Screening for intimate partner violence in a London HIV clinic: characteristics of those screening positive

Abstract

Intimate partner violence (IPV) is widespread and more prevalent in the HIV-positive population than in the general population [1]. However, there is little published work concerning IPV in this population in the UK [2]. Dhairyawan et al. [3] found a 52% lifetime prevalence of IPV in HIV-positive women in a London clinic, with 14% reporting IPV in the last year. Health care workers have been identified as professionals to whom patients might choose to disclose IPV [4].Screening for IPV is recommended in selected health care settings, and at our hospital there is a new post for an independent domestic and sexual violence advisor (IDSVA). We established screening in an out-patient HIV clinic and compared those screened with those not screened, and summarized the characteristics of those reporting current or previous IPV.Multidisciplinary staff were trained to ask the following standardized question: "Have you ever been emotionally or physically hurt by your partner, ex-partner or family member?" Those who answered positively were assessed for current or past IPV by asking, "Are you still in contact with this person and are they still causing you and your family issues?" Screening took place while the patient was alone in a private place. Patients were referred to safeguarding services if necessary and to the IDSVA. If referral to the IDVSA was declined or there was no current risk, leaflets and contact information were given.We report on the demographics of 348 screened patients. Data were collected over 5 months and recorded on a standardized sheet and linked to the HIV database by hospital number and then anonomysed. Groups were compared using the v 2 test or Fisher's exact test for categorical variables, and using the MannÀWhitney U test for continuous variables as they were not normally distributed. No formal adjustment for multiple testing was made.Ten per cent (348 of 3383) of the current clinic population were screened. Those screened had similar demographics and HIV markers to those not screened. Almost a third of participants (103 of 348; 30%) had ever experienced IPV, and were more likely to be female (P = 0.01) with a trend towards heterosexual risk group (P = 0.085) and a detectable viral load (P = 0.088). A total of 68 of 348 patients (20%) had experienced IPV in the past and 35 of 348 (10%) of those screened were experiencing current IPV or were given contact information for future self referral. Fourteen of 348 patients (4%) agreed to be referred to the IVDSA. Ten were women and seven of 14 were of black ethnicity. Other variables were similar to those of the whole population, except that seven of those referred had detectable viraemia (50% vs. 15% in the whole population). Although numbers are small, perhaps this may suggest a relationship between adherence and access to medication, which could be further explored. Among the 103 who screened positive as a group there was also a trend towards detectable viraemia (P = 0.088).There was evidence of differences also when comparing men who screened posit...