AIDS and Behavior

, Volume 11, Issue 6, pp 842–853 | Cite as

Physical and Sexual Abuse among Homeless and Unstably Housed Adults Living with HIV: Prevalence and Associated Risks

  • Kirk D. Henny
  • Daniel P. Kidder
  • Ron Stall
  • Richard J. Wolitski
Original Paper


We examined the prevalence and risks associated with interpersonal (physical and sexual) abuse among HIV-seropositive homeless or unstably housed adults. Data were obtained from the Housing and Health Study of participants living in Baltimore, Chicago, and Los Angeles (n = 644). We used logistic regression to identify risks associated with abuse. About 77% of men and 86% of women reported ever experiencing abuse. Women were at greater risk than men for intimate partner physical abuse, childhood sexual abuse (CSA), and adulthood sexual abuse. Men and women experiencing intimate partner physical abuse reported increased risk of unprotected sex. Other risks associated with abuse include sex exchange; lifetime alcohol abuse; and depressive symptoms. Abuse prevalence among sample exceeds those found in other samples of general USA, HIV-seropositive, and homeless populations. Identifying persons at risk of abuse is needed to reduce risk among homeless or unstably housed persons living with HIV.


Violence Housing HIV/AIDS Childhood sexual abuse Homeless Physical abuse Sexual abuse IPV CSA 


  1. Aidala, A., Cross, J., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251–265.PubMedCrossRefGoogle Scholar
  2. Allen, D., Lehman, S., & Green, T. (1994). HIV infection among homeless adults and runaway youth, United States 1989–1992. AIDS, 8, 1593–1598.PubMedCrossRefGoogle Scholar
  3. Andresen, E., Malmgren, J., Carter, W., & Patrick, D. (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.PubMedGoogle Scholar
  4. Bassuk, E., Buckner, J., Weinrab, L., Browne, A., Bassuk, S., Dawson, R., et al. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87(2), 241–248.PubMedGoogle Scholar
  5. Bauer, H., Gibson, P., Hernandez, M., Kent, C., Klausner, J., & Bolan, G. (2001). Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases. Sexually Transmitted Diseases, 29(7), 411–416.CrossRefGoogle Scholar
  6. Bergen, R. K. (1996). Wife rape: Understanding the response of survivors and service providers. Thousand Oaks, CA: Sage.Google Scholar
  7. Brener, N., McMahon, P., Warren, C., & Douglas, K. (1999). Forced sexual intercourse and associated health-risk behaviors among female college students in the United States. Journal of Consulting and Clinical Psychology, 67, 252–259.PubMedCrossRefGoogle Scholar
  8. Buchsbaum, D., Buchanan, R., Centor, R., et al. (1991). Screening for alcohol abuse using CAGE scores and likelihood ratios. Annals of Internal Medicine, 115, 774–777.PubMedGoogle Scholar
  9. Burt, M., Aron, L., & Lee, E. (2001). Helping America’s homeless: Emergency shelter or affordable housing? Washington, DC: The Urban Institute Press.Google Scholar
  10. Campbell, J., Jones, A., Dienemann, J., Kub, J., Schollenberger, J., O’Campo, P., et al. (2002). Intimate Partner Violence and Physical Health Consequences. Archives of Internal Medicine, 162, 1157–1163.PubMedCrossRefGoogle Scholar
  11. Catz, S., Kelly, J., Bogart, L., et al. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.PubMedCrossRefGoogle Scholar
  12. CDC. (2003). Costs of intimate partner violence against women in the United States. Atlanta, GA: CDC, National Center for Injury Prevention and Control.Google Scholar
  13. CDC. (2004). Youth risk behavior surveillance-United States, 2003. Morbidity and Mortality Weekly Report, 53(SS-02), 1–96.Google Scholar
  14. Chander, G., Lau, B., & Moore, R. (2006). Hazardous alcohol use: A risk factor for non-adherence and lack of suppression in HIV infection. Journal of Acquired Immune Deficiency Syndromes 43(4), 411–417.PubMedCrossRefGoogle Scholar
  15. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.PubMedCrossRefGoogle Scholar
  16. Coker, A., Davis, K., Arias, I., Desai, S., Sanderson, M., & Brandt, H. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23(4), 260–268.PubMedCrossRefGoogle Scholar
  17. Department of Justice. (2003). Criminal victimization 2002. Washington: Government Printing Office.Google Scholar
  18. El-Bassel, N., Witte, S. S., Wada, T., Gilbert, L., & Wallace, J. (2001). Correlates of partner violence among female street-based sex workers: Substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care and STDs, 15, 41–51.PubMedCrossRefGoogle Scholar
  19. English, D. (1998). The extent and consequences of child maltreatment. The Future of Children, Protecting Children from Abuse and Neglect, 8(1).Google Scholar
  20. Ewing, J. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association, 252, 1905–1907.PubMedCrossRefGoogle Scholar
  21. Fournier, A., Tyler, R., Iwasko, N., LaLota, M., Shultz, J., & Greer, P. (1996). Human immunodeficiency virus among the homeless in Miami: A new direction for the HIV epidemic. American Journal of Medicine, 100, 582–584.PubMedCrossRefGoogle Scholar
  22. Heintz, A., & Melendez, R. (2006). Intimate partner violence and HIV/STD risk among lesbian, gay, bisexual, and transgender individuals. Journal of Interpersonal Violence, 21(2), 193–208.PubMedCrossRefGoogle Scholar
  23. Herek, G. M., & Sims, C. (in press). Sexual orientation and violent victimization: Hate crimes and intimate partner violence. In R. J. Wolitski, R.O. Valdiserri, & R. Stall (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. New York, NY: Oxford University Press.Google Scholar
  24. Jewkes, R., Sen, P., & Garcia-Moreno, C. (2002). Sexual violence. In E. Krug, L. L. Dahlberg, & J. A. Mercy (Eds.), World Report on violence and health (pp. 213–239). Geneva: World Health Organization.Google Scholar
  25. Kidder, D., Wolitski, R., Stall, R., Harre, D., Royal, S., & Aidala, A. (2003). The role of housing on health and HIV/AIDS risk behaviors in people living with HIV. Paper presented at the New Partnerships for Ending Homelessness: Housing, Services, and Employment, Washington, D.C.Google Scholar
  26. Lang, A., Rodgers, C., Laffaye, C., Satz, L., Dresselhaus, T., & Stein, M. (2003). Sexual trauma, posttraumatic stress disorder, and health behavior. Behavioral Medicine, 28(4), 150–158.PubMedCrossRefGoogle Scholar
  27. Liebschutz, J., Geier, J., Horton, N., Chuang, C., & Samet, J. (2005). Physical and sexual violence and health care utilization in HIV-infected persons with alcohol problems. AIDS Care, 17, 566–578.PubMedGoogle Scholar
  28. Liebschutz, J., Savetski, J., Saitz, R., Horton, N., Lloyd-Travaglini, C., & Samet, J. (2002). The relationship between sexual and physical abuse and substance abuse consequence. Journal of Substance Abuse Treatment, 22, 121–128.PubMedCrossRefGoogle Scholar
  29. Magura, S., Nwakeze, P. C., Rosenblum, A., & Joseph, H. (2000). Substance misuse and related infectious diseases in a soup kitchen population. Substance Use and Misuse, 35, 551–583.PubMedGoogle Scholar
  30. Meyer, I., Cournos, F., & Empfield, M. (1993). HIV seroprevalence and clinical characteristics of severe inpatient mentally ill homeless. Journal of Social Distress and the Homeless, 2(2), 103–116.CrossRefGoogle Scholar
  31. Newman, P., Rhodes, F., & Weiss, R. (2004). Correlates of sex trading among drug-using men who have sex with men. American Journal of Public Health, 94, 1998–2003.PubMedGoogle Scholar
  32. O’Leary, A., & Martins, P. (2000). Structural factors affecting women’s HIV risk: A life-course example. AIDS, 14(suppl 1), S68–S72.PubMedCrossRefGoogle Scholar
  33. O’Leary, A., Purcell, D., Remien, R., & Gomez, C. (2003). Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care, 15(1), 17–26.PubMedCrossRefGoogle Scholar
  34. Ohene, S., Halcon, L., Ireland, M., Carr, P., & McNeely, C. (2005). Sexual abuse history, risk behavior, and sexually transmitted diseases: The impact of age at abuse. Sexually Transmitted Diseases, 32(6), 358–363.PubMedCrossRefGoogle Scholar
  35. Paris, N., East, R., & Toomey, K. (1996). HIV seroprevalence among Atlanta’s homeless. Journal of Health Care for the Poor and Underserved, 7(2), 83–93.PubMedGoogle Scholar
  36. Purcell, D. W., Patterson, J. D., & Spikes, P. S. Jr. (in press). Childhood sexual abuse experienced by gay and bisexual men: Understanding the disparities and interventions to help eliminate them. In R. J. Wolitski, R.O. Valdiserri, & R. Stall (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. New York, NY: Oxford University Press.Google Scholar
  37. Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  38. Raj, A., Silverman, J., & Amaro, H. (2004). The relationship between sexual abuse and sexual risk among high school students: Findings from the 1997 Massachusetts youth risk behavior survey. Maternal and Child Health Journal, 2, 125–134.Google Scholar
  39. Robertson, M., Clark, R., Charlebois, E., Tulsky, J., Long, H., Bangsberg, D., et al. (2004). HIV seroprevalence among homeless and marginally housed adults in San Francisco. American Journal of Public Health, 94, 1207–1217.PubMedGoogle Scholar
  40. Schutt, R., & Goldfinger, S. (1996). Housing preferences and perceptions of health and functioning among homeless mentally ill persons. Psychiatric Services, 47, 381–386.PubMedGoogle Scholar
  41. Senn, T., Carey, M., Vanable, P., Coury-Doniger, P., & Urban, M. (2006). Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic. Journal of Consulting and Clinical Psychology, 74(4), 720–731.PubMedCrossRefGoogle Scholar
  42. Singer, M. (1994). AIDS and the health crisis of the US urban poor: the perspective of critical medical anthropology. Social Science and Medicine, 39, 931–948.PubMedCrossRefGoogle Scholar
  43. Smereck, G., & Hockman, E. (1998). Prevalence of HIV infection and HIV risk behaviors associated with living place: on-the-street homeless drug users as a special target population for public health intervention. American Journal of Drug and Alcohol Abuse, 24, 299–319.PubMedGoogle Scholar
  44. Surratt, H., & Inciardi, J. (2004). HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA. AIDS Care, 16, 594–604.PubMedCrossRefGoogle Scholar
  45. Susser, E., Valencia, E., & Conover, S. (1993). Prevalence of HIV infection among psychiatric patients in a New York City men’s shelter. American Journal of Public Health, 83, 568–570.PubMedCrossRefGoogle Scholar
  46. Tjaden, P., & Thoennes, N. (2000). Full report of the prevalence, incidence, and consequences of violence against women: Findings from the national violence against women survey (No. NCJ183781). Washington, DC: Department of Justice.Google Scholar
  47. Tucker, J., Burnam, M., Sherbourne, C., et al. (2003). Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. American Journal of Medicine, 114, 573–580.PubMedCrossRefGoogle Scholar
  48. Wyatt, G., Carmona, J., Loeb, T., & Williams, J. (2005). HIV-positive black women with histories of childhood sexual abuse: patterns of substance use and barriers to health care. Journal of Health Care for the Poor and Underserved, 16(4 Suppl B), 9–23.PubMedCrossRefGoogle Scholar
  49. Zierler, S., Cunningham, W., Andersen, R., Shapiro, M., Nakazono, T., Morton, S., et al. (2000). Violence victimization after HIV infection in a US probability sample of adult patients in primary care. American Journal of Public Health, 90, 208–215.PubMedGoogle Scholar
  50. Zierler, S., Witbeck, B., & Mayer, K. (1996). Sexual violence against women living with or at risk for HIV infection. American Journal of Preventive Medicine, 12, 304–309.PubMedGoogle Scholar
  51. Zolopa, A., Hahn, J., Gorter, R., Miranda, J., & Wlodarczyk, D. (1994). HIV and tuberculosis infection in San Francisco’s homeless adults. Journal of the American Medical Association, 272(6), 455–461.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Kirk D. Henny
    • 1
  • Daniel P. Kidder
    • 1
  • Ron Stall
    • 2
  • Richard J. Wolitski
    • 1
  1. 1.National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Graduate School of Public HealthUniversity of PittsburghPittsburghUSA

Personalised recommendations