Effects of Partner Violence on Mental Health and HIV Disease Progression in Women in Baltimore

Purpose: Recently a great deal of national attention has been given to the overlapping issues of intimate partner violence (IPV) and HIV.  The examination of this intersection has focused primarily on the increased risk of HIV acquisition in women who have experienced violence. The effects of IPV as a chronic stressor on the physical and mental health of women living with HIV has had limited examination in the research literature. To examine the prevalence of IPV and its associations with treatment markers and adherence to clinic visits in an urban clinic.

Methods: Survey data regarding IPV and mental health symptoms were collected from eligible women attending an urban HIV clinic in Baltimore, MD.  Clinic records were reviewed for CD4 count, viral load and adherence to clinic visits over the year prior to the survey. 

Results: Of the 169 women with completed study measures, 57% reported past year IPV.  Women who reported IPV were more likely to report symptoms of PTSD (29% vs 15%, p=0.04) and depression (35% vs 18%, p=0.02). On average, women were scheduled for 36 clinic visits in the year prior to the survey and missed 10 visits. Women who reported IPV were not more likely to miss visits than their counterparts who did not report violence.  Women reporting past year IPV were also more likely to have a CD4 count <200 (13% vs 4%, p=.04). 

Conclusion: HIV nurses and providers should be aware of the high rates of IPV seen in this population and the impact it can have on health outcomes.  It does not appear from the data currently available in this study that adherence to clinic visits is playing a large role in this disparity.  Incorporating IPV screening and trauma-informed practices - inlcuding partnerships with IPV and substacne abuse agencies into clinical HIV care may be an opportunity to improve the health outcomes of these patients.