AIDS and Behavior

, Volume 17, Issue 7, pp 2521–2527

HIV Testing and Intimate Partner Violence Among Non-Pregnant Women in 15 US States/Territories: Findings from Behavioral Risk Factor Surveillance System Survey Data

  • Muazzam Nasrullah
  • Emeka Oraka
  • Mathew J. Breiding
  • Pollyanna R. Chavez
Original Paper


Intimate partner violence (IPV) has been shown to be associated with higher rates of HIV infection among women, underscoring the importance of encouraging IPV victims to receive HIV testing. However, we do not know how much HIV testing behavior is influenced by IPV victimization. The current study characterized the association between individual types of IPV and HIV testing in a large sample of non-pregnant women in 15 US states/territories. The 2005 Behavioral Risk Factor Surveillance System data were analyzed after restricting the sample to non-pregnant women. The dependent variable, whether a woman ever had an HIV test, was examined in relation to individual types of IPV victimization (threatened physical violence; attempted physical violence; completed physical violence; and unwanted sex). Associations between HIV testing and types of IPV were assessed using adjusted risk ratios (aRR) that controlled for demographics and HIV-related risk factors (intravenous drug use, sexually transmitted diseases, exchange sex, unprotected anal sex). Approximately 28.6 % of women reported ever having experienced IPV, and 52.8 % of these women reported being tested for HIV. Among women who had not experienced IPV, 32.9 % reported ever having been tested for HIV. HIV testing was associated with lifetime experience of threatened violence (aRR = 1.43; 95 % CI = 1.24−1.65), attempted violence (aRR = 1.43; 95 % CI = 1.20−1.69), completed physical violence (aRR = 1.30; 95 % CI = 1.13−1.48), and unwanted sex (aRR = 1.66; 95 % CI = 1.48−1.86). Women who experienced each type of IPV were more likely to have been ever tested for HIV compared to women with no IPV history. However, nearly half of those reporting IPV, even though at greater risk for HIV infection, had never been tested. Additional efforts are needed to address barriers to testing in this group.


HIV/AIDS HIV test Violence Women 


  1. 1.
    Centers for Disease Control and Prevention. Twenty-five years of HIV/AIDS—United States, 1981–2006. MMWR Morb Mortal Wkly Rep. 2006;55(21):585–9.Google Scholar
  2. 2.
    El-Bassel N, Gilbert L, Wu E, Chang M, Gomes C, Vinocur D, et al. Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening. Emerg Med J. 2007;24(4):255–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Lichtenstein B. Domestic violence, sexual ownership, and HIV risk in women in the American deep south. Soc Sci Med. 2005;60(4):701–14.PubMedCrossRefGoogle Scholar
  4. 4.
    El-Bassel N, Gilbert L, Krishnan S, Schilling R, Gaeta T, Purpura S, et al. Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department. Violence Vict. 1998;13(4):377–93.PubMedGoogle Scholar
  5. 5.
    Hathaway JE, Mucci LA, Silverman JG, Brooks DR, Mathews R, Pavlos CA. Health status and health care use of Massachusetts women reporting partner abuse. Am J Prev Med. 2000;19(4):302–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Chandrasekaran V, Krupp K, George R, Madhivanan P. Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India. Indian J Med Sci. 2007;61(5):253–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Fonck K, Leye E, Kidula N, Ndinya-Achola J, Temmerman M. Increased risk of HIV in women experiencing physical partner violence in Nairobi, Kenya. AIDS Behav. 2005;9(3):335–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A. Intimate partner violence and HIV infection among married Indian women. JAMA. 2008;300(6):703–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Decker MR, Seage GR III, Hemenway D, Raj A, Saggurti N, Balaiah D, et al. Intimate partner violence functions as both a risk marker and risk factor for women’s HIV infection: findings from Indian husband-wife dyads. J Acquir Immune Defic Syndr. 2009;51(5):593–600.PubMedCrossRefGoogle Scholar
  10. 10.
    Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate partner violence surveillance: uniform definitions and recommended data elements,version 1.0. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention: 2002.Google Scholar
  11. 11.
    Decker MR, Silverman JG, Raj A. Dating violence and sexually transmitted disease/HIV testing and diagnosis among adolescent females. Pediatrics. 2005;116(2):e272–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Wingood GM, DiClemente RJ, Raj A. Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters. Am J Prev Med. 2000;19(4):270–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Bauer HM, Gibson P, Hernandez M, Kent C, Klausner J, Bolan G. Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases. Sex Transm Dis. 2002;29(7):411–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Martin SL, Curtis S. Gender-based violence and HIV/AIDS: recognising links and acting on evidence. Lancet. 2004;363(9419):1410–1.PubMedCrossRefGoogle Scholar
  15. 15.
    Kalichman SC, Williams EA, Cherry C, Belcher L, Nachimson D. Sexual coercion, domestic violence, and negotiating condom use among low-income African-American women. J Womens Health. 1998;7(3):371–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Eby KK, Campbell JC, Sullivan CM, Davidson WS II. Health effects of experiences of sexual violence for women with abusive partners. Health Care Women Int. 1995;16(6):563–76.PubMedCrossRefGoogle Scholar
  17. 17.
    Centers for Disease Control and Prevention. US Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women. MMWR Recomm Rep. 1995;44((RR-7)):1–15.Google Scholar
  18. 18.
    Maher JE, Peterson J, Hastings K, Dahlberg LL, Seals B, Shelley G, et al. Partner violence, partner notification, and women’s decisions to have an HIV test. J Acquir Immune Defic Syndr. 2000;25(3):276–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Breaking the silence on abuse of women and HIV. AIDS Wkly. 2000;21.
  20. 20.
    Centers for Disease Control and Prevention. BRFSS annual survey data—survey data and documentation; 2009. Accessed 10 May 2011.
  21. 21.
    Centers for Disease Control and Prevention. Behavioral risk factor surveillance system (BRFSS), 2005 summary data quality report; 2012. Accessed 6 April 2012.
  22. 22.
    Breiding MJ, Black MC, Ryan GW. Chronic disease and health risk behaviors associated with intimate partner violence-18 US states/territories, 2005. Ann Epidemiol. 2008;18(7):538–44.PubMedCrossRefGoogle Scholar
  23. 23.
    Gielen AC, McDonnell KA, Burke JG, O’Campo P. Women’s lives after an HIV-positive diagnosis: disclosure and violence. Matern Child Health J. 2000;4(2):111–20.PubMedCrossRefGoogle Scholar
  24. 24.
    North RL, Rothenberg KH. Partner notification and the threat of domestic violence against women with HIV infection. N Engl J Med. 1993;329(16):1194–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Koenig LJ, Whitaker DJ, Royce RA, Wilson TE, Callahan MR, Fernandez MI. Violence during pregnancy among women with or at risk for HIV infection. Am J Public Health. 2002;92(3):367–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Smith PB, Buzi RS, Weinman ML. HIV testing and counseling among adolescents attending family planning clinics. AIDS Care. 2005;17(4):451–6.PubMedCrossRefGoogle Scholar
  27. 27.
    National HIV/AIDS strategy for the United States. Washington DC: White House; 2010. Accessed 1 July 2012.
  28. 28.
    Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep. 2001;50(RR-19):1–57 quiz CE1-19a1–CE6-19a1.Google Scholar
  29. 29.
    Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1–17 quiz CE1-4.PubMedGoogle Scholar
  30. 30.
    Hutchinson AB, Corbie-Smith G, Thomas SB, Mohanan S, del Rio C. Understanding the patient’s perspective on rapid and routine HIV testing in an inner-city urgent care center. AIDS Educ Prev. 2004;16(2):101–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Health Resources and Services Administration (HRSA). HRSA Care Action: Intimate Partner Violence: US Department of Health and Human Services (2009).Google Scholar
  32. 32.
    Koenig LJ, Moore J. Women, violence, and HIV: a critical evaluation with implications for HIV services. Matern Child Health J. 2000;4(2):103–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2013

Authors and Affiliations

  • Muazzam Nasrullah
    • 1
  • Emeka Oraka
    • 2
  • Mathew J. Breiding
    • 3
  • Pollyanna R. Chavez
    • 1
  1. 1.Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.ICF International at the Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Division of Violence Prevention, National Center for Injury Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations