Journal of General Internal Medicine

, Volume 29, Issue 8, pp 1131–1138

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

  • Maria Pyra
  • Kathleen Weber
  • Tracey E. Wilson
  • Jennifer Cohen
  • Lynn Murchison
  • Lakshmi Goparaju
  • Mardge H. Cohen
Original Research

DOI: 10.1007/s11606-014-2832-y

Cite this article as:
Pyra, M., Weber, K., Wilson, T.E. et al. J GEN INTERN MED (2014) 29: 1131. doi:10.1007/s11606-014-2832-y



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


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.


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.


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.


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.


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.


gay and lesbian health IPV sexual assault HIV/AIDS women’s health 

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Maria Pyra
    • 1
  • Kathleen Weber
    • 2
  • Tracey E. Wilson
    • 3
  • Jennifer Cohen
    • 4
  • Lynn Murchison
    • 5
  • Lakshmi Goparaju
    • 6
  • Mardge H. Cohen
    • 2
    • 7
  1. 1.Hektoen InstituteChicagoUSA
  2. 2.CORE Center, Cook County Bureau of Health ServicesChicagoUSA
  3. 3.SUNY Downstate Medical CenterBrooklynUSA
  4. 4.University of California San FranciscoSan FranciscoUSA
  5. 5.Montefiore Medical CenterBronxUSA
  6. 6.Georgetown University Medical CenterWashingtonUSA
  7. 7.Departments of MedicineRush University and Stroger HospitalChicagoUSA