Physical and Sexual Violence Predictors: 20 Years of the Women's Interagency HIV Study Cohort.
Gender-based violence (GBV) threatens women's health and safety. Few prospective studies examine physical and sexual violence predictors. Baseline/index GBV history and polyvictimization (intimate partner violence, non-partner sexual assault, and childhood sexual abuse) were characterized. Predictors of physical and sexual violence were evaluated over follow-up.



HIV-infected and uninfected participants (n=2,838) in the Women's Interagency HIV Study provided GBV history; 2,669 participants contributed 26,363 person years of follow-up from 1994 to 2014. In 2015-2016, multivariate log-binomial/Poisson regression models examined violence predictors, including GBV history, substance use, HIV status, and transactional sex.



Overall, 61% reported index GBV history; over follow-up, 10% reported sexual and 21% reported physical violence. Having experienced all three forms of past GBV posed the greatest risk (adjusted incidence rate ratio [AIRR]physical=2.23, 95% CI=1.57, 3.19; AIRRsexual=3.17, 95% CI=1.89, 5.31). Time-varying risk factors included recent transactional sex (AIRRphysical=1.29, 95% CI=1.03, 1.61; AIRRsexual=2.98, 95% CI=2.12, 4.19), low income (AIRRphysical=1.22, 95% CI=1.01, 1.45; AIRRsexual=1.38, 95% CI=1.03, 1.85), and marijuana use (AIRRphysical=1.43, 95% CI=1.22, 1.68; AIRRsexual=1.57, 95% CI=1.19, 2.08). For physical violence, time-varying risk factors additionally included housing instability (AIRR=1.37, 95% CI=1.15, 1.62); unemployment (AIRR=1.38, 95% CI=1.14, 1.67); exceeding seven drinks/week (AIRR=1.44, 95% CI=1.21, 1.71); and use of crack, cocaine, or heroin (AIRR=1.76, 95% CI=1.46, 2.11).



Urban women living with HIV and their uninfected counterparts face sustained GBV risk. Past experiences of violence create sustained risk. Trauma-informed care, and addressing polyvictimization, structural inequality, transactional sex, and substance use treatment, can improve women's safety.
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: mdecker@jhu.edu.
Michele R
MR
Decker
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Lorie
L
Benning
The CORE Center, Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, Illinois.
Kathleen M
KM
Weber
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Susan G
SG
Sherman
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Adebola
A
Adedimeji
Department of Community Health Sciences, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York.
Tracey E
TE
Wilson
Department of Clinical Pharmacy, University of California, San Francisco, California.
Jennifer
J
Cohen
Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia.
Michael W
MW
Plankey
Department of Medicine, Stroger Hospital, Chicago, Illinois.
Mardge H
MH
Cohen
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Elizabeth T
ET
Golub
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D000074386:Gender-Based Violence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000523:psychology; D006801:Humans; D012742:Sex Offenses; D014481:United States