Translating Science to Practice: The development
of an HIV Risk Assessment and Safety Plan for
Women who Experience Intimate Partner Violence
Courtenay Cavanaugh, Ph.D.
Kamila A. Alexander, Ph.D., MPH., RN
Jacquelyn Campbell, Ph.D., RN., FAAN
.
May 18, 2015
HIV & Intimate Partner Violence (IPV)
Route of infection among women in U.S.
 84% high-risk heterosexual contact, 16% injection drug use
Women who are abused by intimate partners
 More likely than non-abused women to engage in high-risk
heterosexual contact, share syringes, and/or have a STI
 Often sexually abused by intimate partners
Abusive men
 More likely than non-abusive men to have STI
Behavior Change & HIV
Coates, Richter, & Caceres, 2008
AIDS Risk Reduction Model
Labeling
 HIV transmission knowledge
 Perceived Susceptibility
 Believing having HIV is
undesirable
Commitment
 Costs & benefits, enjoyment
 Response & self- efficacy
 Knowledge & social influence
Enactment
 Information seeking
 Obtaining remedies
 Enacting solutions
Self-Administered HIV Risk
Assessments
 May increase problem perception
 10% increase in self-perceived risk (Merchant et al.,
2009)
 Unaware of any published assessments for abused women
 Lack of assessments that distinguish between HIV risk
behaviors that are consensual and those that are not
 Need to address mental health problems
Mental Health Problems & Women’s
HIV Risk





Alcohol and drug abuse/dependence
Posttraumatic stress
Depression
Suicidal behavior
Dissociative symptoms
Models of Recent Sexual Risk Behavior
Variable
Unadjusted
Adjusted
Odds
Ratios
95% CI
Odds
Ratios
95% CI
Age
0.73
0.47-1.13
0.53*
0.3-0.95
Child abuse
2.22**
1.41-3.49
2.00**
1.19-3.37
Race
1.04
0.42-2.57
1.68
0.58-4.86
Alcohol problems
1.23
0.46-3.58
1.26
0.35-4.48
Drug problems
3.01*
1.21-7.49
1.81
0.60-5.44
2.14-14.59
3.99*
1.33-11.92
IPV-related PTSD 5.58**
CI=Confidence Interval; *p<.05; **p<.01
Cavanaugh, Hansen & Sullivan, AIDS and Behavior 2010
Models of Recent Sexual Risk Behavior
Variable
Unadjusted
Adjusted
Odds
Ratios
95% CI
Odds
Ratios
95% CI
Age
0.73
0.47-1.13
0.53*
0.3-0.95
Child abuse
2.22**
1.41-3.49
2.00**
1.19-3.37
Race
1.04
0.42-2.57
1.68
0.58-4.86
Alcohol problems
1.23
0.46-3.58
1.26
0.35-4.48
Drug problems
3.01*
1.21-7.49
1.81
0.60-5.44
2.14-14.59
3.99*
1.33-11.92
IPV-related PTSD 5.58**
CI=Confidence Interval; *p<.05; **p<.01
Cavanaugh, Hansen & Sullivan, AIDS and Behavior 2010
Models of Recent Sexual Risk Behavior
Variable
Unadjusted
Adjusted
Odds
Ratios
95% CI
Odds
Ratios
95% CI
Age
0.73
0.47-1.13
0.53*
0.3-0.95
Child abuse
2.22**
1.41-3.49
2.00**
1.19-3.37
Race
1.04
0.42-2.57
1.68
0.58-4.86
Alcohol problems
1.23
0.46-3.58
1.26
0.35-4.48
Drug problems
3.01*
1.21-7.49
1.81
0.60-5.44
2.14-14.59
3.99*
1.33-11.92
IPV-related PTSD 5.58**
CI=Confidence Interval; *p<.05; **p<.01
Cavanaugh, Hansen & Sullivan, AIDS and Behavior 2010
AIM
 Develop a brief self-administered HIV risk assessment for
women in domestic violence shelters
 Distinguish between HIV risk behavior that women
choose to do versus that abusive partners
force/coerce/pressure them into doing
 Integrate attention to associated mental health problems
 Increase self-efficacy and action
HIV Risk Assessment Examples
1. “The following are things I have chosen to do that may make
me more likely to get a sexually transmitted infection including
HIV:”
 Not used condoms during every vaginal sex encounter with
a risky partner
2. “It may be difficult for me to care for myself if I am not feeling
well. I have felt or am currently experiencing the following:”
 Feeling that I don’t care if you live or die
3. “The following are things my sexual partner has done to me
that make me more likely to get a sexually transmitted
infection including HIV:”
 Physically forced me (e.g., held me down, beat me up, or
threaten me with a weapon) to have vaginal or anal sex
without a condom
Should the Assessment Include Attention to
Other Associated Problems?
Option:
“The following are other experiences or symptoms I have
had that may increase my risk for contracting sexually
transmitted infections including HIV:”
 Childhood abuse
 Impulsivity
 Avoidance coping
Other Components of Assessment
1.
2.
3.
4.
Identification of obstacles
Identification of steps
Identification of people to help
List of harm reduction strategies
Next Steps
1. Improve readability
2. Include assessment in an adapted HIV prevention
intervention for women in domestic violence shelters
3. Assess acceptability
4. Examine tools influence on perceived susceptibility,
intention to and enactment of HIV risk reduction
strategies
Acknowledgement
 Collaborators—Kamila and Jackie
 Funding support from Center for Prevention Implementation
Methodology (Ce-Pim) for Drug Abuse and Sexual Risk
Behavior (P30-DA027828)
Thank You