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Journal of General Internal Medicine

, Volume 29, Issue 8, pp 1131–1138 | Cite as

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

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

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.

KEY WORDS

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

Notes

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.

REFERENCES

  1. 1.
    Campbell JC, Baty ML, Ghandour RM, Stockman JK, Francisco L, Wagman J. The intersection of intimate partner violence against women and HIV/AIDS: a review. Int J Inj Control Saf Promot. 2008;15(4):221–31.CrossRefGoogle Scholar
  2. 2.
    Adverse health conditions and health risk behaviors associated with intimate partner violence--United States, 2005. MMWR Morb Mortal Wkly Rep. 2008;57(5):113–7.Google Scholar
  3. 3.
    Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA, O'Campo P. HIV/AIDS and intimate partner violence: intersecting women's health issues in the United States. Trauma Violence Abuse. 2007;8(2):178–98.PubMedCrossRefGoogle Scholar
  4. 4.
    Tjaden P, Thoennes N. (NIJ & CDC). Full Report of the Prevalence, Incidence and Consequences of Violence Against Women. 2000.Google Scholar
  5. 5.
    Singer M. A Dose of Drugs, A Touch of Violence, A Case of AIDS: Conceptualizing the SAVA Syndemic. Free Inq Creat Sociol. 1996;24(2):12.Google Scholar
  6. 6.
    Singer M, Clair S. Syndemics and public health: reconceptualizing disease in bio-social context. Med Anthropol Q. 2003;17(4):423–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Singer M. A Dose of Drugs, A Touch of Violence, A Case of AIDS, Part 2: Further Conceptualizing the SAVA Syndemic. Free Inq Creat Sociol. 2006;34(1):16.Google Scholar
  8. 8.
    Meyer JP, Springer SA, Altice FL. Substance abuse, violence, and HIV in women: a literature review of the syndemic. J Womens Health (Larchmt). 2011;20(7):991–1006.CrossRefGoogle Scholar
  9. 9.
    El-Bassel N, Gilbert L, Wu E, Go H, Hill J. HIV and intimate partner violence among methadone-maintained women in New York City. Soc Sci Med. 2005;61(1):171–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Burke JG, Thieman LK, Gielen AC, O'Campo P, McDonnell KA. Intimate partner violence, substance use, and HIV among low-income women: taking a closer look. Violence Against Women. 2005;11(9):1140–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen M, Deamant C, Barkan S, et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. Am J Public Health. 2000;90(4):560–5.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Stockman JK, Campbell JC, Celentano DD. Sexual violence and HIV risk behaviors among a nationally representative sample of heterosexual American women: the importance of sexual coercion. J Acquir Immune Defic Syndr. 2010;53(1):136–43.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Matthews DD, Blosnich JR, Farmer GW, Adams BJ. Operational Definition of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors. LGBT Health. 2013;1(1).Google Scholar
  14. 14.
    IOM. (Institute of Medicine (IOM)). Lesbian Heath: Current Assessment and Directions for the Future. 1999.Google Scholar
  15. 15.
    Group LGaBYSOMW. (Gay and Lesbian Medical Association). Measuring Sexual Orientation of Young People in Health Research. 2003.Google Scholar
  16. 16.
    Decker MR, Wirtz AL, Baral SD, et al. Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers. Sex Transm Infect. 2012;88(4):278–83.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Gilchrist G, Gruer L, Atkinson J. Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland. Addict Behav. 2005;30(5):1019–23.PubMedCrossRefGoogle Scholar
  18. 18.
    Romero-Daza N, Weeks M, Singer M. "Nobody gives a damn if I live or die": violence, drugs, and street-level prostitution in inner-city Hartford, Connecticut. Med Anthropol. 2003;22(3):233–59.PubMedCrossRefGoogle Scholar
  19. 19.
    Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner JS, Tyndall MW. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009;339:b2939.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Tyler KA. A comparison of risk factors for sexual victimization among gay, lesbian, bisexual, and heterosexual homeless young adults. Violence Vict. 2008;23(5):586–602.PubMedCrossRefGoogle Scholar
  21. 21.
    Millay TA, Satyanarayana VA, O'Leary CC, Crecelius R, Cottler LB. Risky business: focus-group analysis of sexual behaviors, drug use and victimization among incarcerated women in St. Louis. J Urban Health. 2009;86(5):810–7.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Bobashev GV, Zule WA, Osilla KC, Kline TL, Wechsberg WM. Transactional sex among men and women in the south at high risk for HIV and other STIs. J Urban Health. 2009;86(Suppl 1):32–47.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Logan T, Leukefeld C. Sexual and drug use behaviors among female crack users: a multi-site sample. Drug Alcohol Depend. 2000;58(3):9.CrossRefGoogle Scholar
  24. 24.
    Weber AE, Boivin JF, Blais L, Haley N, Roy E. HIV risk profile and prostitution among female street youths. J Urban Health. 2002;79(4):525–35.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Zule WA, Costenbader E, Coomes CM, et al. Stimulant use and sexual risk behaviors for HIV in rural North Carolina. J Rural Health. 2007;23(Suppl):6.Google Scholar
  26. 26.
    Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008;66(4):911–21.PubMedCrossRefGoogle Scholar
  27. 27.
    Collins RL, Ellickson PL, Orlando M, Klein DJ. Isolating the nexus of substance use, violence and sexual risk for HIV infection among young adults in the United States. AIDS Behav. 2005;9(1):73–87.PubMedCrossRefGoogle Scholar
  28. 28.
    Muzny CA, Sunesara IR, Martin DH, Mena LA. Sexually transmitted infections and risk behaviors among African American women who have sex with women: does sex with men make a difference? Sex Transm Dis. 2011;38(12):1118–25.PubMedCrossRefGoogle Scholar
  29. 29.
    Bevier PJ, Chiasson MA, Hefferman RT, Castro KG. Women at a Sexually Transmitted Disease Clinic Who Reported Same-Sex Contact: Their HIV Seroprevalence and Risk Behaviors. Am J Public Health. 1995;85(10):6.CrossRefGoogle Scholar
  30. 30.
    Ompad DC, Friedman SR, Hwahng SJ, Nandi V, Fuller CM, Vlahov D. HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City. Subst Use Misuse. 2011;46(2–3):274–84.PubMedCrossRefGoogle Scholar
  31. 31.
    Scheer S, Peterson I, Page-Shafer K, et al. Sexual and Drug Use Behavior Among Women Who Have Sex With Both Women and Men: Results of a Population-Based Survey. Am J Public Health. 2002;92(7):3.CrossRefGoogle Scholar
  32. 32.
    Teti M, Bowleg L, Rubinstein S, Lloyd L, Berhane Z, Gold M. Present But Not Accounted for: Exploring the Sexual Risk Practices and Intervention Needs of Nonheterosexually Identified Women in a Prevention Program for Women with HIV/AIDS. J LGBT Health Res. 2007;3(4):16.Google Scholar
  33. 33.
    Friedman MS, Marshal MP, Guadamuz TE, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health. 2011;101(8):1481–94.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Balsam KF, Rothblum ED, Beauchaine TP. Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. J Consult Clin Psychol. 2005;73(3):477–87.PubMedCrossRefGoogle Scholar
  35. 35.
    Barkan SE, Melnick SL, Preston-Martin S, et al. The Women's Interagency HIV Study. WIHS Collaborative Study Group. Epidemiology. 1998;9(2):117–25.PubMedCrossRefGoogle Scholar
  36. 36.
    Bacon MC, von Wyl V, Alden C, et al. The Women's Interagency HIV Study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol. 2005;12(9):1013–9.PubMedCentralPubMedGoogle Scholar
  37. 37.
    NIAAA. Moderate & Binge Drinking.Google Scholar
  38. 38.
    Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.PubMedCrossRefGoogle Scholar
  39. 39.
    Cassel DL. BootstrapMania!: Re-Sampling the SAS Way. SAS Global Forum 2010. Vol. 2013. Corvallis; 2010.Google Scholar
  40. 40.
    UCLA. How can I boostrap estimates in SAS? In: Group SC, ed. Vol. 2013.Google Scholar
  41. 41.
    Moyer VA, Force USPST. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;158(6):478–86.PubMedCrossRefGoogle Scholar
  42. 42.
    HRSA. Women's Preventive Services Guideline: Affordable Care Act Expands Prevention Coverage or Women's Health and Well-Being. In: Services UDoHaH, ed.Google Scholar
  43. 43.
    ACOG. (The American College of Obstetricians and Gynecologists). Well-Woman Care: Assessments & Recommendations. 2013.Google Scholar
  44. 44.
    Ard KL, Makadon HJ. Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients. J Gen Intern Med. 2011;26(8):930–3.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Brown MJ, Groscup J. Perceptions of Same-sex Domestic Violence Among Crisis Center Staff. J Fam Violence. 2009;24:87–93.CrossRefGoogle Scholar
  46. 46.
    Kulkin HS, Williams J, Borne HF, de la Bretonne D, Laurendine J. A review of research on violence in same-gender couples: a resource for clinicians. J Homosex. 2007;53(4):71–87.PubMedCrossRefGoogle Scholar
  47. 47.
    Jewkes R. Intimate partner violence: the end of routine screening. Lancet. 2013;382(9888):190–1.PubMedCrossRefGoogle Scholar
  48. 48.
    Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World report on violence and health, Ch 4: World Health Organization; 2002.Google Scholar
  49. 49.
    Timko C, Valenstein H, Lin PY, Moos RH, Stuart GL, Cronkite RC. Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs. Subst Abuse Treat Prev Policy. 2012;7:37.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Klostermann KC. Substance abuse and intimate partner violence: treatment considerations. Subst Abuse Treat Prev Policy. 2006;1:24.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    McClennen JC. Domestic violence between same-gender partners: recent findings and future research. J Interpers Violence. 2005;20(2):149–54.PubMedCrossRefGoogle Scholar
  52. 52.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Young RM, Friedman SR, Case P. Exploring an HIV paradox: an ethnography of sexual minority women injectors. J Lesbian Stud. 2005;9(3):103–16.PubMedCrossRefGoogle Scholar
  54. 54.
    Johns MM, Zimmerman M, Bauermeister JA. Sexual attraction, sexual identity, and psychosocial wellbeing in a national sample of young women during emerging adulthood. J Youth Adolesc. 2012;42(1):82–95.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Herrick AL, Lim SH, Plankey MW, et al. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health. 2013;103(1):79–85.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Diamond LM. Female bisexuality from adolescence to adulthood: results from a 10-year longitudinal study. Dev Psychol. 2008;44(1):5–14.PubMedCrossRefGoogle Scholar
  57. 57.
    Mock SE, Eibach RP. Stability and change in sexual orientation identity over a 10-year period in adulthood. Arch Sex Behav. 2012;41(3):641–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Kilpatrick DG, Acierno R, Resnick HS, Saunders BE, Best CL. A 2-year longitudinal analysis of the relationships between violent assault and substance use in women. J Consult Clin Psychol. 1997;65(5):834–47.PubMedCrossRefGoogle Scholar
  59. 59.
    Ross MW, Essien EJ, Williams ML, Fernandez-Esquer ME. Concordance Between Sexual Behavior and Sexual Identity in Street Outreach Samples of Four Racial/Ethnic Groups. Sex Transm Dis. 2003;30(2):4.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Maria Pyra
    • 1
    Email author
  • 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

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