Prevalence and Social-Structural Correlates of Gender-Based Violence Against Women Living With HIV in Metro Vancouver, Canada

Abstract

Violence experienced by cisgender (cis) and gender minority women living with HIV is known to be high. More work is needed to better understand how to support women living with HIV who have experienced violence. The objectives of this study are therefore to identify the prevalence and correlates of violence by any perpetrator among women living with HIV in a Canadian setting. Data were drawn from 9 years (January, 2010 to February, 2019) of a longitudinal community-based open cohort study of 350+ cis and trans women living with HIV who were living and/or accessed care in Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment “SHAWNA”). Participants completed baseline and biannual follow-up interviews. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify correlates of recent (last 6 months) violence (physical and/or sexual) by any perpetrator. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CIs) are presented. At baseline, prevalence of violence was high: 95.5% (recent = 19.4%) of participants reported lifetime physical and/or sexual violence, 94.8% (recent = 17.9%) reported lifetime physical violence, and 84.5% (recent = 5.7%) reported lifetime sexual violence. In multivariable logistic regression with GEE, the following variables were associated with higher odds of recent physical/sexual violence: youth (<30 years) (AOR: 1.60, 95% CI [1.15, 2.22]), recent unstable housing/homelessness (AOR: 1.96, 95% CI [1.30, 2.97]), recent food insecurity (AOR: 1.57, 95% CI [1.13, 2.17]), recent incarceration (AOR: 1.85, 95% CI [1.18, 2.91]), recent opioid use (AOR: 1.38, 95% CI [1.04, 1.82]), recent stimulant use (AOR: 2.48, 95% CI [1.72, 3.56]), and lifetime HIV status disclosure without consent (AOR: 1.59, 95% CI [1.13, 2.24]). Trauma- and violence-informed (TVI) policies that include a focus on confidentiality and safe disclosure practices should be integrated into existing housing, incarceration, and harm reduction programs, and HIV care and practice for women living with HIV. Programs and policies that address high levels of violence remain critical.

Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV

“…People with HIV experience a disproportionate level of intersecting social disadvantages including lower socioeconomic status [8], poor mental health [9], substance misuse [10], structural racism [11], sex-based violence [12], and in particular, HIV-related stigma including selfstigma [13]. The impact of SDH on engagement with HIV care and virological suppression is well recognized; nonwhite ethnicity, low education level, low health literacy, poverty, food insecurity, homelessness, criminal justice involvement, and intimate partner violence have all been associated with suboptimal engagement with care, poor adherence to antiretroviral therapy (ART) and/ or viral rebound [14][15][16][17][18].…”

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

“…Sex workers face disproportionate health and social inequities, for example, high rates of HIV and STI’s, violence, and criminalization ( 56 ). Sex workers and women living with HIV face several sources of structural violence, including lifetime exposure to violence, intimate partner violence, gender-based violence, and police harassment that impacts their access to healthcare services ( 22 , 31 , 57 ). A growing body of evidence has highlighted how culturally safe and trauma-informed healthcare services may reduce barriers to healthcare services among racialized and minoritized populations ( 7 , 58 , 59 ).…”