A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018

Abstract

Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.

Keywords: HIV; intimate partner violence; physical violence; sexual violence; sexually transmitted infections.

FIG. 1.

Flow diagram of participants.

FIG. 2.

Forms of GBV reported in the WIHS, 1995–2018 (N = 24,040 visits). Percentages do not sum to 100.0 due to rounding. Questions about physical and sexual violence did not specify a perpetrator relationship, whereas psychological violence was specific to controlling behaviors perpetrated by a current or former partner. GBV, gender-based violence; WIHS, Women's Interagency HIV Study.

FIG. 3.

Associations of forms of GBV with STI acquisition. Results are from a model adjusted for all forms of GBV included as separate variables. Physical violence, sexual violence, and intimate partner psychological violence were measured in reference to the past 6 months, whereas past GBV refers to lifetime experience of GBV before WIHS entry (measured at baseline). STI was defined as self-reported diagnosis by a health care provider of gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis since the participant's previous study visit (past 6 months). The model was additionally adjusted for HIV status, age, study site, year of WIHS enrollment, race/ethnicity, marital status, residence, employment, household income, recent drug use, and recent transactional sex. N = 23,376 visit pairs contributed by 2824 participants. STI, sexually transmitted infection.