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HIV Sexual Risk Behavior Among Low-Income Women Experiencing Intimate Partner Violence: The Role of Posttraumatic Stress Disorder

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Abstract

Posttraumatic stress disorder resulting from intimate partner violence (IPV-related PTSD), drug problems, and alcohol problems were tested as correlates of women’s sexual risk behavior. Participants were 136 low-income women experiencing physical violence by a male partner during the past 6 months. Sexual risk behavior was assessed by whether women had unprotected sex with a risky primary partner (i.e., HIV-positive, injection drug user, and/or nonmonogamous), unprotected sex with a risky nonprimary partner (i.e. HIV-positive or unknown status), or traded sex during the past 6 months. Nearly one in five women engaged in these recent sexual risk behaviors. Simultaneous logistic regression results revealed IPV-related PTSD, but not drug or alcohol problems, was significantly associated with sexual risk behavior while controlling for childhood abuse and demographic covariates. Women with IPV-related PTSD had four times greater odds of recent sexual risk behavior compared to women without IPV-related PTSD. Implications for HIV prevention interventions are discussed.

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References

  1. CDC. WISQARS 10 leading causes of death, United States, 2006, all races, females. http://webappa.cdc.gov/cgi-bin/broker.exe. Reviewed 23 April 2009, Accessed 14 Oct 2009.

  2. CDC. HIV/AIDS surveillance report, 2007, vol 19. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/pdf/2007SurveillanceReport.pdf. Accessed 14 Oct 2009.

  3. 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 Contr Saf Promot. 2008;15(4):221–31.

    Article  CAS  PubMed  Google Scholar 

  4. Coker AL. Does physical intimate partner violence affect sexual health? A systematic review. Trauma Violence Abuse. 2007;8(2):149–77.

    Article  PubMed  Google Scholar 

  5. Maman S, Campbell J, Sweat MD, Gielen AC. The intersections of HIV and violence: directions for future research and interventions. Soc Sci Med. 2000;50(4):459–78.

    Article  CAS  PubMed  Google Scholar 

  6. Golding JM. Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Violence. 1999;14(2):99–132.

    Article  Google Scholar 

  7. Miller M. A model to explain the relationship between sexual abuse and HIV risk among women. AIDS Care. 1999;11(1):3–20.

    Article  CAS  PubMed  Google Scholar 

  8. Malow R, Devieux J, Lucenko BA. History of childhood sexual abuse as a risk factor for HIV risk behavior. J Psychol Trauma. 2006;5(3):13–32.

    Google Scholar 

  9. Hutton HE, Treisman GJ, Hunt WR, et al. HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners. Psychiatr Serv. 2001;52(4):508–13.

    Article  CAS  PubMed  Google Scholar 

  10. Green BL, Krupnick JL, Stockton P, Goodman L, Corcoran C, Petty R. Effects of adolescent trauma exposure on risky behavior in college women. Psychiatry. 2005;68(4):363–78.

    PubMed  Google Scholar 

  11. Morrill AC, Kasten L, Urato M, Larson MJ. Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse. J Subst Abuse. 2001;13(1):169–84.

    Article  CAS  PubMed  Google Scholar 

  12. Cole J, Logan TK, Shannon L. Risky sexual behavior among women with protective orders against violent male partners. AIDS Behav. 2007;11(1):103–12.

    Article  PubMed  Google Scholar 

  13. El-Bassel N, Gilbert L, Wu E, 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.

    Article  PubMed  Google Scholar 

  14. Raj A, Silverman J, Amaro H. Abused women report greater male partner risk and gender-based risk for HIV: findings from a community-based study with Hispanic women. AIDS Care. 2004;16(4):519–29.

    Article  CAS  PubMed  Google Scholar 

  15. Gielen AC, McDonnell KA, O’Campo PJ. Intimate partner violence, HIV status, and sexual risk reduction. AIDS Behav. 2002;6(2):107–16.

    Article  Google Scholar 

  16. Wu E, El-Bassel N, Witte SS, Gilbert L, Chang M. Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS Behav. 2003;7(3):291–301.

    Article  PubMed  Google Scholar 

  17. Teitelman AM, Ratcliffe SJ, Dichter ME, Sullivan CM. Recent and past intimate partner abuse and HIV risk among young women. J Obstet Gynecol Neonatal Nurs. 2008;37(2):219–27.

    PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Tucker JS, Wenzel SL, Elliott MN, Marshall GN, Williamson S. Interpersonal violence, substance use, and HIV-related behavior and cognitions: a prospective study of impoverished women in Los Angeles County. AIDS Behav. 2004;8(4):463–74.

    Article  PubMed  Google Scholar 

  20. El-Bassel N, Gilbert L, Rajah V, Foleno A, Frye V. Fear and violence: raising the HIV stakes. AIDS Educ Prev. 2000;12(2):154–70.

    CAS  PubMed  Google Scholar 

  21. Wingood GM, DiClemente RJ. The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. Am J Public Health. 1997;87(6):1016–8.

    Article  CAS  PubMed  Google Scholar 

  22. Raj A, Clarke JG, Silverman JG, et al. Violence against women associated with arrests for sex trade but not drug charges. Int J Law Psychiatry. 2006;29(3):204–11.

    Article  PubMed  Google Scholar 

  23. Tolman RM, Rosen D. Domestic violence in the lives of women receiving welfare. Violence Against Women. 2001;7(2):141–58.

    Google Scholar 

  24. Najavits LM, Weiss RD, Shaw SR. The link between substance abuse and posttraumatic stress disorder in women. A research review. Am J Addict. 1997;6(4):273–83.

    CAS  PubMed  Google Scholar 

  25. Brief DJ, Bollinger AR, Vielhauer MJ, et al. Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes. AIDS Care. 2004;16(Suppl 1):S97–120.

    PubMed  Google Scholar 

  26. Arriola KR, Louden T, Doldren MA, Fortenberry RM. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child Abuse Negl. 2005;29(6):725–46.

    Article  PubMed  Google Scholar 

  27. Questionnaire Development System™ User’s manual. Bethesda, MD: NOVA Research Company; 2003.

  28. Sikkema KJ, Wilson PA, Hansen NB, et al. Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. J Acquir Immune Defic. 2008;47(4):506–13.

    Article  Google Scholar 

  29. Sikkema KJ, Hansen NB, Meade CS, Kochman A, Fox AM. Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood. Arch Sex Behav. 2009;38(1):121–34.

    Article  PubMed  Google Scholar 

  30. Foa EB, editor. Posttraumatic Stress Diagnostic Scale manual. Minneapolis: National Computer Systems, Inc.; 1995.

    Google Scholar 

  31. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychol Assess. 1997;9(4):445–51.

    Article  Google Scholar 

  32. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  33. Spitzer RL, Williams JBW, Gibbon M, First MB, editors. Structured Clinical Interview for DSM-III-R-Patient. Washington, DC: American Psychiatric Press; 1990.

    Google Scholar 

  34. Skinner HA. The Drug Abuse Screening Test. Addict Behav. 1982;7(4):363–71.

    Article  CAS  PubMed  Google Scholar 

  35. Skinner HA. Guide for using the Drug Abuse Screening Test (DAST). Unpublished manuscript, available from the author (email: hskinner@yorku.ca). 1984.

  36. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use disorders identification test. 2nd ed. Geneva: World Health Organization; 2001.

    Google Scholar 

  37. Bernstein DP, Fink L. Childhood Trauma Questionnaire. A retrospective self-report questionnaire and manual. San Antonio: The Psychological Coporation; 1998.

    Google Scholar 

  38. Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169–90.

    Article  PubMed  Google Scholar 

  39. Straus MA, Hamby SL, Warren WL. The Conflict Tactics Scales Handbook. Los Angeles: Western Psychological Services; 2003.

    Google Scholar 

  40. Koss MP, Gidycz CA, Wisniewski N. The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. J Consult Clin Psychol. 1987;55(2):162–70.

    Article  CAS  PubMed  Google Scholar 

  41. CDC. HIV/AIDS among Women. http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm (2008). Accessed March 26, 2008.

  42. SPSS. SPSS 15 for Windows. Chicago: SPSS Inc; 2006.

    Google Scholar 

  43. Pallant J. SPSS survival manual. 2nd ed. New York: Open University Press; 2005.

    Google Scholar 

  44. Kenny DA. Mediation. August 12, 2009; http://davidakenny.net/cm/mediate.htm (2009). Accessed 24 September 2009.

  45. Sullivan TP, Holt LJ. PTSD symptom clusters are differentially related to substance use among community women exposed to intimate partner violence. J Trauma Stress. 2008;21(2):173–80.

    Article  PubMed  Google Scholar 

  46. Risser HJ, Hetzel-Riggin MD, Thomsen CJ, McCanne TR. PTSD as a mediator of sexual revictimization: the role of reexperiencing, avoidance, and arousal symptoms. J Trauma Stress. 2006;19(5):687–98.

    Article  PubMed  Google Scholar 

  47. Chu JA. The revictimization of adult women with histories of childhood abuse. J Psychother Pract Res. 1992;1(3):259–69.

    Google Scholar 

  48. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry. 1997;4(5):231–44.

    Article  CAS  PubMed  Google Scholar 

  49. Reed PL, Anthony JC, Breslau N. Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: do early life experiences and predispositions matter? Arch Gen Psychiatry. 2007;64(12):1435–42.

    Article  PubMed  Google Scholar 

  50. Anderson JE, Mosher WD, Chandra A. Measuring HIV risk in the U.S. population aged 15–44: results from cycle 6 of the National Survey of Family Growth. Hyattsville: CDC National Center for Health Statistics; 2006.

    Google Scholar 

  51. Logan TK, Cole J, Leukefeld C. Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull. 2002;128(6):851–85.

    Article  CAS  PubMed  Google Scholar 

  52. Hien DA, Campbell ANC, Killeen T, et al. The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network “Women and Trauma” multi-site study. AIDS Behav (Epub ahead of print); (2009).

  53. Sikkema KJ, Neufeld SA, Hansen NB, et al. Integrating HIV prevention into services for abused women in South Africa. AIDS Behav (in press).

  54. Arata CM. From child victim to adult victim: a model for predicting sexual revictimization. Child Maltreat. 2000;5(1):28–38.

    Article  CAS  PubMed  Google Scholar 

  55. Engstrom M, El-Bassel N, Go H, Gilbert L. Childhood sexual abuse and intimate partner violence among women in methadone treatment: a direct or mediated relationship? J Fam Violence. 2008;23(7):605–17.

    Article  Google Scholar 

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Acknowledgments

This research was supported by grants R03DA017668, T32DA019426, T32DA007292, and K23DA019561 from the National Institute of Drug Abuse and K23MH076671 from the National Institute of Mental Health. This study was presented at the 2009 Convention of the American Psychological Association in Toronto, Canada.

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Authors and Affiliations

  1. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, 4th Floor, M409, Baltimore, MD, 21205, USA

    Courtenay E. Cavanaugh

  2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Nathan B. Hansen & Tami P. Sullivan

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  1. Courtenay E. Cavanaugh
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  2. Nathan B. Hansen
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  3. Tami P. Sullivan
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Correspondence to Courtenay E. Cavanaugh.

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Cavanaugh, C.E., Hansen, N.B. & Sullivan, T.P. HIV Sexual Risk Behavior Among Low-Income Women Experiencing Intimate Partner Violence: The Role of Posttraumatic Stress Disorder. AIDS Behav 14, 318–327 (2010). https://doi.org/10.1007/s10461-009-9623-1

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