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Sexual Minority Status and Violence Among HIV Infected and At-Risk Women

  • Original Research
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Journal of General Internal Medicine Aims and scope Submit manuscript

A Capsule Commentary to this article was published on 03 May 2014

ABSTRACT

IMPORTANCE

Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence.

OBJECTIVE

To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV.

DESIGN & PARTICIPANTS

Longitudinal study of 1,235 HIV infected and 508 uninfected women of the Women's Interagency HIV Study (WIHS) cohort, from New York City, NY, Chicago, IL, Washington D.C., and San Francisco, CA, 1994–2012.

MAIN MEASURES

Primary exposures are sexual identity (heterosexual, bisexual, lesbian/gay) and sexual behavior (male, female, or male & female partners). Primary outcomes are sexual abuse, intimate partner violence (IPV) and physical violence; high-risk sex and substance use were examined as mediators.

KEY RESULTS

Bisexual women were at increased odds for sexual abuse [aOR 1.56 (1.00, 2.44)], IPV [aOR 1.50 (1.08, 2.09)], and physical violence [aOR 1.77 (1.33, 2.37)] compared to heterosexual women. In a separate analysis, women who reported sex with men and women (WSMW) had increased odds for sexual abuse [aOR 1.65 (0.99, 2.77], IPV [aOR 1.50 (1.09, 2.06)] and physical violence [aOR 2.24 (1.69, 2.98)] compared to women having sex only with men (WSM). Using indirect effects, multiple sex partners, cocaine and marijuana were significant mediators for most forms of abuse. Transactional sex was only a mediator for bisexual women. Women who reported sex only with women (WSW) had lower odds of sexual abuse [aOR 0.23 (0.06, 0.89)] and physical violence [aOR 0.42 (0.21, 0.85)] compared to WSM.

CONCLUSIONS

Women who identify as bisexual or report both male and female sex partners are most vulnerable to violence; multiple recent sex partners, transactional sex and some types of substance use mediate this relationship. Acknowledging sexual identity and behavior, while addressing substance use and high-risk sex in clinical and psychosocial settings, may help reduce violence exposure among women with and at-risk for HIV.

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Acknowledgements

Maria Pyra had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis. Data in this manuscript were collected by the Women's Interagency HIV Study (WIHS) Collaborative Study Group with centers (Principal Investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); and Data Coordinating Center (Stephen Gange). The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). The study is co- funded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI Grant Number UL1 RR024131). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Hektoen Institute, 2225 W Harrison St, Suite B, Chicago, IL, 60612, USA

    Maria Pyra MPH

  2. CORE Center, Cook County Bureau of Health Services, Chicago, IL, USA

    Kathleen Weber RN, BSN & Mardge H. Cohen MD

  3. SUNY Downstate Medical Center, Brooklyn, NY, USA

    Tracey E. Wilson PhD

  4. University of California San Francisco, San Francisco, CA, USA

    Jennifer Cohen MPA

  5. Montefiore Medical Center, Bronx, NY, USA

    Lynn Murchison MPH

  6. Georgetown University Medical Center, Washington, DC, USA

    Lakshmi Goparaju PhD

  7. Departments of Medicine, Rush University and Stroger Hospital, Chicago, IL, USA

    Mardge H. Cohen MD

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  1. Maria Pyra MPH
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  2. Kathleen Weber RN, BSN
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Correspondence to Maria Pyra MPH.

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Pyra, M., Weber, K., Wilson, T.E. et al. Sexual Minority Status and Violence Among HIV Infected and At-Risk Women. J GEN INTERN MED 29, 1131–1138 (2014). https://doi.org/10.1007/s11606-014-2832-y

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  • DOI: https://doi.org/10.1007/s11606-014-2832-y

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