A team of researchers led by the University of Maryland, School of Public Health’s Dr. Mona Mittal, conducted an integrated HIV risk reduction intervention for a racially diverse group of economically-disadvantaged women with histories of intimate partner violence (IPV). This intervention resulted in a decrease in unprotected sex and an increase in safer sex communication among its participants. It is one of the few interventions to address the association between gender-based violence and risk of HIV acquisition among women.
The pilot study was led by Dr. Mona Mittal, assistant professor in the department of family science in the University of Maryland School of Public Health, and Dr. Michael Carey, director of the Centers for Behavioral and Preventive Medicine at the Miriam Hospital in Providence, RI.
“Although research has established a strong link between ‘intimate partner violence,’ or IPV, and subsequent HIV infection, there are few empirically-supported interventions that address the unique needs of women who experience IPV and who are at increased risk for contracting HIV,” wrote Dr. Mona Mittal Mittal in her research paper “An Integrated HIV Risk Reduction Intervention for Women with a History of Intimate Partner Violence: Pilot Test Results,” which was published in AIDS and Behavior.
Abused women may be coerced to have unprotected sex or experience fear of violent consequences when negotiating condom use, Dr. Mittal explains. They may also be involved in high-risk sexual behavior, having sex with multiple partners or high-risk individuals, such as injection drug users. Studies also show that women who experience IPV suffer from mental health issues such as depression, PTSD, anxiety and low self-esteem.
Men who engage in abusive behavior are also more likely to engage in high-risk sexual behavior and use condoms infrequently, according to studies by Columbia University researcher, Dr. Nabila El-Bassel.
Dr. Mittal’s research group recruited 55 women who were divided into intervention and control groups. Twenty-seven women received the supporting positive and healthy relationships (SUPPORT) intervention, which consisted of eight weekly sessions that included information about STDs and HIV infection, techniques for deconstructing unhealthy relationships and understanding the link between IPV and STD/HIV infection.
The other 28 women included in the study were placed in a control group that received counseling support related to the abuse cycle, the impact of abuse on children, self-esteem and personal rights, among other topics. The control group intervention, which was organized by a domestic violence agency, focused primarily on IPV and its impact on women’s lives — less on preventing HIV and STD transmission.
Compared to the control group, the SUPPORT group reported four times the number of safer sex conversations, Dr. Mittal noted. The SUPPORT participants also demonstrated improvements in STD knowledge, self-efficacy and condom-negotiating skills. While both groups experienced a reduction in experiences of battering, the SUPPORT group experienced a significant decline in both physical and emotional intimate partner violence.
“What makes this intervention unique is that we recruited women who might currently be in abusive relationships or as recent as the last three months. It is more challenging to work with women with recent experiences of IPV compared to lifetime experiences of IPV,” Dr. Mittal said.
Dr. Mittal hopes to lead a larger trial that will expand on the findings from the pilot study.
“An Integrated HIV Risk Reduction Intervention for Women with a History of Intimate Partner Violence: Pilot Test Results” was published in Aids and Behavior in May.