September 3, 2013
In reviewing the medical records of the women in the study, researchers found that women who experienced IPV had high rates of depression prior to their HIV diagnosis. In general, the intensity of depression was severe and many affected women required prescription medicines to cope.
Women who had IPV also had an increased risk for previously being diagnosed with an anxiety-related disorder. Furthermore, women with IPV were more likely to have attempted to commit suicide before having been diagnosed with HIV.
Women who reported IPV had greatly reduced health-related quality of life.
Women who disclosed IPV were generally diagnosed with HIV relatively early in the course of infection, with CD4+ counts greater than 500 cells. Also, women who disclosed IPV were less likely to use antiretroviral therapy (commonly called ART or HAART); if they did use it, they did so irregularly. Moreover, women who experienced IPV found it difficult to stay engaged with regular clinic visits and other care. Over the long term, such interruptions in care could affect their survival.
Rates of hospitalization were greater for women with IPV than women who did not have IPV.
The Alberta study has found a high overall rate -- 40% -- of IPV among HIV-positive women. According to the researchers, it is possible that the actual rate of IPV is even greater: "Many women experiencing IPV do not interpret their experiences as IPV, often minimizing the situation."
The researchers also found that substance use and a history of smoking were relatively common among women who disclosed IPV. They stated that "helping patients address IPV in a constructive manner may also [reduce the illness and death that can arise from] substance use and smoking."
Another finding noted by researchers was that women who faced IPV "experience multiple barriers to care, such as the immediate threats to the safety of themselves and their dependents, which in turn requires less imminent threats, such as HIV infection, to fall in priority."
The researchers stated that many women "may also experience IPV as a consequence of HIV infection and its disclosure [to their partner]. As such, these women may be risking violent repercussions by engaging in care. Our study supports this [idea], as women who experienced IPV found it more difficult to remain engaged in HIV care."
In this context it is not surprising that many women with IPV had poor health and quality of life, in part due to severe stress and no or intermittent use of ART. So the Alberta team proposes that by "directly addressing IPV, we may support adherence to care and thereby improve [their health and well-being]."
Women who disclosed IPV were less likely to be using ART; this may have at least partially accounted for their increased risk for hospitalization. Therefore, the researchers encourage medical and social teams caring for HIV-positive women to help develop safe and trustworthy relationships so that care teams can address IPV and its psychological consequences. As a result, affected women should improve psychologically and be able to take ART exactly as directed, which would lead to them experiencing better health and quality of life. Physicians, nurses, pharmacists and other healthcare providers can begin to help women with IPV by "appropriate referrals to specialized agencies and other health professionals" who are trained and experienced in dealing with IPV.
The Alberta study is a good first step in tackling the horror of IPV among HIV-positive women. Further research is needed to study the long-term outcomes on the health of affected HIV-positive women who have been able to disclose and escape IPV. As well, more effort needs to be made by regional health authorities everywhere to educate and screen all women about IPV.
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