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Domestic abuse (DA) screening in people living with HIV (PLWH)
More Domestic Abuse Screening in HIV+ During COVID Discloses Spike in Reports
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18th European AIDS Conference, EACS 2021, October 27-30, 2021, London
Mark Mascolini
Simple measures improved routine screening for domestic abuse in people with HIV after the COVID-19 lockdown at a single center in London [1]. Reports of domestic abuse tripled after the COVID pandemic began, and two thirds of HIV-positive people reporting abuse were men, usually nonwhite men who have sex with men (MSM).
Researchers from Mortimer Market Centre in London noted that 5.7% of adults in the UK (2.4 million people) reported domestic abuse in 2019, and domestic abuse explained 20% of UK murders. During the COVID-19 pandemic, calls reporting domestic abuse rose as much as 60% across Europe. Increasing evidence indicates a high frequency of domestic abuse among people with HIV, the researchers added. The British HIV Association recommends asking about previous or current domestic abuse at the initial visit of a person with HIV and then every 6 months. European AIDS Clinical Society (EACS) guidelines do not address this issue.
A Mortimer Market Centre program aimed at improving domestic abuse screening directed all clinicians, nurses, and healthcare support workers to ask patients routinely about domestic abuse. All staff received training on screening for and managing domestic abuse. Weekly reminders with updated screening rates aimed to keep domestic abuse screening on the HIV care agenda. Staff referred disclosures of domestic abuse to health advisors and safeguarding teams.
Before the COVID lockdown, domestic abuse screening rates averaged 8% of people with HIV (range 0 to 19%, 848 people asked). With the improved screening program in place, the domestic abuse screening rate rose to 33% of people with HIV (range 0 to 56%, 3508 people asked).
In the 12 months before the COVID lockdown, 11 people with HIV disclosed domestic abuse, In the 12-month COVID period, that disclosure rate tripled to 36 reports. Among these 47 HIV-positive people reporting domestic abuse, almost two thirds (64%, 30 people) were men, of whom 80% were MSM and 67% were nonwhite British. Among the 17 women disclosing domestic abuse (36% of 47), 11 (65%) were black African-Caribbean. Thirty-two of 47 people who disclosed domestic abuse (68%) were asked more than once before disclosing; 1 person was asked 4 times before disclosing.
Staff reported that their main reasons for not screening for domestic abuse were lacking confidence in how to ask about or manage abuse, feeling other priorities, and assuming people had already disclosed domestic abuse. Staff's reasons for improved screening were being told or reminded to screen, training in screening, and media coverage. Among 14 HIV-positive people asked about screening, 13 responded positively and 1 responded positively but with reservations.
The Mortimer Market researchers stressed that screening for domestic abuse improved after the center took simple measures-regular reminders and training. They noted, though, that this analysis cannot determine whether increased reporting of domestic abuse reflects the program promoting screening or higher abuse rates during the COVID pandemic. Whatever the reason (or reasons), they concluded that "by asking about domestic abuse, we can improve patient outcome, protect and save lives."
Reference
1. Ahmed N, Bennet A, Longman M, et al. Domestic abuse (DA) screening in people living with HIV (PLWH). 18th European AIDS Conference, EACS 2021, October 27-30, 2021, London. Abstract BPD2/5.
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