Gender-based violence related to higher mortality risk in women with HIV

  • July 26, 2012

Women with HIV who are exposed to gender-based violence have a higher mortality risk than those who are not, according to researchers from the CORE Center at Cook County Health and Hospital Systems in Chicago.

The researchers evaluated the effect of sexual, physical and emotional abuse on mortality among 2,222 women: 1,642 were HIV positive and 580 were not. The women were participants in the Women’s Interagency HIV Study, an ongoing cohort study. Marginal structural survival models were used to estimate mortality, which was confirmed using the National Death Index Plus registry.

From 1994 to 2007, 437 women died who had abuse data on the year before death. The women who died were older, had HIV, were not receiving ART, had lower nadir and current CD4, had engaged in transactional sex, used drugs and tobacco, were depressed, reported lower cognitive function and had a history of abuse before the study.

Recent abuse was associated with all-cause mortality (HR=1.54; 95% CI, 1.18-2.02). When stratified by pre-baseline abuse history and by HIV serostatus, this remained significant. Women without HIV were affected (HR=4.39; 95% CI, 1.78-10.82) more than women with HIV (HR=1.42; 95% CI, 1.07-1.89).

References:

Weber K. #WEAD0104. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.

Disclosures:

Ms. Weber reports no relevant financial disclosures.

Perspective
  • This is an incredibly important study. We know that violence and abuse increase women’s risk of acquiring HIV; this study concretely demonstrates that experience of abuse also increases risk of death among HIV-positive women by over 40%. Any factor that increases death rates among HIV-positive persons is cause for concern, but it is especially noteworthy to see such a dramatic increase in mortality from abuse – which is essential a social and contextual risk. These results serve yet again as an urgent call to action – we must prevent and address violence if we are to effectively combat HIV.

    Equally noteworthy from this study is the finding that experience of abuse increases all-cause mortality among socially vulnerable HIV-negative women over 4 times – essentially saying that abuse can be fatal even if death does not results immediately from the assault. Again, these findings are an urgent call to action – we must prevent and address violence against women.

    • Kristin Dunkle, PhD
    • Assistant professor, department of behavioral sciences and health education and Center for AIDS Research
      Rollins School of Public Health, Emory University

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