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Intimate Partner Violence in Half of US MSM Group
Affects Condom-Negotiating Skills
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7th IAS Conference on HIV Pathogenesis, Treatment and Prevention, June 30-July 3, 2013, Kuala Lumpur
Mark Mascolini
Almost half of 745 men who have sex with men (MSM) studied in the Atlanta area reported being a victim of intimate male partner violence [1]. Experiencing such violence independently raised odds that men would feel they could not negotiate condom use.
Much research examines the impact on intimate partner violence on HIV risk in women across the world. But the frequency of violence at the hands of a sex partner--and the impact on HIV-risk behavior--remain poorly studied in gay and bisexual men. The 2010 National Intimate Partner and Sexual Violence Survey (http://www.cdc.gov/violenceprevention/nisvs/) determined that almost 30% of heterosexual, bisexual, and gay men ever experienced intimate partner violence, including stalking, physical violence, and rape. Reports of any intimate partner violence or any sexual violence other than rape were more frequent among bisexual men than gay or heterosexual men.
Project LUST (Let Us Stand Together, http://prismhealth.us/research/past/project-lust/) in the Atlanta area addresses questions about intimate partner violence and HIV risk in 1101 men using a new MSM-specific definition of intimate partner violence. This analysis involved 745 men, 51% of them under 35 years old, 46% white, 41.5% black, and 12.5% Hispanic or other. Two thirds reported being HIV-negative, one quarter said they had HIV infection, and the others didn't know. One third of the men had some college education and almost half had postcollege education. Three quarters were employed. Most men, 89.3%, identified themselves as gay or homosexual while the others called themselves bisexual.
The intimate partner violence scale has five domains: physical and sexual, monitoring (for example, demanding access to text messages and email), controlling (for example preventing you from seeing family or friends), HIV-related (for example, not disclosing HIV status and intentionally infecting you with HIV), and emotional (for example, physical criticism, telling you to "act straight" around certain people).
Almost half of surveyed men (48.2%) reported any form of violence, while 24.8% reported physical/sexual violence, 23.1% monitoring violence, 10.9% controlling violence, 9.8% HIV-related violence, and 29.1% emotional violence. While 81% of men felt they could negotiate condom use, 10% felt they could not and 9% were unsure whether they could. Higher proportions of men reporting each type of intimate partner violence also reported low condom-negotiation skills:
Percent reporting low condom-negotiation skills:
-- Any intimate partner violence (IPV): 23.7% recent IPV vs 15% no recent IPV, P < 0.003
-- Physical/sexual IPV: 31.4% recent IPV vs 15.2% no recent IPV, P < 0.000
-- Controlling IPV: 23.8% recent IPV vs 17.3% no recent IPV, P < 0.000
-- Monitoring IPV: 34.6% recent IPV vs 17.8% no recent IPV, P < 0.078
-- HIV-related IPV: 31.5% recent IPV vs 17.9% no recent IPV, P < 0.000
-- Emotional IPV: 27.7% recent IPV vs 15.7% no recent IPV, P < 0.005
A multivariate model adjusted for age, race, HIV status, education, employment, and sexual orientation determined that any intimate partner violence, physical violence, controlling violence, and emotional violence were each independently associated with poor condom-negotiation skills. There were trends to associations between HIV violence or monitoring violence and poor condom skills:
Adjusted odds ratios (aOR) for poor condom-negotiation skills:
-- Any intimate partner violence (IPV): aOR 1.62, 95% confidence interval (CI) 1.09 to 2.39
-- Physical/sexual IPV: aOR 2.22, 95% CI 1.46 to 3.36
-- Controlling IPV: aOR 2.43, 95% CI 1.44 to 4.11
-- Emotional IPV: aOR 2.05, 95% CI 1.38 to 3.05
-- Monitoring IPV: aOR 1.30, 95% CI 0.84 to 2.02
-- HIV-related IPV: aOR 1.61, 95% CI 0.91 to 2.85
The investigators noted that their analysis does not consider whether facing multiple forms of intimate partner violence compounds risk of poor condom-negotiation skills.
They proposed that poor condom-negotiation skills "may be a pathway through which intimate partner violence increases HIV risk." And they recommended that MSM should be screened for intimate partner violence during routine HIV counseling and testing.
A separate analysis by Project LUST researchers found a link between recent intimate partner violence and a higher number of recent anal sex partners among gay and bisexual men [2].
Link to webcast: http://pag.ias2013.org/flash.aspx?pid=36
References
1. Finneran C, Stephenson R. Recent experience of intimate partner violence reduces self-reported condom negotiation efficacy among gay and bisexual men. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention, June 30-July 3, 2013, Kuala Lumpur. Abstract MOAC0102. http://pag.ias2013.org/session.aspx?s=6
2. Finneran C, Stephenson R. Recent receipt of intimate partner violence is associated with increased reporting of recent number of anal sex partners among gay and bisexual men. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention, June 30-July 3, 2013, Kuala Lumpur. Abstract WEPE553. http://pag.ias2013.org/abstracts.aspx?aid=2657
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