22 patricia millernov1

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  • Speak to feminist theory of abuse and how it leaves gay and bisexual men out more often than not.
  • Speak to association with HIV-acquisition risk factors – unsafe sex, IVDU, other drug use, multiple partners, and violent partners may be more likely to be infected with HIV (evidence from India). Direct – rape.
  • Brief!!
  • Log to ensure more normally-distributed.
  • 9 (5.4%) had both current and previous
  • Illicit substances – by and large marijuana.
  • Illicit substances – by and large marijuana.
  • Illicit substances – by and large marijuana.
  • Illicit substances – by and large marijuana.
  • Illicit substances – by and large marijuana.
  • Discuss retrospective approach – some deaths may have occurred because of
  • 22 patricia millernov1

    1. 1. Reed AC Siemieniuk, BSc,1,2Patricia Miller, MSW,1,3Kate Woodman, PhD,4Karen Ko, MA,1Hartmut B Krentz, PhD,1,3M John Gill, MB, ChB1,31. Southern Alberta HIV Clinic, Calgary, AB2. Mount Royal University, Calgary, AB3. University of Calgary, Calgary, AB4. EndAbuse Canada, Edmonton, AB
    2. 2. DisclosureThere are no conflicts of interest.
    3. 3. BackgroundIntimate partner violence (IPV):any behaviour in an intimate relationship causingphysical, psychological, or sexual harm.1Not often studied among gay and bisexual men( whichmight mean that we are more socially tolerant orsocially ignorant)Our research looks to reconstruct the social healthdiscourse, specific to IPV/HIV/Gay/Bisexual Men’shealth.1. World Health Organization. Intimate partner violence [Factsheet]. Available at:http://www.who.int/violence_injury_prevention/violence/world_repor
    4. 4. BackgroundIPV:A risk factor for HIV-acquisition among women2andincreasingly recognized among gay and bisexual men3Associated with behaviours conferring poor HIV-related outcomesAlso, IPV’s impact is starting to be acknowledged asimpacting a HIV- pos. person’s quality of life.2. Jewkes RK, et al. Lancet. 2010;376:41-8.3. Parsons JT, et al. Am J Public Health. 2012;102:156-62.
    5. 5. Goals of studyDescribe:Prevalence and subtypes of IPVClinical associationsOutcomesHealth-related quality of life (HRQoL)PsychiatricContinuity of careClinical outcomes (AIDS, hospitalizations)Information to develop preventative/interventionhealth care strategies.
    6. 6. MethodsRoutine screening implemented in Southern Albertafor all HIV patients May 2009.Screening tool modified from local EmergencyDepartment’sPreliminary findings and protocol previously described4Study inclusive to December 2011.4. Siemieniuk RA, et al. AIDS Patient Care and STDs. 2010;24:763-70.
    7. 7. MethodsInclusion criteria:Self-reported sex is male and self-reported sexualorientation is gay or bisexual
    8. 8. Figure 1: Screening Interview Algorithm1. Screening Question“Domestic violence and the threat of violence in the home is a problem for many people at SAC and in the community;this can directly affect health. Abuse can be a problem in relationships from all cultures and sexual orientations, andcan take many forms: physical, sexual, emotional, isolation, neglect, intimidation or financial.We routinely ask all patients about domestic abuse in their lives. This often brings up many strong emotions, includingdifferent types of fear and uncertainty, but rest assured that this is a safe place to discuss this issue. Have you or yourchild(ren) ever experienced domestic abuse in any way?”2. If yes, continue semi-structured conversation:• Identify when abuse occurred:a) As an adult with current intimatepartnerb) As an adult with a previous intimatepartnerc) As a child (<16 years of age)• Identify type(s) of abuse experienced:a) Physical abuseb) Sexual abusec) Emotional abused) Isolatione) Neglectf) Intimidationg) Financial abuse2. If no, continue with regular HIV care.3. Identify perceived safety:“Do you feel safe in your current relationship?”4. Offer professionalconsultationMethods
    9. 9. MethodsClinical and demographic data is recordedcontinually on all patientsMultivariable analysis conducted with Poissonregression, adjusted a priori forAgeMonths living with HIVLog of CD4 at initial presentation to careLocation of HIV diagnosis (local vs non-local)
    10. 10. Results687 of 739 (93.0%) gay or bisexual males engaged incare were screened for IPV154 of 687 (22.4%) reported IPVCurrent relationship: 23 (14.9%)Previous relationship: 140 (90.9%)
    11. 11. Results154 of 687 (22.4%) reported IPVCurrent relationship: 23 (14.9%)Previous relationship: 140 (90.9%)Persons disclosing IPV were more likely Aboriginal,younger, victims of childhood abuse, had depressionprior to diagnosis, use ongoing psychiatric resources, torecently have participated in unprotected sex, havepoor to fair versus good to excellent quality of life.Also, higher rates of clinically relevant interruptions incare, more HIV-related hospitalizations.
    12. 12. DemographicsIPV (% or SD) No IPV (% or SD) APR (95% CI) PAge (SD) 43.8 (9.7) 46.1 (10.7) 0.97 (0.95-0.99) 0.01Years in care (SD) 5.5 (4.4) 5.7 (4.5) 1.03 (0.98-1.08) 0.28Diagnosed elsewhere 39 (25.3) 126 (23.6) 1.11 (0.72-1.70) 0.6EthnicityAboriginal 13 (8.4) 18 (3.4) 2.48 (1.18-5.2) 0.02Black 2 (1.3) 9 (1.7) 0.81 (0.12-3.79) 0.8Other 14 (9.1) 48 (9.0) 0.97 (0.51-1.86) 0.9Caucasian 125 (81.2) 458 (85.9) RefChildhood abuse 64 (41.6) 80 (15.0) 4.27 (2.84-6.41) <0.001Lives alone 39 (31.0) 156 (35.5) 0.91 (0.59-1.41) 0.7
    13. 13. DemographicsIPV (% or SD) No IPV (% or SD) APR (95% CI) PAge (SD) 43.8 (9.7) 46.1 (10.7) 0.97 (0.95-0.99) 0.01Years in care (SD) 5.5 (4.4) 5.7 (4.5) 1.03 (0.98-1.08) 0.28Diagnosed elsewhere 39 (25.3) 126 (23.6) 1.11 (0.72-1.70) 0.6EthnicityAboriginal 13 (8.4) 18 (3.4) 2.48 (1.18-5.2) 0.02Black 2 (1.3) 9 (1.7) 0.81 (0.12-3.79) 0.8Other 14 (9.1) 48 (9.0) 0.97 (0.51-1.86) 0.9Caucasian 125 (81.2) 458 (85.9) RefChildhood abuse 64 (41.6) 80 (15.0) 4.27 (2.84-6.41) <0.001Lives alone 39 (31.0) 156 (35.5) 0.91 (0.59-1.41) 0.7
    14. 14. Mental HealthIPV (%) No IPV (%) APR (95% CI) PAlcohol abuse 11 (8.8) 31 (7.1) 1.16 (0.56-2.42) 0.7Illicit substance use 36 (33.0) 86 (21.7) 1.54 (0.95-2.50) 0.08SmokingCurrent 75 (59.5) 171 (37.3) 2.53 (1.59-4.00) <0.001Former 16 (12.7) 83 (18.1) 1.23 (0.64-2.38) 0.5Never 35 (27.8) 204 (44.5) RefDepression prior toHIV diagnosis*35 (43.2) 77 (28.4) 1.87 (1.10-3.16) 0.02Anxiety disorder priorto HIV diagnosis*22 (29.3) 48 (18.0) 1.82 (0.98-3.40) 0.06HIV psychiatryappointment in thepast year11 (7.1) 16 (3.0) 2.67 (1.20-5.95) 0.02HIV psychiatryappointment ever*35 (30.4) 51 (12.5) 3.53 (2.05-6.10) <0.001*Local patients only
    15. 15. Sexual risk-takingIPV (%) No IPV (%) APR (95% CI) PSex since last visit 58 (50.9) 198 (47.5) 1.08 (0.70-1.64) 0.9Unprotected sex sincelast visit36 (33.0) 86 (21.7) 2.29 (1.10-4.77) 0.03
    16. 16. Health-related Quality of LifeIPV (%) No IPV (%) APR (95% CI) PPoor 5 (4.1) 8 (1.8)2.91 (1.57-5.39) 0.001Fair 18 (14.8) 32 (7.2)Good 56 (45.9) 180 (40.4)1.60 (1.02-2.50) 0.04Very Good 28 (23.0) 173 (38.8)Excellent 15 (12.3) 53 (11.9) Ref*Local patients only
    17. 17. Continuity of careIPV (%) No IPV (%) APR (95% CI) PLongest interruption≥365 days50 (32.5) 133 (25.0) 1.50 (0.97-2.32) 0.07Clinically significantinterruption in care§ 41 (26.6) 87 (16.3) 1.95 (1.23-3.08) 0.004§Lost to follow up ≥365 days and returned with VL ≥200/mm3
    18. 18. Clinical OutcomesIPV (%) No IPV (%) APR (95% CI) PHistory of AIDS 41 (26.6) 126 (23.6) 1.40 (0.90-2.19) 0.14History of AIDS,presenting CD4 ≥20022 (19.1) 44 (11.5) 2.06 (1.15-3.69) 0.02§Lost to follow up ≥365 days and returned with VL ≥200/mm3
    19. 19. Clinical outcomesIPV No IPV RR PPersonshospitalizedTotalhospitalizationsRate (/1000patient-years)(95% CI)PersonshospitalizedTotalhospitalizationsRate (/1000patient-years)(95% CI)Allhospitalizations52 11990.6(75.4-108.1)175 39689.3(80.9-98.5)1.01(0.83-1.23)0.9HIV-unrelated 42 8967.8(54.8-83.0)143 33074.4(66.7-82.8)0.92(0.73-1.15)0.45HIV-related 21 3022.9(15.7-32.2)55 6614.9(11.6-18.8)1.55(0.99-2.33)0.05HIV-related afterinitial HIVdiagnosis20 2821.3(14.5-30.4)30 348.6(6.1-11.6)2.46(1.51-3.99)<0.001Follow-up time(patient-years)1313 4433
    20. 20. LimitationsSelf-reported outcomesGay and bisexual men were studied together – mayexperience IPV differently
    21. 21. ConclusionsHigh prevalence of IPV (1/4.5)Associated with:Aboriginal ethnicityChildhood abusePsychiatric diseaseRisky sexual behaviourPoor health-related quality of lifeInterruptions in careProgression to AIDS among those presenting earlyHIV-related hospitalizations
    22. 22. ConclusionsIPV is an important (but underecognized) socialcomorbidity among HIV-positive gay and bisexualmenProspective studies will help further clarify its impactEvidence-based interventions to identify victims andprovide effective support may improve wellbeing for asubstantial proportion of HIV-positive gay andbisexual men.Knowledge transfer needed between helpingprofessionals in order to reduce the impact of IPV.
    23. 23. AcknowledgementsAlberta Health Services and its InformationTechnology Department for support of the clinicaldatabase that has allowed us to undertake this work.The Southern Alberta HIV Clinic nurses and socialworkers
    24. 24. Types of IPVType of abuseEmotional 125 (81.2)Physical 113 (73.4)Sexual 30 (19.5)Intimidation 22 (14.3)Financial 21 (13.6)Isolation 12 (7.8)Neglect 8 (5.2)
    25. 25. Number of types of abuseNumber of abuse typesOne 55 (35.7)Two 52 (33.7)Three 31 (20.1)Four 6 (3.9)Five 6 (3.9)Six 3 (1.9)Seven 1 (0.6)

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