Determinants of HIV and STI Testing Among Women Experiencing Intimate Partner Violence

Purpose: HIV testing and counseling among high risk populations has been identified as a key strategy to reducing HIV related health disparities (CDC, 2007). There is a growing body of research documenting the disproportionate risk of acquiring HIV and other sexually transmitted infections (STIs) that individuals experiencing intimate partner violence (IPV) face (Campbell et al., 2008; Geilen et al., 2007; Li et al., 2014; Phillips et al., 2014). Disparities experienced by victims of IPV may be exacerbated by racial and ethnic disparities in the occurrence of HIV and other STIs and access to culturally appropriate testing and counseling services (CDC, 2012). Little is known about these and other social and familial determinants that may impact whether a woman experiencing IPV seeks HIV and STI testing. The purpose of this study is to investigate determinants of HIV/STI testing (both the desire to have a test and actual receipt of a test) among a racially and ethnically diverse sample of individuals experiencing IPV.

Methods: A community-based participatory approach was used to conduct this study; HIV and STI testing services were implemented within a domestic violence service agency based on an identified need. HIV/STI testing behaviors among all clients of the agency were monitored over a 1-year period.  Chart reviews of clients seeking services at the domestic violence agency during this time period were used to explore potential disparities and identify predictors of HIV and STI testing. Specific predictors examined included individual (gender, race/ethnicity, age, education, pregnancy, health insurance), relationship (marital status, relationship to abuser, living with partner), abuse (physical, verbal, psychological, sexual, stalking) and previous HIV and STI testing characteristics. Three logistic regression models were conducted examining the impact of these predictors on 1) desire to have an HIV and/or STI test; 2) receipt of an HIV test; and 3) receipt of an STI test.

Results: Completed data were obtained from 320 clients. Most were either Hispanic (54.3%) or Black/African American (35.3%) and had at least some college education (56.9%). A little over half of the sample had health insurance (52.2%) and a majority had received a prior HIV test (78.8%) or STI test (65.0%). Preliminary results found that individuals who lived with their abuser in the past (but not currently), did not have health insurance, had a previous HIV test, or were a victim of physical violence had higher odds of wanting to get an HIV and/or STI test. Predictors of actually receiving an HIV test or an STI test included race/ethnicity, with Blacks/African Americans having higher odds of receiving a test compared to Hispanics, and not having health insurance. In addition, individuals who were younger and had not received a previous STI test had higher odds of receiving an STI test, but not an HIV test.

Conclusion: These findings have implications for policy and practice changes regarding the implementation of HIV/STI testing for individuals affected by IPV. Individuals without health insurance were more likely to use testing services likely because they were unable to obtain services elsewhere. This indicates the importance of providing free services in locations easily accessible to high risk populations. Racial/ethnic differences were not found in the desire to obtain an HIV or STI test; however, Blacks/African Americans had higher odds of actually receiving testing compared to Hispanics. Additional research is needed to better understand barriers Hispanics face in receiving testing including the provision of culturally sensitive, trauma-informed services.