Half the female patients at the HIV clinic in Homerton Hospital, east London, have suffered intimate partner violence, Dr Rageshri Dhairyawan told the British HIV Association (BHIVA) conference in Birmingham yesterday. One in seven had experienced it in the last twelve months.
Dr Dhairyawan called on HIV clinicians to screen all their female patients, including those attending antenatal services, for intimate partner violence.
Intimate partner violence (IPV) is defined as the infliction of physical, sexual or psychological harm by a current or former partner. For the current study, the researchers used a tool (the HARK questionnaire) that had been previously validated in general practice settings in east London.
In this questionnaire, the respondent is asked whether she has ever been humiliated or emotionally abused by a partner; been afraid of a partner; raped or forced into sexual activity by a partner; or kicked, hit, slapped or physically hurt by a partner. All questions also relate to former partners.
The issue has previously been studied in other countries, where it has been shown that women living with HIV are more likely to experience IPV than other women. However, it has never been previously studied in the UK.
Researchers at the Homerton Hospital, which serves a socially disadvantaged district of east London, asked all adult women attending HIV outpatient services if they would take part in the study. Of 314 women invited to participate, 191 did so and provided valid responses.
In keeping with the patient profile at the Homerton, average age was 38 and three-quarters of participants were of black African ethnicity. Almost all participants got HIV during heterosexual contact; no participant acquired HIV through injecting drug use.
Half of the women (99 of 191, 52%) had ever experienced intimate partner violence. Nearly one in seven (27 of 191, 14%) had experienced it during a pregnancy.
Furthermore, one in seven patients (27 of 191, 14%) had experienced intimate partner violence in the past twelve months. For 12% of women this related to humiliation or emotional abuse; 9% were afraid of a partner; 4% had been kicked or otherwise attacked; and 3% had been raped.
These rates are higher than those found in women attending general practice in east London.
Older women were less likely to report IPV. Compared to black African women, women of other black ethnicities (including black British and black Caribbean) were four times more likely to report violence (odds ratio 4.63, p=<0.05).
Women who had experienced IPV were three times more likely than other women to report having had mental health problems (odds ratio 3.44, p=<0.05). However, the researchers point out that with a single survey, it cannot be known which came first – the violence, or the mental health problems.
There were no statistically significant associations between intimate partner violence and immigration status, socioeconomic status, educational background or substance use.
The researchers point out that, in relation to HIV, intimate partner violence can create difficulties in relation to a woman’s ability to disclose her HIV status with safety and limit her ability to access healthcare, adhere to medication and practice safer sex.
They call for HIV healthcare professionals in the UK to be more aware of the issue and for them to universally screen female patients for intimate partner violence.
Dhairyawan R et al. Intimate partner violence in women living with HIV attending an inner city clinic in the United Kingdom: prevalence and associated factors. 18th Annual Conference of the British HIV Association, Birmingham, abstract O5, 2012. See abstract here.