Substance Abuse, Violence, and HIV in Women: A Literature Review of the Syndemic

Abstract

Women in the United States are increasingly affected by HIV/AIDS. The SAVA syndemic-synergistic epidemics of substance abuse, violence, and HIV/AIDS-is highly prevalent among impoverished urban women and potentially associated with poor HIV outcomes. A review of the existing literature found 45 articles that examine SAVA's impact on (1) HIV-associated risk-taking behaviors, (2) mental health, (3) healthcare utilization and medication adherence, and (4) the bidirectional relationship between violence and HIV status. Overall, results confirm the profound impact of violence and victimization and how it is intertwined with poor decision making, increased risk taking and negative health consequences, particularly in the context of substance abuse. Among current findings, there remain diverse and inconsistent definitions for substance abuse, violence, mental illness, adherence, and healthcare utilization that confound interpretation of data. Future studies require standardization and operationalization of definitions for these terms. Development and adaptation of evidencebased interventions that incorporate prevention of violence and management of victimization to target this vulnerable group of women and thereby promote better health outcomes are urgently needed.

Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil

“…Finally, while cigarette smoking was associated with unprotected sex among both genders, sex under the influence of alcohol or drugs, and having suffered any verbal violence were independent correlates of unprotected sex among women only, and this result was consistent with other studies 26,27,28,29,30,31 . Sex under the influence of alcohol or drugs can alter cognitive abilities and decision-making power, thus potentially leading to high risk behaviors 6 .…”

Fatores associados à violência contra mulheres profissionais do sexo de dez cidades brasileiras

“…The presence of structural factors and alcohol and drug consumption often interweaves in these relations, producing conflicts and further favoring men's control over women, including by violent means. A literature review on the intersection between substance abuse, violence, and HIV/AIDS in women in the United States found that 76% of women that report physical assault and rape in adulthood were victims of their own intimate partners 25 .…”

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

“…Recent reviews of the literature revealed several mechanisms that link these women's health problems and empirical data have supported these associations. [5][6][7][8] Women who are forced to have sex with an HIV-positive partner could be exposed to infection, and living with violence or the fear of abuse by an intimate partner can limit women's ability to negotiate safe sex behaviors. [9][10][11][12][13][14][15][16] Conversely, women who are HIV-positive might experience abuse upon disclosure of their HIV status.…”