Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care

Rob J Fredericksen ,Sonia Napravnik ,Delaney Jac,Michael J Mugavero ,Ameeta S Kalokhe ,Barbara N Harding ,Joseph J Eron ,W Christopher Mathews ,Carlos Del Rı́o ,Benigno Rodrı́guez ,Robin M Nance ,Emma Fitzsimmons ,Stephanie A Ruderman ,Kenneth H Mayer ,Daniel J Feaster ,Lisa R Metsch ,Jennifer Potter ,Conall Oʼcleirigh ,Bridget M Whitney ,Heidi M Crane

doi:10.1186/s12889-021-11854-x

Abstract

BackgroundAmong people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes. We examined non-physical, psychological intimate partner violence (psy-IPV) and HIV care outcomes using data from two U.S. consortia.MethodsWe conducted multivariable analyses with robust standard errors to compare patients indicating/not indicating psy-IPV.ResultsAmong PLWH (n = 5950), 9.5% indicated psy-IPV; these individuals were younger (− 3; 95% CI [− 2,-4], p-value < 0.001), less likely to be on antiretroviral treatment (ART) (0.73 [0.55,0.97], p = 0.03), less adherent to ART (− 4.2 [− 5.9,-2.4], p < 0.001), had higher odds of detectable viral load (1.43 [1.15,1.78], p = 0.001) and depression (2.63 [2.18,3.18], p < 0.001), and greater use of methamphetamines/crystal [2.98 (2.30,3.87),p < 0.001], cocaine/crack [1.57 (1.24,1.99),p < 0.001], illicit opioids [1.56 (1.13,2.16),p = 0.007], and marijuana [1.40 (1.15,1.70), p < 0.001].ConclusionPsychological IPV, even in the absence of physical or sexual IPV, appears to be associated with HIV care outcomes and should be included in IPV measures integrated into routine HIV care.

Highlights

Among people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes
Among PLWH (n = 5950), 9.5% indicated psychological intimate partner violence (psy-IPV); these individuals were younger (− 3; 95% CI [− 2,4], pvalue < 0.001), less likely to be on antiretroviral treatment (ART) (0.73 [0.55,0.97], p = 0.03), less adherent to ART (− 4.2 [− 5.9,2.4], p < 0.001), had higher odds of detectable viral load (1.43 [1.15,1.78], p = 0.001) and depression (2.63 [2.18,3.18], p < 0.001), and greater use of methamphetamines/crystal [2.98 (2.30,3.87),p < 0.001], cocaine/crack [1.57 (1.24,1.99),p < 0.001], illicit opioids [1.56 (1.13,2.16),p = 0.007], and marijuana [1.40 (1.15,1.70), p < 0.001]
Psychological IPV, even in the absence of physical or sexual IPV, appears to be associated with HIV care outcomes and should be included in IPV measures integrated into routine HIV care

Summary

Introduction

Among people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes. Living with HIV has been associated with both psychological and physical IPV [8], and any IPV among PLWH has been associated with poorer antiretroviral treatment (ART) adherence, more clinically relevant interruptions in care [7, 9,10,11], and increased HIV-related hospitalizations [11] In both PLWH and those without HIV, any IPV has been associated with psychiatric conditions, such as depression [6, 12,13,14,15] and post-traumatic stress disorder (PTSD) [6, 16] and adverse health behaviors, including substance abuse [6, 12, 17,18,19,20] and high-risk sexual behavior [4, 6, 21, 22]. Among HIV-negative women at high risk for contracting HIV, both lifetime and past-year violence of any type was associated with increased CD4+ activation [23]; among PLWH, physical IPV has been shown to have a negative impact on virologic outcomes [24] and CD4+/CD8+ T-cell decay [25]

Methods

Results

Discussion

Conclusion