Physical and Sexual Violence and Incident Sexually Transmitted Infections

Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri 63110-1501, USA.
Journal of Women's Health (Impact Factor: 2.05). 03/2009; 18(4):529-34. DOI: 10.1089/jwh.2007.0757
Source: PubMed


To investigate whether women aged 13-35 who were victims of interpersonal violence were more likely than nonvictims to experience incident sexually transmitted infections (STIs).
We examined 542 women aged 13-35 enrolled in Project PROTECT, a randomized clinical trial that compared two different methods of computer-based intervention to promote the use of dual methods of contraception. Participants completed a baseline questionnaire that included questions about their history of interpersonal violence and were followed for incident STIs over the 2-year study period. We compared the incidence of STIs in women with and without a history of interpersonal violence using bivariate analyses and multiple logistic regression.
In the bivariate analyses, STI incidence was found to be significantly associated with African American race/ethnicity, a higher number of sexual partners in the past month, and a lower likelihood of avoidance of sexual partners who pressure to have sex without a condom. In both crude and adjusted regression analyses, time to STI incidence was faster among women who reported physical or sexual abuse in the year before study enrollment (HRR(adj) = 1.68, 95% CI 1.06, 2.65).
Women with a recent history of abuse are at significantly increased risk of STI incidence than are nonvictims.

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    • "Resulting concern for STI including HIV, is exacerbated by the HIV epidemics in these sites: while the Johannesburg epidemic is on a higher order of magnitude with an estimated 15.2% of 15-49 year olds infected in Gauteng province [56], Baltimore remains an epicenter of the US HIV epidemic, with the fourth highest caseload in the nation [57] [58]. IPV is consistently associated with STI/ HIV [8,53,59e61], and prospective research from both the US and South Africa confirms a temporal link of IPV with incident infection [53] [59]. Sexual and reproductive health promotion efforts , including STI/HIV screening programs, may be uniquely positioned to integrate GBV prevention messaging as well as support for survivors and links to services. "
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    ABSTRACT: Globally, adolescent women are at risk for gender-based violence (GBV) including sexual violence and intimate partner violence (IPV). Those in economically distressed settings are considered uniquely vulnerable.Methods Female adolescents aged 15–19 from Baltimore, Maryland, USA; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China (n = 1,112) were recruited via respondent-driven sampling to participate in a cross-sectional survey. We describe the prevalence of past-year physical and sexual IPV, and lifetime and past-year non-partner sexual violence. Logistic regression models evaluated associations of GBV with substance use, sexual and reproductive health, mental health, and self-rated health.ResultsAmong ever-partnered women, past-year IPV prevalence ranged from 10.2% in Shanghai to 36.6% in Johannesburg. Lifetime non-partner sexual violence ranged from 1.2% in Shanghai to 12.6% in Johannesburg. Where sufficient cases allowed additional analyses (Baltimore and Johannesburg), both IPV and non-partner sexual violence were associated with poor health across domains of substance use, sexual and reproductive health, mental health, and self-rated health; associations varied across study sites.Conclusions Significant heterogeneity was observed in the prevalence of IPV and non-partner sexual violence among adolescent women in economically distressed urban settings, with upwards of 25% of ever-partnered women experiencing past-year IPV in Baltimore, Ibadan, and Johannesburg, and more than 10% of adolescent women in Baltimore and Johannesburg reporting non-partner sexual violence. Findings affirm the negative health influence of GBV even in disadvantaged urban settings that present a range of competing health threats. A multisectoral response is needed to prevent GBV against young women, mitigate its health impact, and hold perpetrators accountable.
    Full-text · Article · Nov 2014 · Journal of Adolescent Health
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    • "Evidence of immediate and long-term physical, psychological, reproductive and social harms of GBV is extensive. Physical sequelae may include bodily and genital injury [3,6,7], pelvic pain, traumatic fistulas [8,9], unwanted pregnancy, increased risk of HIV [9,10] and sexually transmitted infections [11,12], and even death [13]. Adolescents and young women and those without prior sexual intercourse experiences are particularly vulnerable to physical trauma and genital-anal injury associated with sexual violence [6,9,14-16]. "
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    ABSTRACT: Background High levels of gender-based violence (GBV) persist among conflict-affected populations and within humanitarian settings and are paralleled by under-reporting and low service utilization. Novel and evidence-based approaches are necessary to change the current state of GBV amongst these populations. We present the findings of qualitative research, which were used to inform the development of a screening tool as one potential strategy to identify and respond to GBV for females in humanitarian settings. Methods Qualitative research methods were conducted from January-February 2011 to explore the range of experiences of GBV and barriers to reporting GBV among female refugees. Individual interview participants (n=37) included female refugees (≥15 years), who were survivors of GBV, living in urban or one of three camps settings in Ethiopia, and originating from six conflict countries. Focus group discussion participants (11 groups; 77 participants) included health, protection and community service staff working in the urban or camp settings. Interviews and discussions were conducted in the language of preference, with assistance by interpreters when needed, and transcribed for analysis by grounded-theory technique. Results Single and multiple counts of GBV were reported and ranged from psychological and social violence; rape, gang rape, sexual coercion, and other sexual violence; abduction; and physical violence. Domestic violence was predominantly reported to occur when participants were living in the host country. Opportunistic violence, often manifested by rape, occurred during transit when women depended on others to reach their destination. Abduction within the host country, and often across borders, highlighted the constant state of vulnerability of refugees. Barriers to reporting included perceived and experienced stigma in health settings and in the wider community, lack of awareness of services, and inability to protect children while mothers sought services. Conclusions Findings demonstrate that GBV persists across the span of the refugee experience, though there is a transition in the range of perpetrators and types of GBV that are experienced. Further, survivors experience significant individual and system barriers to disclosure and service utilization. The findings suggest that routine GBV screening by skilled service providers offers a strategy to confidentially identify and refer survivors to needed services within refugee settings, potentially enabling survivors to overcome existing barriers.
    Full-text · Article · Jun 2013 · Conflict and Health
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    • "Data on the relationship between mental healthdmost commonly identified as depressiondand STIs is mixed, but most studies report a positive correlation between depression and risky sexual behavior, an established precursor to STIs (Buffardi, et al., 2008; Parsons, Halkitis, Wolitski, Gomez & the Seropositive Urban Men's Study Team, 2003; Shrier, Harris, Sternberg, & Beardslee, 2001). Similarly, research suggests a positive relationship between alcohol use and STIs (Buffardi, et al., 2008; Cook & Clark, 2005) drug use and STIs (Manhart et al., 2006) and multiple sexual partners and STI risk (Allsworth et al., 2009; Rosenberg et al., 1999). Finally, both race and marital status are associated with sexual violence and STIs. "
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    ABSTRACT: Sexually transmitted infections (STIs) are among the most common infections in the United States and are particularly prevalent in survivors of sexual violence. The purpose of this study is to examine co-occurring risk factors for sexual violence and STIs including mental health, alcohol use, drug use, and multiple partners as intersecting pathways to STIs for women who experienced sexual abuse in the past year. Secondary analyses were conducted on cross-sectional data from women originally recruited as respondents for an epidemiologic survey funded by the Centers for Disease Control and Prevention (CDC): Project CHOICES. The survey was administered to 2,672 women in six settings: A large, urban jail and residential alcohol and drug treatment facilities (Texas); a gynecology clinic (Virginia); two primary care clinics (Virginia and Florida); and media solicitation (Florida). Women were included in the current study if they were fertile, sexually active, and not pregnant or trying to get pregnant (n = 1,183). Structural equation modeling (SEM) was used to test the conceptual path model between sexual violence and STI occurrence. In the SEM, there were no significant paths from mental health, alcohol severity, or drug use to STI occurrence contrary to the results of the initial bivariate analyses. Multiple sexual partners significantly mediated the relationship between sexual violence and STIs and between mental health and drug use and STIs. This study highlights the importance of providing effective treatment to survivors of sexual violence, which includes addressing risky sexual behaviors to reduce STI occurrence.
    Full-text · Article · Feb 2012 · Women s Health Issues
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