Skip to main content

‘If the Partner Finds Out, then there’s Trouble’: Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV)

AIDS and Behavior volume 26, pages 2266–2278 (2022)Cite this article

Abstract

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violencefear partners’ interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during the appraisal process, providers conduct routine IPV screening, facilitate HIV risk perception, and offer PrEP. Strategic safety planning utilizes concealment tactics, informal sources of support, role playing and cover stories. Future interventions to enhance PrEP services among women exposed to IPV should implement safety planning strategies, integrate PrEP care with IPV services, and employ novel PrEP modalities to maximize effectiveness.

Resumen

La profilaxis previa a la exposición (PrEP) es una estrategia eficaz de prevención del VIH controlada por las mujeres, pero las mujeres que experimentan violencia de pareja íntima (IPV) temen que la interferencia de la pareja y la posterior violencia puedan limitar su utilidad. Este estudio explora las percepciones de los proveedores sobre las estrategias de planificación de seguridad para prevenir la escalada de violencia, mitigar la interferencia de la pareja y promover la adherencia diaria a la PrEP oral. Realizamos entrevistas (N = 36) con proveedores de atención médica (n = 18) y proveedores de servicios de IPV (n = 18) en Baltimore y New Haven. Utilizando el modelo de Evaluación contextualizada para la planificación estratégica de la seguridad, organizamos los datos en dos categorías: el proceso de evaluación y la planificación estratégica de la seguridad. Temas revelados durante el proceso de evaluación, los proveedores realizan pruebas de detección de VPI de rutina, facilitan la percepción del riesgo de VIH y ofrecen PrEP. La planificación estratégica de seguridad utiliza tácticas de ocultación, fuentes informales de apoyo, juegos de roles e historias de cobertura. Las intervenciones futuras para mejorar los servicios de PrEP entre las mujeres expuestas a IPV deben implementar estrategias de planificación de seguridad, integrar la atención de PrEP con los servicios de IPV y emplear nuevas modalidades de PrEP para maximizar la efectividad.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Data Availability

To prevent potential identification of participants, we will not share data or material from this study.

Code Availability

Not applicable.

References

  1. Smith, SG, Zhang, X, Basile KC et al. National Center for Injury Prevention and Control. The National Intimate Partner and Sexual Violence Survey: 2015 Data Brief — Updated Release. 2018:32. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf

  2. Seth P, Wingood GM, Robinson LS, Raiford JL, DiClemente RJ. Abuse Impedes Prevention: The intersection of intimate partner violence and HIV/STI risk among young African American women. AIDS Behav. 2015;19(8):1438–45.

    Article  Google Scholar 

  3. Anderson JC, Campbell JC, Glass NE, Decker MR, Perrin N, Farley J. Impact of intimate partner violence on clinic attendance, viral suppression and CD4 cell count of women living with HIV in an urban clinic setting. AIDS Care. 2018;30(4):399–408.

    Article  Google Scholar 

  4. Kouyoumdjian FG, Findlay N, Schwandt M, Calzavara LM. A systematic review of the relationships between intimate partner violence and HIV/AIDS. PLoS One. 2013;8(11):e81044.

    Article  Google Scholar 

  5. Bergmann JN, Stockman JK. How does intimate partner violence affect condom and oral contraceptive use in the United States?: a systematic review of the literature. Contraception. 2015;91(6):438–55.

    Article  Google Scholar 

  6. Willie T, Kershaw T, Campbell JC, Alexander KA. Intimate partner violence and prep acceptability among low-income, young black women: exploring the mediating role of reproductive coercion. AIDS Behav. 2017;21(8):2261–9.

    Article  Google Scholar 

  7. Campbell JC. Health consequences of intimate partner violence. The Lancet. 2002;359(9314):1331–6.

    Article  Google Scholar 

  8. Draughon JE. Sexual Assault Injuries and Increased Risk of HIV Transmission. Adv Emerg Nurs J. 2012;34(1):82–7.

    Article  Google Scholar 

  9. Alexander KA, Coleman CL, Deatrick JA, Jemmott LS. Moving beyond safe sex to women-controlled safe sex: a concept analysis. J Adv Nurs. 2012;68(8):1858–69.

    Article  Google Scholar 

  10. Bush S, Rawlings K, Magnuson D, Martin P, Lugo-Torres O, Mera-Giler R. Utilization of emtricitabine/tenofovir (FTC/TDF) for HIV pre-exposure prophylaxis in the United States by gender (2013–1Q2016). Abstracts of the HIV Glasgow supplement. J Int AIDS Soc. 2016;((Suppl 7):Abstract O314).

  11. Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR. Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. AIDS Care. 2017;29(6):751–8.

    Article  Google Scholar 

  12. Willie TC, Stockman JK, Overstreet NM, Kershaw TS. Examining the impact of intimate partner violence type and timing on pre-exposure prophylaxis awareness, interest, and coercion. AIDS Behav. 2018;22(4):1190–200.

    Article  Google Scholar 

  13. Willie TC, Stockman JK, Keene DE, Calabrese SK, Alexander KA, Kershaw TS. Social networks and its impact on women’s awareness, interest, and uptake of HIV pre-exposure prophylaxis (PrEP): implications for women experiencing intimate partner violence. JAIDS. 2019;80(4):386–93.

    PubMed  Google Scholar 

  14. Cottrell ML, Yang KH, Prince HMA, Sykes C, White N, Malone S, et al. A translational pharmacology approach to predicting outcomes of preexposure prophylaxis against HIV in men and women using Tenofovir Disoproxil Fumarate with or without Emtricitabine. J Infect Dis. 2016;214(1):55–64.

    CAS  Article  Google Scholar 

  15. Messing JT, Ward-Lasher A, Thaller J, Bagwell-Gray ME. The state of intimate partner violence intervention: progress and continuing challenges. Soc Work. 2015;60(4):305–13.

    Article  Google Scholar 

  16. Bermea AM, Khaw L, Hardesty JL, Rosenbloom L, Salerno C. Mental and active preparation: examining variations in women’s processes of preparing to leave abusive relationships. J Interpers Violence. 2017;35(3–4):988–1011.

    PubMed  Google Scholar 

  17. Hanson GC, Messing JT, Anderson JC, Thaller J, Perrin NA, Glass NE. Patterns and usefulness of safety behaviors among community-based women survivors of intimate partner violence. J Interpers Violence. 2019;4:886260519853401.

    Google Scholar 

  18. Eden KB, Perrin NA, Hanson GC, Messing JT, Bloom TL, Campbell JC, et al. Use of online safety decision aid by abused women: effect on decisional conflict in a randomized controlled trial. Am J Prev Med. 2015;48(4):372–83.

    Article  Google Scholar 

  19. Alvarez C, Debnam K, Clough A, Alexander K, Glass NE. Responding to intimate partner violence: healthcare providers’ current practices and views on integrating a safety decision aid into primary care settings. Res Nurs Health. 2018;41(2):145–55.

    Article  Google Scholar 

  20. Lindhorst T, Nurius P, Macy RJ. Contextualized assessment with battered women: strategic safety planning to cope with multiple harms. J Soc Work Educ. 2005;41(2):331–52.

    Article  Google Scholar 

  21. Glass NE, Perrin NA, Hanson GC, et al. The longitudinal impact of an internet safety decision aid for abused women. Am J Prev Med. 2017;52(5):606–15.

    Article  Google Scholar 

  22. U.S. Preventive Services Task Force. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Recommendation Statement. AFP. 2019;99(10). https://www.aafp.org/afp/2019/0515/od1.html. Accessed 23 March 2021

  23. Dedoose [Computer software]. Version 8.0.35. Los Angeles, CA: SocioCultural Research Consultants; 2018.

  24. Cascio MA, Lee E, Vaudrin N, Freedman DA. A team-based approach to open coding: considerations for creating intercoder consensus. Field Methods. 2019;31(2):116–30.

    Article  Google Scholar 

  25. Blair E. A reflexive exploration of two qualitative data coding techniques. J Methods Meas Soc Sci. 2015;6(1):14–29.

    Google Scholar 

  26. Alvarez C, Fedock G, Grace KT, Campbell J. Provider screening and counseling for intimate partner violence: A systematic review of practices and influencing factors. Trauma Violence Abuse. 2017;18(5):479–95.

    Article  Google Scholar 

  27. O’Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev [Internet]. 2015 Jul 22 [cited 2020 Oct 22];2015(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599831/

  28. Sabri B, Holliday CN, Alexander KA, Huerta J, Cimino A, Callwood GB, et al. Cumulative violence exposures: Black women’s responses and sources of strength. Soc Work Public Health. 2016;31(3):127–39.

    Article  Google Scholar 

  29. O’Malley TL, Hawk ME, Egan JE, Krier SE, Burke JG. Intimate partner violence and pre-exposure prophylaxis (PrEP): a rapid review of current evidence for women’s HIV prevention. AIDS Behav. 2020;24(5):1342–57.

    Article  Google Scholar 

  30. Willie TC, Keene DE, Stockman JK, Alexander KA, Calabrese SK, Kershaw TS. Intimate partner violence influences women’s engagement in the early stages of the HIV pre-exposure prophylaxis (prep) care continuum: using doubly robust estimation. AIDS Behav. 2020;24(2):560–7.

    Article  Google Scholar 

  31. Reisenhofer S, Taft A. Women’s journey to safety – The transtheoretical model in clinical practice when working with women experiencing Intimate Partner Violence: A scientific review and clinical guidance. Patient Educ Couns. 2013;93(3):536–48.

    Article  Google Scholar 

  32. Chang JC, Decker MR, Moracco KE, Martin SL, Petersen R, Frasier PY. Asking about intimate partner violence: advice from female survivors to health care providers. Patient Educ Couns. 2005;59(2):141–7.

    Article  Google Scholar 

  33. Chang JC, Dado D, Hawker L, Cluss PA, Buranosky R, Slagel L, et al. Understanding turning points in intimate partner violence: factors and circumstances leading women victims toward change. J Womens Health. 2010;19(2):251–9.

    Article  Google Scholar 

  34. Taha F, Zhang H, Snead K, Jones AD, Blackmon B, Bryant RJ, et al. Effects of a culturally informed intervention on abused, suicidal African American women. Cultur Divers Ethnic Minor Psychol. 2015;21(4):560–70.

    Article  Google Scholar 

  35. Huang YA. HIV Preexposure prophylaxis, by race and ethnicity — United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2018;67.

  36. St. Vil NM, Sabri B, Nwokolo V, Alexander KA, Campbell JC. A qualitative study of survival strategies used by low-income Black women who experience intimate partner violence. Soc Work. 2017;62(1):63–71.

  37. Dale SK, Safren SA. Resilience takes a village: Black women utilize support from their community to foster resilience against multiple adversities. AIDS Care. 2018;30(sup5):S18-26.

    Article  Google Scholar 

  38. Willie TC, Stockman JK, Perler R, Kershaw TS. Associations between intimate partner violence, violence-related policies, and HIV diagnosis rate among women in the United States. Ann Epidemiol. 2018;28(12):881–5.

    Article  Google Scholar 

  39. Calabrese SK, Krakower DS, Willie TC, Kershaw TS, Mayer KH. US guideline criteria for Human Immunodeficiency Virus preexposure prophylaxis: clinical considerations and caveats. Clin Infect Dis. 2019;69(5):884–9.

    Article  Google Scholar 

  40. Beymer MR, Holloway IW, Pulsipher C, Landovitz RJ. Current and future PrEP medications and modalities: on-demand, injectables, and topicals. Curr HIV/AIDS Rep. 2019;16(4):349–58.

    Article  Google Scholar 

  41. Celum CL, Delany-Moretlwe S, Baeten JM, van der Straten A, Hosek S, Bukusi EA, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22 Suppl 4:e25298.

  42. LeGrand S, Reif S, Sullivan K, Murray K, Barlow ML, Whetten K. A Review of recent literature on trauma among individuals living with HIV. Curr HIV/AIDS Rep. 2015;12(4):397–405.

    Article  Google Scholar 

  43. Sikkema KJ, Mulawa MI, Robertson C, et al. Improving AIDS Care After Trauma (ImpACT): Pilot outcomes of a coping intervention among HIV-Infected women with sexual trauma in South Africa. AIDS Behav. 2018;22(3):1039–52.

    Article  Google Scholar 

  44. Dale SK, Safren SA. Striving Towards Empowerment and Medication Adherence (STEP-AD): A tailored cognitive behavioral treatment approach for Black women living with HIV. Cogn Behav Pract. 2018;25(3):361–76.

    Article  Google Scholar 

  45. Teitelman AM, Koblin BA, Brawner BM, et al. Just4Us: Development of a counselor-navigator and text message intervention to promote prep uptake among cisgender women at elevated risk for HIV. J Assoc Nurses AIDS Care. 2021;32(2):188–204.

    Article  Google Scholar 

  46. Molina J-M, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–10.

    Article  Google Scholar 

  47. Grace KT, Anderson JC. Reproductive coercion: a systematic review. Trauma Violence Abuse. 2018;19(4):371–90.

    Article  Google Scholar 

  48. Amico KR, Wallace M, Bekker L-G, et al. Experiences with HPTN 067/ADAPT study-provided open-label PrEP among women in cape town: facilitators and barriers within a mutuality framework. AIDS Behav. 2017;21(5):1361–75.

    Article  Google Scholar 

Download references

Funding

This study was funded by the Johns Hopkins Population Center [NIH/NICHD 5R24HD042854] and the Center for Interdisciplinary Research on AIDS – Yale University [P30MH062294]. TCW was supported by the National Institute on Minority Health and Health Disparities (NIMHD) [K01MD015005]. KAA was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Office for Research on Women’s Health (NICHD/ORWH) [K12HD085845].

Author information

Authors and Affiliations

  1. Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Noelene K. Jeffers

  2. Marquette University College of Nursing, Milwaukee, WI, USA

    Jessica L. Zemlak

  3. Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA

    Lourdes Celius & Kamila A. Alexander

  4. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Tiara C. Willie

  5. Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA

    Trace Kershaw

Authors
  1. Noelene K. Jeffers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica L. Zemlak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lourdes Celius
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tiara C. Willie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Trace Kershaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kamila A. Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: NKJ, KAA; Methodology: KAA; Formal analysis and investigation: NKJ, LC, KAA; Writing—original draft: NKJ, KAA, JZ; Writing—review and editing: KAA; TK, TCW; Funding acquisition: KAA; TK, TCW; Supervision: KAA.

Corresponding author

Correspondence to Kamila A. Alexander.

Ethics declarations

Conflict of Interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Johns Hopkins University School of Medicine Institutional Review Board (#IRB00129432) and Yale University Human Investigation Committee (#IRB1602017161).

Consent to Participate

Informed consent to participate was obtained from all individual participants included in the study.

Consent for Publication

Participants gave verbal informed consent to publish their data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jeffers, N.K., Zemlak, J.L., Celius, L. et al. ‘If the Partner Finds Out, then there’s Trouble’: Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV). AIDS Behav 26, 2266–2278 (2022). https://doi.org/10.1007/s10461-021-03565-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03565-6

Keywords

  • Intimate Partner Violence
  • HIV
  • Pre-exposure prophylaxis
  • Women