Depending on how it's defined, between 13% and 46% of American gay men report intimate partner violence

A study which aimed to produce a definition of intimate partner violence (physical, sexual, or psychological harm caused by a current or former partner) that would be appropriate for gay, bisexual and other men who have sex with men (MSM) has found that up to 46% of men have experienced it.

The study also suggested that many gay men consider non-disclosure of HIV status to be a form of violence. And men with experience of intimate partner violence were more likely to report unprotected sex.

These data from the US city of Atlanta were reported to the Nineteenth International AIDS Conference (AIDS 2012) on July 27th.

Intimate partner violence is a similar concept to domestic violence. While precise definitions of these terms differ, they have in general been formulated in relation to women suffering at the hands of male partners. And although it's usually acknowledged that such abuse can occur in the context of a same-sex relationship, Catherine Finneran of Emory University wanted to find out if intimate partner violence took different forms for gay and bisexual men.

She also suspected that experience of intimate partner violence might be linked to the risk of HIV infection, as it is already established that such abuse has links with other sexually transmitted infections, drug use, alcohol use, prior childhood sexual abuse, mental health issues and internalised homophobia.

She began her work by developing a definition of intimate partner violence that would be meaningful to gay and bisexual men.

Firstly, during seven focus groups, men examined one of the most commonly used definitions – the Conflict Tactics Scale – and discussed whether it corresponded with actions they would understand to be violent.

This generated new items for a scale, which were tested with 1074 men recruited at Atlanta gay venues. Using a computerised questionnaire, men were again asked whether they thought that such actions from a current or former partner would amount to violence. They were also asked if they had ever been the victim or perpetrator of such actions.

Half the participants had a college education, half were non-white and a quarter was living with HIV.

Using a statistical technique called rotational factor analysis, the researchers then identified key aspects of intimate partner violence that were widely agreed upon by the gay and bisexual men surveyed. The process identified five key ‘factors’ or types of violence.

The most important grouped together obvious manifestations of physical and sexual violence, including kicking, punching, slapping, rape and damage to property.

The second most important factor was made up of ‘monitoring’ behaviour – reading a partner’s email without permission, demanding access to his mobile phone, repeatedly posting on his Facebook page and so on.

The next factor was defined as ‘controlling’ – preventing someone from seeing family or friends, either his own or his partner’s.

Another factor grouped together ‘emotional’ abuse – calling a partner fat, criticising his clothes or asking him to act ‘straight’.

The final factor – and the most controversial one – included things that were related to HIV. Three points were included – lying about HIV status, not saying that he had HIV before having sex and intentionally transmitting HIV.

A speaker from the floor questioned the inclusion of non-disclosure of HIV status as ‘violence’. He noted that this part of the definition was all about things a person with HIV might do to an HIV-negative partner, and never the other way round.

Catherine Finneran said that she was also uncomfortable with the results. But she stressed that the definition had come from and had been empirically validated by the gay and bisexual men she recruited.

“That's what the data say and I feel I have to report it,” she said. Moreover the survey stage had eliminated two items (refusing to use a condom and unintentional HIV transmission) as the respondents did not see them as violent.

The survey work also looked at what proportion of gay and bisexual men in Atlanta had experienced intimate partner violence. Three definitions were tested:

• The CDC’s definition, which is limited to physical and sexual abuse. 13% reported being a victim and 8% reported being a perpetrator.
• The Conflicts Tactics Scale, which includes more forms of sexual and emotional abuse, but has been developed in relation to women’s experience. 28% (victim) and 19% (perpetrator) reported this.
• The new definition for gay and bisexual men, as described above. 46% (victim) and 32% (perpetrator) reported this.

The numbers reporting abuse were a little higher in black and Latino men than in white men.

Whatever the definition used, men who had been victims of intimate partner violence were more likely to report that they did not use a condom the last time they had anal sex (whether it was with a casual or regular partner). Using the updated definition they were almost twice as likely to do so (odds ratio 1.90).

Finneran said that the scale would need to be validated with other groups of men who have sex with men. Finally, she noted the lack of appropriate services for gay and bisexual men who had experienced intimate partner violence.