[procaare] Violence During Pregnancy Among Women with or at Risk for HIV

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Violence During Pregnancy Among Women with or at Risk for HIV Infection
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American Journal of Public Health (03.02)::Linda J. Koenig, PhD; Daniel J. Whitaker, PhD;
Rachel A. Royce, PhD, MPH; Tracey E.
Wilson, PhD; Michelle R. Callahan, PhD; M. Isabel Fernandez, PhD, for the Perinatal
Guidelines Evaluation Project Group

Conservative estimates suggest that 4 percent to 8 percent of women in the United States
experience violence during pregnancy. Several factors suggest that risk for violence may
be even higher for pregnant women with HIV. In this study, data collected as part of the
Perinatal Guidelines Evaluation Project- HIV and Pregnancy Study were used to examine the
prevalence of violence during pregnancy among women with HIV and to ascertain if, and in
what way, violence might be related to HIV serostatus.

Between October 1996 and October 1998, pregnant women (336 HIV-infected and 298
HIV-uninfected but at-risk) receiving prenatal care were recruited from health departments
and clinics in Brooklyn, Connecticut, Miami and North Carolina. Demographic, behavioral
and HIV-related information was collected from women through interviews at 24 weeks or
more of pregnancy.

Recent violence was reported by 8.9 percent of women. All but one woman reporting sexual
violence also reported physical violence. Most women had a main male partner; 21.5 percent
described their partner as physically or verbally/emotionally abusive. Almost
three-fourths of the women who experienced violence were not currently in a relationship
with a physically abusive partner.

Neither violence nor having an abusive partner differed according to serostatus. The
proportion of women reporting violence was not higher among the 142 seropositive women
diagnosed with HIV during the current pregnancy (5.8 percent) than among seronegative
women (10.7 percent) or seropositive women with a prior HIV diagnosis (9.4 percent). Of
the 260 HIV-infected women with main male partners, only 206 (79.2 percent) said their
partner knew their serostatus. Of these, 20 (9.7 percent) indicated that something bad
happened when he found out. One woman was physically assaulted by her partner; one woman
physically assaulted her partner. Other common negative outcomes included anger,
depression or shock (n=3D9) and relationship problems or terminations (n=3D6).

Extrapolating from the 6,000 to 7,000 yearly births to US women with HIV, the researchers
calculated that violence likely affects between 528 and 616 HIV-infected women each year.
Moreover, many more women may be at risk for violence, as 21.5 percent of the women in the
study currently had an abusive partner. Many women whose partners were not physically
abusive, or who had no partner, experienced violence. This reinforces the need for routine
risk assessment in prenatal care settings and for increased awareness that women face risk
from ex-partners, non-partners and current partners.

Taken together, the findings suggest that violence against HIV-infected women is more
likely related to the socioeconomic or behavioral contexts that characterize their lives
than to serostatus itself.

"HIV-infected women's risk for violence may be best addressed by providing access to
economic and social services (e.g., financial assistance, substance abuse treatment) that
target conditions known to be associated with the risk of violence," the authors
concluded. "The prenatal care setting, with its multiple schedule provider contacts, may
provide an important opportunity for identifying and referring women at risk."

Source: [AEGiS] CDC HIV/STD/TB Prevention News Update 05/13/02

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