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Intimate partner violence, threats tied to worse HIV outcomes in U.S.

Submitted by Mark Mascolini

Intimate partner violence and being threatened by a partner raised the risk of a low CD4 count, a detectable viral load, and missing HIV clinic appointments in a 251-person study in Virginia, the U.S. state just south of Washington, DC. Prevalence of intimate partner violence did not differ by gender or sexual orientation.

Experiencing “multiple traumas” is associated with AIDS-related mortality and all-cause mortality, with increased opportunistic infections, with progression to AIDS, and with decreased adherence to therapy. But the clinical impact of intimate partner violence in HIV-positive people is not understood well.

Researchers recruited HIV-positive people attending a public HIV clinic in Charlottesville, Virginia to take part in this observational study. Participants completed interviews about intimate partner violence and clinical factors. The three main outcomes were a CD4 count below 200 cells/µL, a detectable viral load, and no-show rate—the proportion of scheduled clinic visits that a person missed.

Of the 251 adults who joined the study, 74 percent were men, 55 percent white, and 52 percent men who have sex with men. Eighty-three participants (33 percent) reported intimate partner violence, with no difference by gender or sexual orientation.

Univariate analysis found significant associations between intimate partner violence and a CD4 count below 200 cells/µL (P = 0.005) and a detectable viral load (P = 0.04). There was a trend toward an association between intimate partner violence and a high no-show rate (P = 0.077).

Being threatened by a partner was significantly associated with all three outcomes—a CD4 below 200 cells/µL (P = 0.005), a detectable viral load (P = 0.011), and a high no-show rate (P = 0.019).

Multivariate analysis found significant associations between intimate partner violence and a CD4 below 200 cells/µL (P =0.005) and detectable viral (P =0.035), while being threatened by a partner was significantly associated with a CD4 below 200 cells/µL (P =0.020), a detectable viral load (P = 0.007), and a high no-show rate (P = 0.020).

Source: Katherine R. Schafer, Julia Brant, Shruti Gupta, John Thorpe, Christopher Winstead-Derlega, Relana Pinkerton, Kathryn Laughon, Karen Ingersoll, Rebecca Dillingham. Intimate partner violence: a predictor of worse HIV outcomes and engagement in care. AIDS Patient Care and STDs. 2012; 26: 356-365.

For the study abstract (Downloading the complete article requires a subscription to AIDS Patient Care and STDs or an online payment; the abstract is free.)

Written by Mark Mascolini on behalf of the International AIDS Society

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