This document discusses social determinants of health as they relate to HIV risk and outcomes. It covers topics like stigma, myths, prevalence, transmission, prevention, and treatment of HIV. It also discusses the links between sexual violence and increased HIV risk. Key points include:
- Social factors like income, education, housing, and stigma influence HIV risk.
- Stigma of HIV can lead to worse health outcomes due to isolation, stress, and lack of care.
- Violence limits individuals' ability to negotiate safer sex or end risky relationships, increasing HIV risk.
- Collaboration is needed between HIV and violence support services to address the intersection of these issues.
Addressing Sexual Assault and Intimate Partner Violence in Medical Care and Education in the U.S. and Globally
Jennifer A. Wagman, PhD, MHS
April 13th, 2018
UCSD HIV & Global Health Rounds
Addressing Sexual Assault and Intimate Partner Violence in Medical Care and Education in the U.S. and Globally
Jennifer A. Wagman, PhD, MHS
April 13th, 2018
UCSD HIV & Global Health Rounds
Global Medical Cures™ | HIV among YOUTH
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The gendered foundations of partner violence and its relationship to HIVHopkinsCFAR
Lori Heise, PhD
Senior Lecturer in Social Epidemiology, London School of Hygiene & Tropical Medicine
Co-Research Director, STRIVE: A research consortium tacking the structural drivers of HIV
Co-Investigator, "What works to prevent VAWG"
Thursday, February 25, 2016
Johns Hopkins Bloomberg School of Public Health
Terri Clark (ActionAIDS), Kate Clark (Philadelphia Corporation for Aging), and Katie Young (Philadelphia Corporation for Aging) presented on HIV and Aging at the January meeting of the Philadelphia Ryan White Part A Planning Council.
This guide provides practical examples and case studies. It provides methods of addressing the issues and how to respond to the issues. It is against the backdrop of the understanding that religious leaders and traditional leaders are two of the closest institutions to the citizenry. They are central to decision making in various families and also by individuals.
October is time for raising domestic violence issues within our communities. It is extra special to survivors like me for people to help spread the facts about domestic violence instead of letting rumors fly around.
Presentation by Chris Jennings, Disability Project Worker from Women's Domestic Violence Crisis Service. This presentation was delivered to DVRCV's 'Sowing the seeds of change' forum for and by women with disabilities.
HackStore it is an amazing free alternative of App Store for side developers
and apps for Mac OS which Apple doesn't accept.
Free from Apple Mac App Store censors. HackStore is not related to piracy.
http://www.hack-store.com
Global Medical Cures™ | HIV among YOUTH
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The gendered foundations of partner violence and its relationship to HIVHopkinsCFAR
Lori Heise, PhD
Senior Lecturer in Social Epidemiology, London School of Hygiene & Tropical Medicine
Co-Research Director, STRIVE: A research consortium tacking the structural drivers of HIV
Co-Investigator, "What works to prevent VAWG"
Thursday, February 25, 2016
Johns Hopkins Bloomberg School of Public Health
Terri Clark (ActionAIDS), Kate Clark (Philadelphia Corporation for Aging), and Katie Young (Philadelphia Corporation for Aging) presented on HIV and Aging at the January meeting of the Philadelphia Ryan White Part A Planning Council.
This guide provides practical examples and case studies. It provides methods of addressing the issues and how to respond to the issues. It is against the backdrop of the understanding that religious leaders and traditional leaders are two of the closest institutions to the citizenry. They are central to decision making in various families and also by individuals.
October is time for raising domestic violence issues within our communities. It is extra special to survivors like me for people to help spread the facts about domestic violence instead of letting rumors fly around.
Presentation by Chris Jennings, Disability Project Worker from Women's Domestic Violence Crisis Service. This presentation was delivered to DVRCV's 'Sowing the seeds of change' forum for and by women with disabilities.
HackStore it is an amazing free alternative of App Store for side developers
and apps for Mac OS which Apple doesn't accept.
Free from Apple Mac App Store censors. HackStore is not related to piracy.
http://www.hack-store.com
Digital,Social & Mobile in 2016
Including stats for more than 240 countries around the world, and profiling 30 of the world’s biggest economies in detail, this report is the most comprehensive, free compendium of
up-to-date digital statistics and data you’ll find.
Jill Blumenthal MD of UC San Diego presents "Free to Be You and Me: Providing Culturally-Sensitive Patient Care to Transgender Individuals" at AIDS Clinical Rounds
This presentation offers stats, trends, and factors associated with higher HIV-infection risk and how clinicians can attend to it.This was my presentation for Bayless Bahavioral Health- Didactic training on 12.10.13, it explores the HIV problem in the US and AZ and
Dr. K. Wendy Freed, M.D.
Consulting psychiatrist for Miller Children's Hospital Abuse and Violence Intervention Center in Long Beach, CA
March 13, 2007
HIV/AIDS and Infectious Diseases: Prevalence and Attitudes Among U.S. Latinos
Dr Li Loriz, PhD, ARNP, BC, Director, School of Nursing, University of North Florida
July 22, 2005 - UNF Hispanic Health Issues Seminar
This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
Friday, February 7, 2014 Nonprofit Commons was happy to feature members of the nonprofit Protect Yourself1 (PY1), Executive Director, Monique Richert (Chayenn in SL), and PY1 Development Consultant, Tom Kujawski (Incarn8 in SL) who presented facts and statistics and PY1 Safe2Live Program in support of the National Black HIV/AIDS Awareness Day.
2. • Pt. 1: Understanding HIV
• Social Determinants
• Stigma
• Myths
• Virus and Disease
• Prevalence
• Transmission
• Prevention
• Treatment
• Law
• Pt. 2: HIV & Sexual
Violence
• Links, Statistics, and
Research
• Addressing the Intersection
• Barriers
• Needs
• Recommendations
• Referrals
3. • “The social determinants of health are the conditions in
which people are born, grow, live, work and age. These
circumstances are shaped by the distribution of money,
power and resources at global, national and local levels.”
• World Health Organization
• An individual’s position in social hierarchy can influence
health outcomes
• Underlying drivers of HIV risk and vulnerability
4.
5. • What are some social determinants related to HIV?
• Conditions for early childhood development
• Education
• Employment, income, job security
• Access to food
• Access to health services
• Housing
• Social exclusion
• Stigma
• The extent to which each of these vary among different racial,
ethnic, religious, social-economic status, sexual identity, gender
identity, physical and mental disability populations
6. • People living with HIV often highly stigmatized
• Negative outcomes of stigma:
• Reduced likelihood of testing and treatment
• Financial and work difficulties
• Social isolation
• Minority Stress Theory
• High, constant stress
• Poorer mental health
• Poorer physical health
8. • T or F: AIDS is a medical condition without a cure, spread
mainly by unprotected sex or sharing needles with
someone who is living with HIV.
• True
9. • T or F: New HIV/AIDS drug treatments have lowered the
number of AIDS-related deaths in the United States.
• True
10. • T or F: Only drug users and gay men need to worry about
becoming infected with HIV.
• False
11. • You can become infected with HIV by ...
A. sharing utensils with or drinking from the same cup as
someone with HIV
B. mosquito bites
C. hugging someone with HIV
D. none of the above
12. • If you were infected with HIV, you might show symptoms
...
A. within a few weeks
B. within a year
C. in 10 or more years
D. any of the above
13. • HIV is not present in ...
A. semen and vaginal secretions
B. sweat
C. blood
D. breast milk
14. • Common myths:
• HIV is airborne at close range
• Possible transmission from a toilet
• 100% chance of transmission via sexual or needle contact with LWHIV
person
• Vaginal intercourse 0.1 – 0.2%
• Anal intercourse 0.5 – 3%
• Transmission through touching HIV+ blood
• Transmission through saliva
• Undectable viral load = safe to have sex
• A mother can’t transmit HIV to child
• You can’t have a child if you are LWHIV
• There is a low survival rate for HIV infection
• HIV originated from sex with monkeys
• Others?
15. • Human (affects humans)
• Immunodeficiency (attacks the immune system)
• Virus (unlike bacterial infections)
• AIDS is advanced stage of HIV (stage 3)
• Acquired
• Immuno-
• Deficiency
• Syndrome
16. • Virus that attacks T Cells in immune system
• Overtime, kills off T Cells
• Decreases ability to defend against other infections
17. • Estimated 1,148,200 people over 13 years living with HIV
in US
• Most common: large cities, and the south
• African Americans and MSM are disproportionately
affected
• 1/5 people with HIV do not know
• Estimated 18,800 cases of HIV in Michigan, 940 in
Macomb County, 6,840 in Detroit
• HIV infection prevalence relatively steady in Macomb
• Number of new cases slowly dropping
• Young people—new cases not dropping
26. • Sex with person living with HIV
• Vaginal
• Anal
• Oral
• Condomless sex greatly increases likelihood of transmission
• Using needles used by person with HIV
• IDU
• Tattoo (rare)
• Childbirth
• Breastfeeding
• Blood transfusion (rare)
28. • Abstinence
• Condoms
• Not sharing needles/using used-needles
• Sero-sorting
• PrEP
• Limiting partners or monogamy
• Sperm washing & antiretroviral therapy (for vertical transmission)
• Testing, dialogue, and sexual planning
• Discussion and negotiation necessary for almost all methods
• How are these methods potentially affected by sexual and
relational violence?
29. • Window Period—6 weeks to 3 months; depends on test!
• Rapid testing—finger prick, results in 20min
• Usually free (free @ AIDS Service Organizations)
• Private
• For more information or to find a testing center near you,
call Michigan HIV/AIDS Hotline 1-800-872-2437
30. • No cure… but treatment is available to EVERYONE!
• Life-long medication
• Stay healthy
• Reduce chance of transmission
• Side effects
• Life-long medical supervision
• Potential lifestyle changes
31. • Labs & Providers must report HIV status to local health
dept.
• Health depts. prohibited from keeping roster of names
• Otherwise, HIV-related info is strictly confidential
• But when might we accidently disclose HIV information?
• Findings: discreteness, isolation or privacy, crowdedness, public,
locale size, privacy procedure, discussion of anonymous testing,
forced explanations
32. Why do you think
violence may put
individuals at increased
risk for HIV?
32
33. • Sexual violence as a risk and consequence of
HIV infection.
• Individuals who have violent partners are less
likely to negotiate condom use and more
likely to be abused when they do.
• Individuals who are assaulted are unable to
negotiate protective strategies
• Various adverse health effects related to
intimate partner violence compromise
women’s immune systems in a way that
increases their risk of HIV. 33
34. • 12% of HIV/AIDS infection among women in
romantic relationships are due to intimate partner
violence (Sareen, et al., 2009)
• Women who experience intimate partner
violence were over 3 times more likely to have a
diagnosis of HIV/AIDS (Sareen, et al., 2009)
• The prevalence of intimate partner violence
among women at risk for HIV may be as high as
67% (Cohen, et al., 2000)
34
35. • Violent or coerced sex increases individual’s risk for HIV
through physical trauma:
o Bleeding and tearing of genital area creates passageways for HIV.
o Heightened risk of bleeding and tearing of anus and rectum.
• Violence and threats of violence:
o Limit negotiating power for safer sex.
o Limit ability to leave/end a relationship.
• Sexual abuse as a child:
o Related to high HIV risk behaviors as an adult (multiple partners,
unprotected sex).
• Disclosure of HIV status:
o Could result in increased violence (emotional, physical, sexual,
economic).
• Violent men more likely to be living with HIV*
• Women living with HIV may experience more violence than
others*
35
36. • Many service providers lack of
understanding of the link between violence
against women and increase in HIV risk.
• Not enough resources or skills.
• Many service providers discomfort
discussing IPV, sexual assault, and risky
behaviors for HIV.
• Lack of coordination and referrals with
other services.
• Contrary beliefs, biases, attitudes.
36
37. • Understanding of the link between sexual
violence and HIV.
• Staff training and cross-training as needed.
• Adequate policies and procedures that
encourages integration of HIV and Survivor
services.
• Good risk-related information for clients.
• Increased collaboration and referral between
Survivor and HIV agencies.
37
38. • Potential indicators to discuss:
• Engaging in risk behaviors for HIV (multiple sexual
partners, condomless sex, sexual “acting out”).
• Reluctant to get tested for HIV.
• Resistant to disclosing a positive test result to a
partner.
• Unable to adhere to an HIV medication regimen.
• How to:
• Avoid judgmental/accusatory language
• Actively listen
• Provide information, not correction
• Sensitively relate risk-reduction to individual’s life-
goals
• Offer referrals, when appropriate
39. • HIV Testing
• Michigan HIV/AIDS Hotline 1-800-872-2437
• StatusSexy.com
• UNIFIED (APM & HARC), CHAG, Horizons Project, MAC
Teen Hype
• YAC
• Macomb County Public Health 586-465-8434
• Wayne County Dept. of Public Health 734-727-7078
• Oakland County Health Division 248-858-5416 or 888-350-0900 ext.
85416
40. • What can we do, in our professional settings, to be more
sensitive to issues surrounding HIV?
• What can we do to assist in HIV testing & care?
Editor's Notes
Ask audience for examples of underlying drivers of HIV risk and vulnerability
Which groups do we think may be more affected by HIV due to their social determinants?
Determinants of transmission, infection, and treatment.
Very important factor to social determinants—often overlooked or misunderstood
“The picture on the last slide may show a more intimate social setting, and may not seem that relevant to HIV to many of us. But here is a very real example of stigma regarding YMSM living with HIV from the NY Dept. of PH.”
Example of how even professionals in healthcare/public health may perpetuate HIV-related stigma
Video meant to target YMSM of color, and reduce idea that “HIV isn’t so serious—you just have to take some meds every day and you’re fine.”
A lot of what perpetuates stigma is silence, and what fills in that silence is misunderstanding and ignorance, which furthers the stigma.
In light of this, I want to go through some common thoughts about HIV and AIDS, and separate the fact from fiction.
Some of these statements you may have heard before, or even endorsed, and others will be unfamiliar, whether true or false.
Pass out “HIV Myths” handout to entire group
HIV leads to acquired immune deficiency syndrome (AIDS), a chronic and potentially life-threatening condition.
AIDS is characterized by the emergence of opportunistic infections in body systems.
There is no cure for HIV/AIDS, but medications can slow the progress of the disease.
Very quick, very brief
Brief
--Estimations are all recorded cases + ~2,000 estimated unreported cases for each group
Prevalence = all people living with HIV, currently
New cases = incidence
HIV does not discriminate
Next several graphs from 2013 Macomb report (most recent for just Macomb)
Asian/PI and Am Indian/AN are significantly less than 1%
American Indian/AN is less than 1% for both
Asian is 3% of overall population
See how prevalence does NOT match demographics—disproportionate burden (social determinants factoring in)
Males = 84%
Females = 16%
Again—this is prevalence, not incidence
Think back to social determinants—risk factors intertwined into one’s socio-ecological environment
Blood products less than 1%
Heterosexual—more easily transferred to females during vaginal, due to greater surface area of exposed permeable tissue
Anal intercourse higher transmission rates for similar reason
***Does this graph match our expectations for what puts people at greatest risk for HIV?
“There is a sizeable chunk of people that we still don’t know about”ppl who don’t know they have HIV, lack of disease awareness/knowldedge, etc.
“Risk factors increase likelihood of transmission”
“Once HIV is transmitted, one is at higher risk for…”
“But what can we do to prevent this from ever occurring in the first place?”
Multiple methods always better than just one
Discuss dangers of only providing a few prevention methods?
Mention Gary’s intervention in which promoting condom-negotiation status among young latina women actually led to increase in IPV—safety of women must be a priority **”but also remember, like IPV presentation mentioned, we do need to facilitate self-determination in order to successfully promote lasting-safety. It is a sensitive issue, which is why we need more awareness and training in the intersections between IPV and HIV”
-Although consistent condom use is IDEAL… we need to be realistic and stress RISK REDUCTION
“One of the most important prevention strategies we mentioned is knowing your status”
“More on testing locations/resources in a bit”
The drugs are often referred to as antiretrovirals, ARVs or anti-HIV or anti-AIDS drugs.
Taking two or more antriretrovial drugs at a time is called combination therapy.
Taking a combination of three or more anti-HIV drugs is referred to as Highly Active Antiretroviral Therapy (HAART).
Taking two or more treatments at the same time reduces treatment resistance.
*Note to DV orgs: If a client is in shelter (or receiving services from your organization in another capacity) and being treated for HIV, make sure you help them continue treatment. This should be a priority! It is important for clients to adhere to HIV treatment.
Status can be reported to Dept. of Community Health by others without pt consent if it is to protect one’s health, prevent further transmission, or diagnose & care for a pt
Other exemptions in confidentiality can be made to known contacts, foster parents, or if deemed necessary under child protection law
BUT NOT AGENCIES! For example, if someone comes into shelter, it is not necessary that other shelter members know of this individuals HIV status! Staff may be aware in certain situations where clients may need assistance getting medications, etc.
Get into groups and come up with 1 or two reasons.
Source: UN (2011). Understand the linkages between HIV/AIDS and violence against women and HIV. Available at http://www.endvawnow.org/en/articles/677-understand-the-linkages-between-hiv-aids-against-women-and-girls-.html. Retrieved 11/30/11.
Real-world data to provide context to previous slide
brief
Source: UN (2011). Understand the linkages between HIV/AIDS and violence against women and HIV. Available at http://www.endvawnow.org/en/articles/677-understand-the-linkages-between-hiv-aids-against-women-and-girls-.html. Retrieved 11/30/11.
http://www.svri.org/hiv.htm
Question: How do we explain last two, keeping in mind earlier discussion of HIV risk?
Ask audience: How do we feel about these? Do they seem pretty accurate?
Add we, us, many in general…etc.
To audience: Now here is some structural real change! As participants in this training, you are ALREADY part of this great change.
Pass out “The Global Coalition on Women & AIDS” document…explain that the back offers suggestions on how to move forward as a community.
Similar to all the work we do…validate the client
YAC has testing locator
To audience: Let’s brainstorm, what can we do right after this meeting? Please take some of the agency related information at the table on your way out.
Recommended resource: http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Guides_Sexual-Violence-and-HIV_A-Technical-Assistance-Guide-for-Victim-Service-Providers_0.pdf