence , 2017, Violence against women.

[28]  A. Raj,et al.  Impact of Sexual Violence Across the Lifespan on HIV Risk Behaviors Among Transgender Women and Cisgender People Living With HIV , 2017, Journal of acquired immune deficiency syndromes.

[29]  Jacky Vallée.  The Cégep Curriculum : Responding to the Truth and Reconciliation Commission of Canada : Calls to Action , 2017 .

[30]  T. Poteat,et al.  Evidence for action: a call for the global HIV response to address the needs of transgender populations , 2016, Journal of the International AIDS Society.

[31]  P. Nguyen,et al.  High prevalence of risky income generation among street-involved youth in a Canadian setting. , 2016, The International journal on drug policy.

[32]  M. Ford-Gilboe,et al.  EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings , 2015, International Journal for Equity in Health.

[33]  H. Stöckl,et al.  Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis , 2015, AIDS.

[34]  David C. Ribar,et al.  A Longitudinal Analysis of Violence and Housing Insecurity , 2015, SSRN Electronic Journal.

[35]  A. Twycross,et al.  Validity and reliability in quantitative studies , 2015, Evidence-Based Nursing.

[36]  S. Bewley,et al.  “Violence. Enough already”: findings from a global participatory survey among women living with HIV , 2015, Journal of the International AIDS Society.

[37]  M. Boily,et al.  Global epidemiology of HIV among female sex workers: influence of structural determinants , 2015, The Lancet.

[38]  L. Lovern,et al.  The United Nations Declaration on the Rights of Indigenous Peoples , 2015 .

[39]  M. Boyle,et al.  Child abuse and mental disorders in Canada , 2014, Canadian Medical Association Journal.

[40]  C. Garcia-Moreno,et al.  A systematic review of the correlates of violence against sex workers. , 2014, American journal of public health.

[41]  Barbara Perry,et al.  “I Don’t Know Where it is Safe”: Trans Women’s Experiences of Violence , 2014 .

[42]  A. Avery,et al.  Understanding the Revolving Door: Individual and Structural-Level Predictors of Recidivism Among Individuals with HIV Leaving Jail , 2013, AIDS and Behavior.

[43]  D. Wantland,et al.  Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America , 2013, BMC Public Health.

[44]  Charlotte Watts,et al.  Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. , 2013 .

[45]  P. Regmi,et al.  Violence against Women Living with HIV: A Cross Sectional Study in Nepal , 2012, Global journal of health science.

[46]  Stephen W. Baron,et al.  Factor Structure and Reliability of the Childhood Trauma Questionnaire and Prevalence Estimates of Trauma for Male and Female Street Youth , 2012, Journal of interpersonal violence.

[47]  N. El-Bassel,et al.  Intimate Partner Violence and HIV Among Drug-Involved Women: Contexts Linking These Two Epidemics—Challenges and Implications for Prevention and Treatment , 2011, Substance use & misuse.

[48]  M. Gill,et al.  Domestic violence screening: prevalence and outcomes in a Canadian HIV population. , 2010, AIDS patient care and STDs.

[49]  T. Kerr,et al.  Safety and danger in downtown Vancouver: understandings of place among young people entrenched in an urban drug scene. , 2010, Health & place.

[50]  Kate Shannon,et al.  Community-based HIV prevention research among substance-using women in survival sex work: The Maka Project Partnership , 2007, Harm reduction journal.

[51]  R. Kimerling,et al.  Intimate partner violence and housing instability. , 2007, American journal of preventive medicine.

[52]  S. Gruskin,et al.  Ensuring Sexual and Reproductive Health for People Living with HIV: An Overview of Key Human Rights, Policy and Health Systems Issues , 2007, Reproductive health matters.

[53]  Andrea Carlson Gielen,et al.  Women living with HIV: Disclosure, violence, and social support , 2000, Journal of Urban Health.

[54]  A. Gielen,et al.  Intimate Partner Violence, Substance Use, and HIV Among Low-Income Women , 2005, Violence against women.

[55]  N. Trocmé,et al.  Pathways to the Overrepresentation of Aboriginal Children in Canada’s Child Welfare System , 2004, Social Service Review.

[56]  A. Gielen,et al.  Intimate Partner Violence, HIV Status, and Sexual Risk Reduction , 2002, AIDS and Behavior.

[57]  A. Gielen,et al.  Women's Lives After an HIV-Positive Diagnosis: Disclosure and Violence , 2000, Maternal and Child Health Journal.

[58]  A. O'Leary,et al.  From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention. , 2004 .

[59]  L. Koenig,et al.  Sexual abuse of girls and HIV infection among women: Are they related? , 2004 .

[60]  C. Fields-Gardner,et al.  Nutrition intervention in the care of persons with human immunodeficiency virus infection: position of the American Dietetic Association and Dietitians of Canada. , 2004, Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada.

[61]  M. Newcomb,et al.  Development and validation of a brief screening version of the Childhood Trauma Questionnaire. , 2003, Child abuse & neglect.

[62]  Jacquelyn C. Campbell,et al.  HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. , 2002, American journal of public health.

[63]  Jacquelyn C Campbell,et al.  Health consequences of intimate partner violence , 2002, The Lancet.

[64]  Jackie Green,et al.  Peer education , 2001, Promotion & education.

[65]  Sally C. Morton,et al.  Violence victimization after HIV infection in a US probability sample of adult patients in primary care. , 2000, American journal of public health.

[66]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[67]  D. Stokols.  Translating Social Ecological Theory into Guidelines for Community Health Promotion , 1996, American journal of health promotion : AJHP.

[68]  C. Olson,et al.  Validation of the Radimer/Cornell measures of hunger and food insecurity. , 1995, The Journal of nutrition.

[69]  M. Ivimey.  Annual report , 1958, IRE Transactions on Engineering Writing and Speech.