Tag Archives: domestic violence

Retraumatization: The Increased Risk of HIV Transmission among Abuse and Assault Victims

While the transmission of HIV and the causes of HIV-related death are actually more complicated—and even more nuanced—than public discussion would let on, a few presumptions about it remain fairly accurate.

For women who are marginalized in their communities, who are victims of abuse or assault, and who are economically or socially dependent on a spouse, the risk of them contracting HIV or dying from multiple complications from AIDS is simply greater than that of women fortunate enough to not be subjected to these circumstances. Take these scenarios:

  • The power dynamic in an abusive relationship may prohibit women from being able to protect herself from a partner who refuses to wear a condom
  • Women in poverty and those who need to rely on a partner for financial support may have greater risk of comorbid infections than women of economic independence. They are less likely to have the health insurance and relationship with a healthcare provider that would support HIV testing and provide the essential—and expensive—HIV medications to ensure a healthy life and lower the risk of co-morbid infections
  • People without social support, living in fear of what an HIV-positive diagnosis means, or those who have reason to fear stigma around personal behavior when seeking treatment are less likely to know where to access treatment or seek it out because of that fear, stigma and lack of support

Common sense would seem to support these statements. But until recently, the pathways of infection were not always clear, and while the conclusions above seemed certainly reasonable, specific data to support them had been difficult to collect. Two recent studies led by a UCSF-researcher have changed that. One synthesized what is known about PTSD and exposure to trauma among HIV-positive women, and the other explored the root of this relationship.

The results were remarkable. HIV-positive women had between two and six times the rates of childhood and adult physical and sexual abuse, and PTSD. The snapshot of risk behaviors among HIV-positive women was sobering:

  Sample size Number (%) of participants with each characteristic
Sexual activity
Any sexual activity in the past 6 months 113 61 (54.0%)
 With a main partnerMedian number of main partners (if any) 61 43 (70.5%)1 (range 1–2)
 With casual partnersMedian number of casual partners (if any)a 61 23 (37.7%)1 (range 1–25)
Sex with any HIV negative or unknown serostatus partners (if sexually active) in the last 6 months 61 51 (83.6%)
 Disclosure of HIV status less than all of the time with these partners 51 29 (56.9%)
 Using condoms less than all of the time with these partners 51 31 (60.8%)
 Detectable viral load 51 30 (58.8%)
 Disclosure of HIV status less than all of the time, and using condoms less than all of the time, and a detectable viral load 51 16 (31.4%)
Substance use (any, recent)
Cigarettes 110 71 (64.5%)
Alcohol 111 50 (45.0%)
Marijuana 111 39 (35.1%)
Crack/cocaine, heroin, and/or methamphetamines 111 45 (40.5%)
IDUb 112 11 (9.8%)
 IDU who share needles 11 5 (45.5%)
 IDU who have a detectable viral load 11 6 (54.5%)

aOne participant had a very high number of sexual partners (N = 250) and was excluded from the analysis; b IDU injection drug use; ©2012 Machtinger, et al. (retrieved December 16, 2012.)

There were striking findings in terms of both HIV treatment failure and the impact of the above risk behavior in these women, bringing us the first real data hoping to explain this relationship. Those who suffered from recent trauma had more than four times the odds of anti-retroviral (ART) failure while on treatment than HIV-positive non-victims—and this was seemingly not due to self-reported poor adherence to the medication. One potential explanation offered by the study authors is that abuse and trauma interfere with an individual’s ability to stay on a consistent medication schedule, which is essential for control of the virus. Other studies have confirmed that abuse manifest as control, in which a male partner prevents his HIV-positive female partner from accessing services at a clinic out of fear that the stigma of HIV would be attached to him.

HIV-positive victims of recent trauma also all reported experiencing what the study calls “coerced sex,” and have over three times the odds of un-traumatized women of having sex with HIV-negative or status-unknown individuals. They had greater than four times the odds of inconsistent condom use, potentially exposing those casual partners to the virus. While high-risk sex behavior is always a factor in HIV-transmission, HIV-positive individuals who adhere consistently to HIV treatments are significantly less likely to infect HIV-negative partners during sex. So the lack of treatment adherence among traumatized HIV-positive women combined with the risky sex behavior is a great concern.

Interestingly, these figures were only significant among women who experienced recent trauma, indicating that the ongoing—not merely one occurrence—circumstances of abuse are the key to the relationship between HIV-infection and HIV-related illness and death. This can actually be seen as a snapshot of hope—if we are able to offer abuse, assault, and PTSD victims the appropriate support to heal from the experiences, we may be able to weaken the HIV/trauma relationship.

These studies draw a clear line between victims of assault and trauma and both the spread of HIV within their communities and the increased risk of HIV-related illness and death. But interestingly, the risk goes much deeper than these socioeconomic circumstances. The conversation around HIV transmission is generally split into one of two categories: social and behavioral—risky activity, injection drug use, the prejudicial judgment of sex workers; and medical and clinical—how the virus infiltrates the immune system, takes over cells, and how it is and isn’t suppressed with antiretroviral medications. What isn’t usually discussed is the possible combination of these two categories and how together they create a perfect storm for potential infection.

Recent studies have shown that those individuals suffering from PTSD had significantly higher rates of cytomegalovirus (CMV) in their body. A virus that is found in between 50%-80% of adults in the United States, CMV remains largely undetected—latent, suppressed, unproblematic—in healthy individuals. It’s also seen as a marker of immune health and function, and of the body’s ability to control potential infections. Given that 30% of American women with HIV/AIDS have PTSD (five times the national average), the potential relationship between their HIV-status and even further compromised immune function could lead to a myriad of comorbid infections and premature death. Other research has also shown that additional biological mechanisms may prevent ART-treatment from being as effective as possible, including high cortisol (stress hormone) levels. Not only do these victims have to fight against abuse and assault, they have been left without the essential social support to decrease risky behaviors that may expose others to the virus, and their own bodies are in revolt.

Collecting this kind of information is difficult. It requires consistent and positive communication between women and providers, unobstructed access to medical care and uninterrupted ART treatment, and of course, in this example, most importantly—removal from an abusive environment.

The combination of immunosuppression due to PTSD, the detectable rates of HIV in traumatized women whose viral loads are not suppressed by consistent anti-retroviral treatments, and the concurrent risk behaviors of abused HIV-positive women, all contribute to higher rates of HIV-infection in communities, as well as the potential for co-morbid infections and HIV-related death. Until these women are able to find the essential social and community support, free from abuse and trauma, and until their access to care and preventative measures are fully realized, the relationship between trauma and HIV will only deepen.

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Filed under Epidemiology and Population Health, Feminism, Health Behavior, Mental Health, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Violence Against Women, Women's Health

Think Domestic Violence is Funny?

A whole slew of people who aren’t afraid to admit that they think domestic violence is a total joke made it clear last night when the Twitterverse erupted during Chris Brown’s performance. Other writers have well articulated the reasons why I was upset to see him perform, much less have him so vocally supported – a standing ovation? Really?  Frankly, I was surprised that there was restraint in showing Rihanna’s reaction to his numbers.

Despite the outpouring of affection for this man, I was still shocked to see the responses of women watching around the country. Trigger warning for abuse – here are some responses to his performance via Twitter:

“I’d let Chris Brown beat me up anytime ;) #womanbeater”

“Like I’ve said multiple times before, Chris Brown can beat me all he wants…I’d do anything to have him oh my”

“chris brown can beat me all he wants, he is flawless”

“Chris brown.. please beat me😉.”

“I’d let chris brown beat me any day😉.”

“I’d let chris brown punch me in the face”

“I don’t know why Rihanna complained. Chris Brown could beat me up anytime he wanted to.”

What do we gather from these tweets? (Full list here, again, trigger warning.) These go beyond the lack-of-filter in-the-moment tweets that often get people in trouble because they show that these people have a clear understanding of his actions – no one here is pleading ignorance to his abusive history or denouncing it while commenting on his performance. They are doing just the opposite, celebrating and glorifying his violence. Taking it further, they sexualize it as they coyingly ask him – instruct him – to beat them whenever he wants as an acceptable, warranted, and defensible act for being lucky enough to be his partner. The winky smiley faces, the promotion of his supposed flawlessness, the admission that they would suffer innumerable beatings just to be with him, capped off with the dismissal of Rihanna’s rightful decision to report him as a mere “complaint” – we have a major problem here. Combined with a collective short-term memory problem (all those rallying screams at the Grammy’s last night), these messages serve to tell domestic violence victims that they are overreacting, that they should not “complain” if their assailant is considered talented and desired by so many women, that abuse is entirely excusable when perpetrated by a superstar with mass appeal, and very disturbingly, that violence is, of all things, so so sexy (“i wish chris brown would punch me!” begged one tweet). The claim that they would “let” a man punch them in the face does nothing but support the dangerous stereotype that women want to be beaten, that it turns them on.

What a way to let Chris Brown forget about what he’s done. Not only does he get to say that he supposedly regrets his actions, but if he ever felt a creeping of guilt or was actually on some path to understanding what he’s done and why it’s so disturbing and utterly unacceptable – you know, the tough mental work that is required to be rehabilitated – all he’d need to do is head over to Twitter and type his own name into a search. He’d be greeted by plenty of women and men not only excusing his actions, but praising them, supporting them, begging him to repeat them. We’ve got a really long way to go, here.

Update: Charmingly, Chris Brown responded to his critics on his on Twitter page, before it seems his handlers thought it best he stay silent on the issue.

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Filed under Pop Culture, Violence, Violence Against Women