Intimate Partner Violence Among HIV-Infected Crack Cocaine Users

HIV-infected crack cocaine users are at high risk for HIV transmission and disease progression because they encounter difficulty practicing safe sex, entering and remaining in HIV care, and taking antiretroviral therapy (ART). We hypothesized intimate partner violence (IPV) occurs frequently in this population and contributes to these shortcomings. From December 2006 to April 2010 inpatient HIV-infected crack users were recruited from Grady Memorial (Atlanta, GA) and Jackson Memorial Hospitals (Miami, FL). Participants were screened for IPV using a 5-item tool that was adapted from a previously validated instrument, the STaT. IPV survivors were questioned about support service utilization. Multivariable analysis was conducted to evaluate the association between IPV and unprotected sexual intercourse and sexually transmitted infection (STI) diagnosis in the prior 6 months, use of outpatient HIV care in the past year, and current ART use. We enrolled 343 participants, the majority African Americans of low socioeconomic status. The estimated IPV prevalence was 56%, highest in women (68%) and gay, bisexual, and transgendered men (71%). In multivariable analysis, IPV was associated with diminished ART use (adjusted prevalence ratios adjPRs 0.57; 95% confidence interval CI 0.41-0.80), unprotected sexual intercourse (adjPR 1.34; 95% CI 1.08-1.68) and STI diagnosis in the prior 6 months (adjPR 3.49; 95% CI 1.60-7.62). After experiencing abuse, IPV survivors most commonly turned to emergency services; however, 38% reported not using any supportive services. This study highlights that IPV occurs frequently among HIV-infected crack users and is associated with outcomes known to facilitate HIV transmission and disease progression. Reduced utilization of outpatient HIV care, ART nonadherence, and new STI diagnoses in this population should trigger IPV screening and support services referral.