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Screening for intimate partner violence in a London HIV clinic: characteristics of those screening positive

2016; Wiley; Volume: 18; Issue: 1 Linguagem: Inglês

10.1111/hiv.12404

1468-1293

Sara Madge, Colette Smith, Charlotte Warren‐Gash, Jude Bayly, A. Bartley,

Adolescent Sexual and Reproductive Health

HIV MedicineVolume 18, Issue 1 p. 66-68 Letter to the EditorFree Access Screening for intimate partner violence in a London HIV clinic: characteristics of those screening positive S Madge, Corresponding Author S Madge sara.madge@nhs.net Ian Charleson Centre for HIV Medicine, Royal Free, London NHS Foundation Trust, London, UKCorrespondence: Sara Madge, Ian Charleson Centre for HIV Medicine, Royal Free, London NHS Foundation Trust, London, UK. Tel: 0207 8302775; fax: 02078302730; e-mail: sara.madge@nhs.netSearch for more papers by this authorC Smith, C Smith Research Department of Infection and Population Health, University College London, London, UKSearch for more papers by this authorC Warren-Gash, C Warren-Gash Institute of Health Informatics, University College London, London, UKSearch for more papers by this authorJ Bayly, J Bayly Maternity Department, Royal Free, London NHS Foundation Trust, London, UKSearch for more papers by this authorA Bartley, A Bartley Public Health Department, Royal Free, London NHS Foundation Trust, London, UKSearch for more papers by this author S Madge, Corresponding Author S Madge sara.madge@nhs.net Ian Charleson Centre for HIV Medicine, Royal Free, London NHS Foundation Trust, London, UKCorrespondence: Sara Madge, Ian Charleson Centre for HIV Medicine, Royal Free, London NHS Foundation Trust, London, UK. Tel: 0207 8302775; fax: 02078302730; e-mail: sara.madge@nhs.netSearch for more papers by this authorC Smith, C Smith Research Department of Infection and Population Health, University College London, London, UKSearch for more papers by this authorC Warren-Gash, C Warren-Gash Institute of Health Informatics, University College London, London, UKSearch for more papers by this authorJ Bayly, J Bayly Maternity Department, Royal Free, London NHS Foundation Trust, London, UKSearch for more papers by this authorA Bartley, A Bartley Public Health Department, Royal Free, London NHS Foundation Trust, London, UKSearch for more papers by this author First published: 01 December 2016 https://doi.org/10.1111/hiv.12404Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Intimate partner violence (IPV) is widespread and more prevalent in the HIV-positive population than in the general population 1. However, there is little published work concerning IPV in this population in the UK 2. Dhairyawan et al. 3 found a 52% lifetime prevalence of IPV in HIV-positive women in a London clinic, with 14% reporting IPV in the last year. Health care workers have been identified as professionals to whom patients might choose to disclose IPV 4. Screening for IPV is recommended in selected health care settings, and at our hospital there is a new post for an independent domestic and sexual violence advisor (IDSVA). We established screening in an out-patient HIV clinic and compared those screened with those not screened, and summarized the characteristics of those reporting current or previous IPV. Multidisciplinary staff were trained to ask the following standardized question: "Have you ever been emotionally or physically hurt by your partner, ex-partner or family member?" Those who answered positively were assessed for current or past IPV by asking, "Are you still in contact with this person and are they still causing you and your family issues?" Screening took place while the patient was alone in a private place. Patients were referred to safeguarding services if necessary and to the IDSVA. If referral to the IDVSA was declined or there was no current risk, leaflets and contact information were given. We report on the demographics of 348 screened patients. Data were collected over 5 months and recorded on a standardized sheet and linked to the HIV database by hospital number and then anonomysed. Groups were compared using the χ2 test or Fisher's exact test for categorical variables, and using the Mann−Whitney U test for continuous variables as they were not normally distributed. No formal adjustment for multiple testing was made. Ten per cent (348 of 3383) of the current clinic population were screened. Those screened had similar demographics and HIV markers to those not screened. Almost a third of participants (103 of 348; 30%) had ever experienced IPV, and were more likely to be female (P = 0.01) with a trend towards heterosexual risk group (P = 0.085) and a detectable viral load (P = 0.088). A total of 68 of 348 patients (20%) had experienced IPV in the past and 35 of 348 (10%) of those screened were experiencing current IPV or were given contact information for future self referral. Fourteen of 348 patients (4%) agreed to be referred to the IVDSA. Ten were women and seven of 14 were of black ethnicity. Other variables were similar to those of the whole population, except that seven of those referred had detectable viraemia (50% vs. 15% in the whole population). Although numbers are small, perhaps this may suggest a relationship between adherence and access to medication, which could be further explored. Among the 103 who screened positive as a group there was also a trend towards detectable viraemia (P = 0.088). There was evidence of differences also when comparing men who screened positive for IPV according to risk group. Of the 224 men who were screened, 54 (24.1%) reported previous or current IPV. When stratified by risk for HIV acquisition, 38 of 119 (24.2%) MSM, six of 44 (13.6%) heterosexual men, nine of 16 (56.3%) injecting drug users and one of eight (12.5%) men with other risks reported current/previous IPV (P = 0.0326). There was no evidence of a difference by age (see Table 1). Furthermore, the median (range) age of men who were screened for IPV was 48 (18–75) years and the median age of women was 44 (16–77) years. After adjusting for age in a multivariable logistic regression model, a strong association between having a positive IPV screen and gender remained (odd ratio [OR] = 0.34 for men vs women; 95% CI 0.15–0.75; P = 0.0080]. Table 1. Patient characteristics according to whether the individual was screened or not and whether the individual had ever experienced intimate partner violence (IPV) All screened Positive screen Negative screen Not screened P (screened vs. not screened) P (positive screen vs. negative screen) n 348 103 245 3035 Male gender [n (%)] 224 (64.4) 54 (52.4) 170 (69.4) 2286 (75.3) < 0.0001 0.01 Age (years) [median (range)] 47 (16–77) 46 (25–77) 47 (16–77) 46 (17–86) 0.73 0.79 Ethnicity [n (%)] White 172 (49.4) 50 (48.5) 122 (49.8) 1734 (57.1) 0.0227 0.37 Black African 97 (27.9) 25 (24.3) 72 (29.4) 725 (23.9) Other 79 (22.7) 28 (48.5) 51 (20.8) 576 (19.0) Risk [n (%)] MSM 157 (45.1) 38 (36.9) 119 (48.6) 1666 (54.9) 0.0017 0.085 Heterosexual 154 (44.3) 50 (48.5) 104 (42.5) 1135 (37.4) Other 37 (10.6) 15 (14.6) 22 (9.0) 234 (7.7) Time since diagnosis (years) [median (range)] 11.5 (0.0–29.5) 11.3 (0.2–27.7) 11.5 (0.0–29.5) 11.1 (0.7–34.3) 0.94 0.77 Ever had AIDS diagnosis [n (%)] 90 (25.9) 25 (24.3) 65 (26.5) 791 (26.1) 0.0675 0.66 CD4 count nadir (cells/μL) [median (range)] 194 (0–1368) 200 (0–1368) 188 (1–783) 199 (0–1700) 0.83 0.43 Current CD4 count (cells/μL) [median (range)] 568 (9–1604) 576 (114–1604) 566 (9–1501) 606 (1–2295) 0.11 0.75 Viral load < 50 copies/mL [n/total (%)] 291/339 (85.8) 80/99 (80.8) 211/240 (87.9) 2593/3021 (85.8) 1.00 0.088 Total duration of ART (years) [median (range)] 9.7 (0.2–23.9) 9.6 (0.2–22.3) 10.2 (0.4–23.9) 9.5 (0.0–27.5) 0.99 0.68 ART, antiretroviral therapy; MSM, men who have sex with men. Compared with other specialities in our hospital undertaking screening, IPV was more commonly reported in the HIV clinic; for example, IPV was reported by 5.7% of patients in genitourinary medicine (GUM) services 5. This may be because those with HIV infection are a more vulnerable group. Screening was often performed by a person with whom the patient had a long-standing relationship, which may encourage disclosure. Those who had experienced past IPV were offered referral to the psychology service. Future work could look at age/gender-matched controls across different hospital departments. This pilot suggests that the pathway is robust and a variety of staff could be successfully trained (Table 2). Table 2. Patient characteristics according to whether the individual had ever experienced intimate partner violence (IPV), further stratified by gender Women Men Positive screen Negative screen Positive screen Negative screen n 49 75 54 170 Age (years) [median (range)] 44 (25–77) 44 (16–77) 48 (31–67) 48 (18–75) Ethnicity [n (%)] White 11 (22.5) 11 (14.7) 39 (72.2) 111 (65.3) Black African 29 (59.2) 49 (65.3) 4 (7.4) 36 (21.2) Other 9 (18.4) 15 (20.0) 11 (20.4) 23 (13.5) Risk [n (%)] MSM – – 38 (70.4) 119 (70.0) Heterosexual 44 (89.8) 66 (88.0) 6 (11.1) 38 (22.4) Other 5 (10.2) 9 (12.0) 10 (18.5) 13 (7.7) Time since diagnosis (years) [median (range)] 11.5 (1.3–25.2) 10.5 (0.2–23.9) 10.9 (0.2–27.7) 11.8 (0.0–29.5) Ever had AIDS diagnosis [n (%)] 13 (26.5) 21 (28.0) 12 (22.2) 44 (25.8) CD4 count nadir (cells/μL) [median (range)] 200 (0–452) 187 (7–783) 198 (150–1604) 189 (1–707) Current CD4 count (cells/μL) [median (range)] 534 (114–1055) 560 (123–1369) 637 (150–1604) 566 (9–1501) Viral load < 50 copies/mL [n (%)] 34 (75.6) 63 (90.0) 46 (85.2) 148 (87.1) Total duration of ART (years) [median (range)] 9.6 (0.2–22.3) 9.5 (0.6–23.9) 9.4 (0.2–20.9) 10.2 (0.4–23.9) ART, antiretroviral therapy; MSM, men who have sex with men. There are limitations to this study, which could be explored in future work. Although the relationship of the perpetrator to the victim was known it was not recorded on the screening proforma. Neither was the nature of the IPV, which was wide ranging, including physical, verbal and sexual abuse, blackmail and financial control, and threats to disclose HIV status and withhold antiviral medication (S. Madge, personal observation). We did not record education or employment demographics. This screening tool was useful as it included a "family member" as a possible perpetrator, and this could have contributed towards the relatively high detection rate of IPV. HIV-positive patients experience a high lifetime risk for IPV and warrant further investigation as a high-risk group. A clinic setting appears to be an appropriate venue for screening and referral by a variety of health care workers using this tool and pathway. Staff reported that, although screening was sometimes time-consuming, they felt that it improved their satisfaction with the consultation. Patients could also be asked about their experience and opinion. More patients should be screened with more detailed data recorded to establish common factors for those at highest risk. The possible relationship between viral load and current IPV merits further exploration. Detectable viraemia might be a trigger for discussion about IPV in the HIV clinic. Acknowledgement We thank R. Watts and staff, who helped carry out screening. References 1Siemieniuk RA, Krentz HB, Gill MJ. Intimate partner violence and HIV: a review. Curr HIV/AIDS Rep 2013; 10: 380– 389. 2 National Institute for Health and Care Excellence. Domestic violence and abuse; how health service, social care and the organisations they work for can respond effectively. February 2014:Report No:50 3Dhairyawan R, Tariq S, Scourse R et al. Intimate partner violence in women living with HIV attending an inner city clinic in the UK: prevalence and associated factors. HIV Med 2013; 14: 303– 310. 4Khalifeh H, Oram S, Trevillion K et al. Recent intimate partner violence among people with chronic mental illness: findings from a national cross-sectional survey. Br J Psychiatry 2015; 207: 207– 212. 5Warren-Gash C, Bartley A, Bayley J et al. Outcomes of domestic violence screening at an acute London trust: are there missed opportunities for intervention? BMJ Open 2016; 6: e009069. Citing Literature Volume18, Issue1January 2017Pages 66-68 ReferencesRelatedInformation