Decker Michele R, Benning Lorie, Weber Kathleen M, Sherman Susan G, Adedimeji Adebola, Wilson Tracey E, Cohen Jennifer, Plankey Michael W, Cohen Mardge H, Golub Elizabeth T
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Prev Med. 2016 Nov;51(5):731-742. doi: 10.1016/j.amepre.2016.07.005. Epub 2016 Aug 29.
Gender-based violence (GBV) threatens women's health and safety. Few prospective studies examine physical and sexual violence predictors. Baseline/index GBV history and polyvictimization (intimate partner violence, non-partner sexual assault, and childhood sexual abuse) were characterized. Predictors of physical and sexual violence were evaluated over follow-up.
HIV-infected and uninfected participants (n=2,838) in the Women's Interagency HIV Study provided GBV history; 2,669 participants contributed 26,363 person years of follow-up from 1994 to 2014. In 2015-2016, multivariate log-binomial/Poisson regression models examined violence predictors, including GBV history, substance use, HIV status, and transactional sex.
Overall, 61% reported index GBV history; over follow-up, 10% reported sexual and 21% reported physical violence. Having experienced all three forms of past GBV posed the greatest risk (adjusted incidence rate ratio [AIRR]=2.23, 95% CI=1.57, 3.19; AIRR=3.17, 95% CI=1.89, 5.31). Time-varying risk factors included recent transactional sex (AIRR=1.29, 95% CI=1.03, 1.61; AIRR=2.98, 95% CI=2.12, 4.19), low income (AIRR=1.22, 95% CI=1.01, 1.45; AIRR=1.38, 95% CI=1.03, 1.85), and marijuana use (AIRR=1.43, 95% CI=1.22, 1.68; AIRR=1.57, 95% CI=1.19, 2.08). For physical violence, time-varying risk factors additionally included housing instability (AIRR=1.37, 95% CI=1.15, 1.62); unemployment (AIRR=1.38, 95% CI=1.14, 1.67); exceeding seven drinks/week (AIRR=1.44, 95% CI=1.21, 1.71); and use of crack, cocaine, or heroin (AIRR=1.76, 95% CI=1.46, 2.11).
Urban women living with HIV and their uninfected counterparts face sustained GBV risk. Past experiences of violence create sustained risk. Trauma-informed care, and addressing polyvictimization, structural inequality, transactional sex, and substance use treatment, can improve women's safety.
基于性别的暴力（GBV）威胁着女性的健康与安全。很少有前瞻性研究探讨身体暴力和性暴力的预测因素。对基线/索引期的GBV病史及多重受害情况（亲密伴侣暴力、非伴侣性侵犯和童年性虐待）进行了特征描述。在随访期间评估了身体暴力和性暴力的预测因素。
女性机构间HIV研究中的HIV感染和未感染参与者（n = 2838）提供了GBV病史；2669名参与者在1994年至2014年期间提供了26363人年的随访数据。在2015 - 2016年，多变量对数二项式/泊松回归模型研究了暴力预测因素，包括GBV病史、物质使用情况、HIV状态和交易性行为。
总体而言，61%的人报告有索引期GBV病史；在随访期间，10%的人报告遭受过性暴力，21%的人报告遭受过身体暴力。经历过所有三种形式的既往GBV风险最高（调整发病率比[AIRR]=2.23，95%置信区间[CI]=1.57，3.19；AIRR = 3.17，95% CI = 1.89，5.31）。随时间变化的风险因素包括近期的交易性行为（AIRR = 1.29，95% CI = 1.03，1.61；AIRR = 2.98，95% CI = 2.12，4.19）、低收入（AIRR = 1.22，95% CI = 1.01，1.45；AIRR = 1.38，95% CI = 1.03，1.85）和使用大麻（AIRR = 1.43，95% CI = 1.22，1.68；AIRR = 1.57，95% CI = 1.19，2.08）。对于身体暴力，随时间变化的风险因素还包括住房不稳定（AIRR = 1.37，95% CI = 1.15，1.62）；失业（AIRR = 1.38，95% CI = 1.14，1.67）；每周饮酒超过七杯（AIRR = 1.44，95% CI = 1.21，1.71）；以及使用快克可卡因、可卡因或海洛因（AIRR = 1.76，95% CI = 1.46，2.11）。
感染HIV的城市女性及其未感染的同龄人面临持续的GBV风险。过去的暴力经历会造成持续的风险。提供创伤知情护理，解决多重受害、结构性不平等、交易性行为和物质使用治疗问题，可以提高女性的安全性。
