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亲密伴侣暴力对城市诊所环境中感染艾滋病毒女性的就诊率、病毒抑制及CD4细胞计数的影响。

Impact of intimate partner violence on clinic attendance, viral suppression and CD4 cell count of women living with HIV in an urban clinic setting.

作者信息

Anderson Jocelyn C, Campbell Jacquelyn C, Glass Nancy E, Decker Michele R, Perrin Nancy, Farley Jason

机构信息

a Department of Community-Public Health , Johns Hopkins University School of Nursing , Baltimore , MD , USA.

b Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.

出版信息

AIDS Care. 2018 Apr;30(4):399-408. doi: 10.1080/09540121.2018.1428725.

Abstract

The substance abuse, violence and HIV/AIDS (SAVA) syndemic represents a complex set of social determinants of health that impacts the lives of women. Specifically, there is growing evidence that intimate partner violence (IPV) places women at risk for both HIV acquisition and poorer HIV-related outcomes. This study assessed prevalence of IPV in an HIV clinic setting, as well as the associations between IPV, symptoms of depression and PTSD on three HIV-related outcomes-CD4 count, viral load, and missed clinic visits. In total, 239 adult women attending an HIV-specialty clinic were included. Fifty-one percent (95% CI: 45%-58%) reported past year psychological, physical, or sexual intimate partner abuse. In unadjusted models, IPV was associated with having a CD4 count <200 (OR: 3.284, 95% CI: 1.251-8.619, p = 0.016) and having a detectable viral load (OR: 1.842, 95% CI: 1.006-3.371, p = 0.048). IPV was not associated with missing >33% of past year all type clinic visits (OR: 1.535, 95% CI: 0.920-2.560, p = 0.101) or HIV specialty clinic visits (OR: 1.251, 95% CI: 0.732-2.140). In multivariable regression, controlling for substance use, mental health symptoms and demographic covariates, IPV remained associated with CD4 count <200 (OR: 3.536, 95% CI: 1.114-11.224, p = 0.032), but not viral suppression. The association between IPV and lower CD4 counts, but not adherence markers such as viral suppression and missed visits, indicates a need to examine potential physiologic impacts of trauma that may alter the immune functioning of women living with HIV. Incorporating trauma-informed approaches into current HIV care settings is one opportunity that begins to address IPV in this patient population.

摘要

药物滥用、暴力与艾滋病毒/艾滋病(SAVA)共病代表了一系列复杂的健康社会决定因素,对女性的生活产生影响。具体而言,越来越多的证据表明,亲密伴侣暴力(IPV)使女性面临感染艾滋病毒以及艾滋病毒相关不良后果的风险。本研究评估了艾滋病毒诊所环境中亲密伴侣暴力的患病率,以及亲密伴侣暴力、抑郁症状和创伤后应激障碍(PTSD)与三项艾滋病毒相关指标——CD4细胞计数、病毒载量和错过诊所就诊之间的关联。总共纳入了239名在艾滋病毒专科诊所就诊的成年女性。51%(95%置信区间:45%-58%)的女性报告在过去一年遭受过心理、身体或性方面的亲密伴侣虐待。在未调整模型中,亲密伴侣暴力与CD4细胞计数<200(比值比:3.284,95%置信区间:1.251-8.619,p = 0.016)以及可检测到病毒载量(比值比:1.842,95%置信区间:1.006-3.371,p = 0.048)相关。亲密伴侣暴力与过去一年错过超过33%的所有类型诊所就诊(比值比:1.535,95%置信区间:0.920-2.560,p = 0.101)或艾滋病毒专科诊所就诊(比值比:1.251,95%置信区间:0.732-2.140)无关。在多变量回归中,控制药物使用、心理健康症状和人口统计学协变量后,亲密伴侣暴力仍与CD4细胞计数<200相关(比值比:3.536,95%置信区间:1.114-11.224,p = 0.032),但与病毒抑制无关。亲密伴侣暴力与较低的CD4细胞计数相关,但与病毒抑制和错过就诊等依从性指标无关,这表明需要研究创伤可能对感染艾滋病毒女性的免疫功能产生的潜在生理影响。将创伤知情方法纳入当前的艾滋病毒护理环境是解决该患者群体中亲密伴侣暴力问题的一个契机。

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