Article Text
Abstract
Background The Sydney Sexual Health Centre in Australia uses a proforma tool to screen all new female clients for recent physical intimate partner violence (IPV). This study describes the prevalence and associations of recent physical IPV among women attending a sexual health clinic.
Method The clinic database was used to identify all first visits by women reporting recent physical IPV between September 2003 and September 2007. Women reporting, and the next two age-matched women not reporting, recent physical IPV were compared regarding clinical, demographic and behavioural variables.
Results 5519 (92%) of 6013 women attending were screened and 313 (5.7%) reported recent physical IPV. Recent physical IPV was not associated with current acute sexually transmitted infections (STIs). Women reporting IPV were more likely to report current sex work (AOR 1.75, 95% CI 1.23 to 2.48), a past STI (AOR 1.58, 95% CI 1.05 to 2.39) and a prior induced (AOR 1.64, 95% CI 1.18 to 2.27) or spontaneous (AOR 1.90, 95% CI 1.08 to 3.33) abortion. They were less likely to be in a current relationship (AOR 0.73, 95% CI 0.54 to 0.98) and consistently used condoms (AOR 0.67, 95% CI 0.48 to 0.94).
Conclusion Women reporting recent physical IPV at a sexual health clinic were not more likely to have a current STI. The association of IPV with sex work, prior STIs and lower condom use suggests sexual health clinics would be appropriate venues to screen women for intimate partner violence.
- Intimate partner violence
- screening
- sexually transmitted infection
- women
- screening
- sexual health
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Introduction
Intimate partner violence (IPV) is a common problem with significant health, social and economic costs. In Australia, 4% of women report suffering IPV in the past year with 3% experiencing physical IPV.1 As IPV is associated with controlling behaviours by men over their partners,1 women experiencing IPV may have less autonomy over their sexual and reproductive practices and so suffer from poorer sexual health. There has been extensive research into the association between IPV and sexual health; however, few studies have examined the association of recent IPV and microbiologically proven sexually transmitted infections (STIs), and none were performed among clients of a sexual health clinic.2 The aim of this study was to describe the prevalence and associations of recent physical IPV among female clients of a sexual health clinic.
Methods
The Sydney Sexual Health Centre is the main public sexual health service for inner and eastern Sydney, Australia. Symptomatic patients and those at high risk of STIs are actively triaged into the service. All new female clients over 16 years of age are screened for recent IPV using a proforma screening tool.3 Data were obtained from the clinic database for all new female clients attending from September 2003 to September 2007. Cases were women answering affirmatively to the question, “Within the last year have you been hit, slapped or hurt in other ways by your partner or ex-partner?” The next two women who attended and did not report recent physical IPV were selected as controls. As age is the strongest predictor of STIs among women in our clinic, control women were matched for age. All clients are routinely screened for STIs using standard microbiological tests, and women reporting IPV are referred to an internal counsellor for assessment and referral to specialised services. Statistical analyses were performed using STATA 11.0, with χ2 or Fisher's exact test for categorical data and Student t test for continuous data. Variables with a p<0.1 on univariate analysis were used to develop a forward stepwise logistic regression model. The South-eastern Sydney Illawarra Area Health Service Human Research Ethics Committee granted ethics approval.
Results
Over the study period, 6013 women attended the Sydney Sexual Health Centre for the first time: 5519 (92%) were screened and 313 (5.7%) reported recent physical IPV. Recent physical IPV was associated with being born in Australia, not being in a current sexual relationship, current sex work, injecting drug user (IDU), hazardous alcohol use, past STIs, past induced and spontaneous abortion, inadequate contraception and inconsistent condom use (table 1). Women suffering IPV were of similar age (mean 27, p=0.61), reported a similar number of recent non-paying partners (p=0.19) and were equally likely to present with anogenital symptoms (p=0.99) or as a contact of a STI (p=0.76). They were no more likely to have inconsistent Papanicolaou smears (p=0.11). Women reporting IPV were not significantly more likely to be diagnosed with a current acute STI (OR 1.16, 95% CI 0.78 to 1.72) and nor was there any clear trend when considering each STI separately (table 1).
Multivariate analysis showed that factors associated with recent physical IPV were being born in Australia, not in a current relationship, past STIs, current sex work, IDU, past induced and spontaneous abortion, and inconsistent condom use (table 1).
Discussion
While women attending the clinic reported recent physical IPV more frequently than a random sample of Australian women,1 there was no association with current STIs. Prior studies are conflicting; no association in primary care4 and antenatal clinics,5 but significantly more recent IPV reported by young African-American women diagnosed with a STI.6 In common with prior studies, there was an association with past STIs along with demographic and behavioural factors associated with STIs. Given the sparse and conflicting data, it remains unclear to what extent IPV influences STI prevalence and whether this varies for different populations.
Despite similar contraceptive use, women reporting IPV were more likely to report prior spontaneous abortion, which is consistent with another recent study;7 as the temporal relationship between violence and spontaneous abortion is unknown, the mechanism of this association is unclear.
The study was limited in power to detect a small but real increased prevalence of STIs evidenced by the relatively wide CIs; furthermore the findings cannot be generalised to women in other settings.
Asking about recent physical IPV in a sexual health clinic is not useful in predicting the risk of a current STI. However, as women attending a sexual health clinic are at higher risk of IPV these clinics may be appropriate venues for IPV screening.
Key points
5.7% of female sexual health clinic attendees reported recent physical intimate partner violence, which is higher than found in a recent population-based study.
No association was found between intimate partner violence and current sexually transmitted infections (STIs) in this clinic-based sample.
Intimate partner violence was more likely among women reporting sex work, past STIs and inconsistent condom use.
Acknowledgments
We would like to thank Warwick Allan for assistance with the initial planning of the study, Heng Lu for data extraction, and Basil Donovan and Handan Wand for assistance with data analysis.
Footnotes
Competing interests None declared.
Ethics approval This study was conducted with the approval of the South Eastern Sydney Illawarra Area Health Service (North Hospital Network) Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.