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Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics
  1. Michele R Decker1,
  2. Elizabeth Miller2,
  3. Heather L McCauley2,
  4. Daniel J Tancredi3,
  5. Heather Anderson2,
  6. Rebecca R Levenson4,
  7. Jay G Silverman5
  1. 1Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pittsburgh, USA
  3. 3University of California Davis, Sacramento, California, USA
  4. 4Futures Without Violence, San Francisco, California, USA
  5. 5Division of Global Public Health, Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, California, USA
  1. Correspondence to Dr Michele R Decker, Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E4142, Baltimore, MD 21212, USA; mdecker{at}jhsph.edu

Abstract

Background/Objectives Adolescent and young adult women are at high risk for sexually transmitted infections (STIs)/HIV and intimate partner violence (IPV). We evaluate the prevalence of IPV in the past 3 months and its associations with STI/HIV risk, STI and related care-seeking over the same time period.

Methods Female family planning clinic patients ages 16–29 years (n=3504) participated in a cross-sectional survey in 2011–2012 as a baseline assessment for an intervention study. We examined associations of recent IPV with sexual and drug-related STI/HIV risk behaviour, self-reported STI and STI-related clinical care seeking via logistic regression.

Results Recent physical or sexual IPV (prevalence 11%) was associated with recent sexual and drug-related STI/HIV risk, specifically unprotected vaginal sex (adjusted OR (AOR) 1.93, 95% CI 1.52 to 2.44), unprotected anal sex (AOR 2.22, 95% CI 1.51 to 3.27) and injection drug use, their own (AOR 3.39, 95% CI 1.47 to 7.79) and their partner's (AOR 3.85, 1.91 to 7.75). IPV was also linked with coercive sexual risk: involuntary condom non-use (AOR 1.87 to 95% CI 1.51 to 2.33), and fears of requesting condoms (AOR 4.15, 95% CI 2.73 to 6.30) and refusing sex (AOR 11.84, 95% CI 7.59 to 18.45). STI-related care-seeking was also more common among those abused (AOR 2.49, 95% CI 1.87 to 3.31).

Conclusions Recent IPV is concurrent with sexual and drug-related STI/HIV risk, including coercive sexual risk, thus compromising women's agency in STI/HIV risk reduction. Clinical risk assessments should broaden to include unprotected heterosexual anal sex, coercive sexual risk and IPV, and should promote safety and harm reduction.

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