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Implementing a Screening Program for Domestic Abuse

April 16, 2015

Thanks to the availability of potent combination anti-HIV therapy (commonly called ART or HAART), many people with HIV are living longer in Canada and other high-income countries. As a result, researchers in the HIV field are able to explore a range of different issues in the lives of this population. One such issue is intimate partner violence (IPV), which a team of researchers in Calgary, Alberta, has defined as follows (based on a report by the World Health Organization):

"Violence committed by a current or former intimate partner involving the threat, attempt, or completion of physical, sexual or psychological violence." Included in this are issues such as "neglect, isolation, intimidation and financial abuse."

IPV is also known as interpersonal violence, battering or domestic abuse.


IPV and Its Relation to Health and HIV

IPV can have a broad range of negative effects on a person's health and quality of life.

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The Calgary researchers state: "Not only are [people who experience] IPV more vulnerable to acquiring HIV infection, but also the presence of IPV negatively impacts their care by delaying access to [HIV] diagnosis and subsequent engagement in care, missed clinical appointments, non-adherence to antiretroviral therapy, increased hospitalizations, and [increasing the risk for developing AIDS]."

This statement is based on findings from studies conducted in Alberta and elsewhere.

The Calgary team notes that other researchers have found that "the presence of HIV infection may increase the risk of subsequent IPV within a relationship." Therefore, they say that identifying HIV-positive people who have experienced or are experiencing IPV "offers the potential for mitigating its negative effects on both their general and HIV health."


Past and Present

Several years ago the Southern Alberta Clinic (SAC) began implementing a program to screen HIV-positive patients for IPV. The Calgary team recently conducted a study to assess the program. They found that IPV was common -- overall, 35% of 1,721 participants disclosed this problem. However, IPV was even more common among some subgroups. Researchers conducted detailed interviews with a subset of 158 participants. This latter group reported appreciation for the screening program and gave feedback that the researchers used to make recommendations for other clinics implementing an IPV screening program.


Results

Of the 1,721 participants screened for IPV, a total of 605 (35%) reported at least one of the following issues:

  • They were currently experiencing IPV.
  • They had experienced IPV in a previous relationship.
  • They had experienced abuse as a child.


IPV and Demographic Information

Participants who were diagnosed with HIV when they were younger than 30 years old were more likely to disclose IPV than participants who were diagnosed with HIV in their later years.

Other findings by the Calgary team included the following:

  • IPV was more common in women (46%) than in men (32%)
  • 67% of Aboriginal people reported experiences of IPV
  • participants whose risk factor for HIV infection was injecting street drugs were more likely to disclose IPV than participants whose HIV risk factor was condomless sex with men or condomless sex with men and women
  • bisexual men and women reported high rates of IPV (48%)
  • gay men reported more IPV (35%) than straight men (25%)
  • straight women reported high rates of IPV (44%)


Findings From Interviews

In June and July 2014, the research team interviewed 158 people -- a subset of the larger study of 1,721 participants -- to hear their views about IPV screening in the clinic. The main findings are as follows:

  • Prior to being a patient at the SAC, only 22% of participants had been screened about IPV. The Calgary team found this surprising, as they said that many participants belonged to "demographic groups well known to be at increased risk for IPV."
  • The researchers reported that 73% of participants suggested that "IPV screening should be routinely discussed [as part of regular HIV care]."
  • However, 53% of participants said that routine screening for IPV should be delayed until after several clinic visits had occurred. This delay provided time for patients to develop a trusting relationship with clinic staff. This trusting relationship was revealed by both participants and researchers to be a critical factor for successful participation in IPV screening.
  • Participants did not express any clear preference for the type of specialist -- doctor, nurse, social worker -- who should perform IPV screening.
  • In general, participants did not express a preference for the gender of the healthcare worker who would perform IPV screening. However, the researchers stated that among those who did state a preference "most preferred females to ask questions."
  • According to the researchers, about half of the participants recommended that "a clear and precise definition of IPV must be included in any questioning about partner violence."
  • Participants felt that questions about IPV should be asked routinely in the clinic (41%) or every six months (31%).


In Context

The latest results from the Calgary researchers confirm their earlier findings and conclusions -- that "IPV is common, ongoing and a pervasive issue across all of our different communities living with HIV in southern Alberta."

Furthermore, the researchers stated that "screening and providing proper follow-up and referral for IPV can and should be incorporated effectively in the HIV clinic setting."

Recommendations for Clinics

Based on their experience of screening for IPV for at least five years in southern Alberta, the researchers made the following recommendations for other clinics that provide care for HIV-positive people:

  • IPV screening can and should be incorporated into regular HIV care.
  • A trusting relationship with the patient should be established prior to asking about IPV.
  • Any healthcare provider with an established trust relationship can enquire about IPV.
  • A clear and understandable definition of abuse must be included when asking about IPV.
  • A protocol and referral process must be in place for people who disclose IPV.
  • Patients disclosing abuse in a current relationship must have close follow-up and be asked about abuse at subsequent routine appointments.
  • All patients should be asked about their IPV status at least annually, even if they have not previously disclosed IPV.

Although the present study was done in southern Alberta, IPV knows no boundaries, so HIV clinics in other regions can hopefully learn from the experience of the Calgary research team.


References

  1. World Health Organization. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Report. 2013.
  2. Raissi SE, Krentz HB, Siemieniuk RA, et al. Implementing an intimate partner violence (IPV) screening protocol in HIV care. AIDS Patient Care and STDs. 2015 Mar;29(3):133-41.



This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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