伴侣暴力与物质相关服务的使用：女性中按艾滋病毒感染状况的差异
Partner Violence and Substance-Related Service Use: Differences by HIV Status Among Women.
作者信息
Ogden Shannon N, Shafer Paul R, Dichter Melissa E, Clark Jack A, Kempf Mirjam-Colette, Jones Deborah L, Wingood Gina M, Chandran Aruna, Cohen Mardge H, Jain Jennifer P, Goparaju Lakshmi, Wilson Tracey E, Adedimeji Adebola, Haley Danielle F
机构信息
Division of Research, Kaiser Permanente Northern California, Pleasanton, California; Department of Health Policy, Law, & Management, Boston University School of Public Health, Boston, Massachusetts.
Department of Health Policy, Law, & Management, Boston University School of Public Health, Boston, Massachusetts.
出版信息
Am J Prev Med. 2025 Jun;68(6):1150-1159. doi: 10.1016/j.amepre.2025.03.001. Epub 2025 Mar 25.
INTRODUCTION
Substance use disorders are prevalent among women living with HIV and women experiencing intimate partner violence. The study aimed to examine the association between intimate partner violence and substance-related service utilization among women living with and without HIV.
METHODS
Utilizing Women's Interagency HIV Study (2013-2019) data, linear regression models in 2023-2024 estimated the association between recent and lifetime intimate partner violence and drug- and alcohol-related service utilization among women reporting substance use. Adjusted models included an interaction between intimate partner violence and HIV status, time-variant covariates, person-level fixed effects, and standard errors clustered at the individual level.
RESULTS
Among 1,550 participants, 40% had a baseline history of intimate partner violence and 67% were living with HIV. Any recent intimate partner violence and recent psychological intimate partner violence were associated with increased alcohol-related service utilization (aβ=0.039, 95% CI=0.002, 0.076; aβ=0.042, 95% CI=0.002, 0.083; respectively). Recent sexual intimate partner violence was associated with increased drug- (aβ=0.082, 95% CI=0.000, 0.165) and alcohol-related (aβ=0.131, 95% CI=0.028, 0.233) service utilization. Those living with HIV who had experienced recent sexual intimate partner violence were less likely to utilize drug- (aβ= -0.143, 95% CI= -0.249, -0.037) and alcohol-related services (aβ= -0.122, 95% CI= -0.237, -0.007). Any lifetime intimate partner violence and lifetime psychological intimate partner violence were associated with decreased alcohol-related service use (aβ= -0.097, 95% CI= -0.169, -0.025; aβ= -0.096, 95% CI= -0.171, -0.020; respectively).
CONCLUSIONS
Findings highlight the complex relationship between intimate partner violence and substance use disorder service utilization and differences of living with HIV on substance-related service utilization among women. Implementing a trauma-informed approach to address intimate partner violence, HIV, and substance use in healthcare settings could improve substance use disorder-related service utilization and outcomes, and overall well-being among women.
引言
物质使用障碍在感染艾滋病毒的女性和遭受亲密伴侣暴力的女性中普遍存在。该研究旨在调查有无艾滋病毒的女性中亲密伴侣暴力与物质相关服务利用之间的关联。
方法
利用妇女机构间艾滋病毒研究（2013 - 2019年）的数据，在2023 - 2024年使用线性回归模型估计近期和一生中亲密伴侣暴力与报告有物质使用情况的女性中与毒品和酒精相关服务利用之间的关联。调整后的模型包括亲密伴侣暴力与艾滋病毒状态之间的相互作用、随时间变化的协变量、个体水平的固定效应以及在个体层面聚类的标准误差。
结果
在1550名参与者中，40%有亲密伴侣暴力的基线病史，67%感染艾滋病毒。任何近期亲密伴侣暴力和近期心理亲密伴侣暴力都与酒精相关服务利用增加有关（调整后的β系数分别为0.039，95%置信区间 = 0.002，0.076；调整后的β系数为0.042，95%置信区间 = 0.002，0.083）。近期性亲密伴侣暴力与毒品相关（调整后的β系数为0.082，95%置信区间 = 0.000，0.165）和酒精相关（调整后的β系数为0.131，95%置信区间 = 0.028，0.233）服务利用增加有关。感染艾滋病毒且近期经历过性亲密伴侣暴力的女性使用毒品相关（调整后的β系数 = -0.143，95%置信区间 = -0.249，-0.037）和酒精相关服务（调整后的β系数 = -0.122，95%置信区间 = -0.237，-0.007）的可能性较小。任何一生中亲密伴侣暴力和一生中心理亲密伴侣暴力都与酒精相关服务使用减少有关（调整后的β系数分别为 -0.097，95%置信区间 = -0.169，-0.025；调整后的β系数为 -0.096，95%置信区间 = -0.171，-0.020）。
结论
研究结果凸显了亲密伴侣暴力与物质使用障碍服务利用之间的复杂关系，以及感染艾滋病毒对女性物质相关服务利用的差异。在医疗环境中采用创伤知情方法来解决亲密伴侣暴力、艾滋病毒和物质使用问题，可能会改善与物质使用障碍相关的服务利用和结果，以及女性的整体幸福感。
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