Globally, one in three women will experience some form of intimate partner violence in their lives. Some North American studies indicate this may be much more likely for women living with HIV. Despite improvements in HIV disease outcomes among women living with HIV in BC, multiple interacting inequities continue to disproportionately impact the health, wellbeing, and survival of women living with HIV. Experiences of intimate partner violence have been previously found to be associated with reduced likelihood of achieving viral suppression and lower adherence to life saving antiretroviral medication. Although some studies have investigated the link between experiences of intimate partner violence and HIV outcomes, there has been no study to date which has sought to investigate the association between experiences of intimate partner violence and mortality among women living with HIV.
However, a recent BC-CfE publication found that among women living with HIV in the province, multiple experiences of intimate partner violence (sexual, physical, and emotional) was associated with increased likelihood of dying. Led by PhD student Kalysha Closson, the paper is entitled ‘Severe intimate partner violence is associated with all-cause mortality among women living with HIV‘ and was published in AIDS. The paper is the first, to the BC-CfE’s knowledge, to demonstrate an association between multiple experiences of intimate partner violence and all-cause mortality.
Women participating in the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study were asked about their history of violent experiences during a cross-sectional questionnaire that was delivered to 1,000 people living with HIV in BC between 2007-2010. Using linked data to the BC-CfE’s drug treatment program, participants in LISA were passively followed from time of interview until death, most recent contact with the DTP, or December 31st, 2017. During this follow up period 25% of the 252 women (trans inclusive) in LISA, who were not lost to follow up, had passed away. Nearly a third of women who reported experiencing all three forms of intimate partner violence passed away during the follow-up period. Age-adjusted mortality rates among women who experienced severe intimate partner violence were over twice as high (44.7 per 1,000 women-years) than women reporting no history of intimate partner violence (20.9 per 1,000 women-years) and nearly six times higher than women in the province (7.4 per 1,000 women-years). After adjusting for potential confounders, women experiencing severe intimate partner violence were over two times more likely to have died over the study period.
These results highlight the pervasiveness and severity of experiences of intimate partner violence among women living with HIV. If international targets to end both AIDS and gender-based violence by 2030 are to be achieved, critical efforts are needed to prioritize women living with HIV in the response. This is particularly important during the COVID-19 pandemic, as global rates of intimate partner violence are rising, and access to care is limited.
During this time innovative trauma-aware approaches centered on the priorities and needs of women living with HIV are profoundly needed.