Sexual minority status and violence among HIV infected and at-risk women.
OBJECTIVE
Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence.


OBJECTIVE
To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV.


METHODS
Longitudinal study of 1,235 HIV infected and 508 uninfected women of the Women's Interagency HIV Study (WIHS) cohort, from New York City, NY, Chicago, IL, Washington D.C., and San Francisco, CA, 1994-2012.


METHODS
Primary exposures are sexual identity (heterosexual, bisexual, lesbian/gay) and sexual behavior (male, female, or male & female partners). Primary outcomes are sexual abuse, intimate partner violence (IPV) and physical violence; high-risk sex and substance use were examined as mediators.


RESULTS
Bisexual women were at increased odds for sexual abuse [aOR 1.56 (1.00, 2.44)], IPV [aOR 1.50 (1.08, 2.09)], and physical violence [aOR 1.77 (1.33, 2.37)] compared to heterosexual women. In a separate analysis, women who reported sex with men and women (WSMW) had increased odds for sexual abuse [aOR 1.65 (0.99, 2.77], IPV [aOR 1.50 (1.09, 2.06)] and physical violence [aOR 2.24 (1.69, 2.98)] compared to women having sex only with men (WSM). Using indirect effects, multiple sex partners, cocaine and marijuana were significant mediators for most forms of abuse. Transactional sex was only a mediator for bisexual women. Women who reported sex only with women (WSW) had lower odds of sexual abuse [aOR 0.23 (0.06, 0.89)] and physical violence [aOR 0.42 (0.21, 0.85)] compared to WSM.


CONCLUSIONS
Women who identify as bisexual or report both male and female sex partners are most vulnerable to violence; multiple recent sex partners, transactional sex and some types of substance use mediate this relationship. Acknowledging sexual identity and behavior, while addressing substance use and high-risk sex in clinical and psychosocial settings, may help reduce violence exposure among women with and at-risk for HIV.
Hektoen Institute, 2225 W Harrison St, Suite B, Chicago, IL, 60612, USA, Maria.Pyra@hektoen.org.
Maria
M
Pyra
Kathleen
K
Weber
Tracey E
TE
Wilson
Jennifer
J
Cohen
Lynn
L
Murchison
Lakshmi
L
Goparaju
Mardge H
MH
Cohen
D000328:Adult; D001727:Bisexuality / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D020010:Heterosexuality / Q000523:psychology; D018452:Homosexuality, Female / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012742:Sex Offenses / Q000523:psychology / Q000639:trends*; D012747:Sexual Partners / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology; D014754:Violence / Q000523:psychology / Q000639:trends*