Intimate Partner Violence, Police Abuse, Substance Use, and HIV Risk Behaviors Among HIV-Positive People in Ukraine

Background: Violence exposure has been consistently associated with substance use and HIV risk behaviors. However, most relevant studies have focused on violence exposure at a micro level, intimate partner violence. Exposure at a higher ecological level, e.g., police violence, and its association with with substance use and HIV risk behaviors, has been less studied. Violence exposure at a higher ecological level may play a critical role in substance use and other HIV risk behaviors, particularly among stigmatized subgroups, such as HIV-positive people who use drugs (PWUD). Very few studies empirically tested possible unique influences of violence exposure at micro and macro ecological levels on substance use and HIV risk behaviors, particularly in regional areas other than North America. A better understanding of structural violence risks might yield concrete approaches for social work interventions targeting HIV-positive PWUD and their associated HIV risk behaviors. The current study addressed two central research questions. First, we evaluated the extent to which intimate partner- and policy-related violence exposure is associated with substance use and its associated HIV risk behaviors. Second, we tested potential sex differences. 

Methods: Data came from the Providence/Boston-CFAR-Ukraine Study involving 192 HIV-positive PWUD at six addiction treatment facilities in Ukraine in areas most affected by the HIV epidemic. Verbal, physical, and sexual violence experiences in personal relationships and during encounters with police were assessed using survey items adapted for the study to capture the unique cultural context of Ukraine. We assessed self-reported past-12-month alcohol use using the abbreviated Alcohol Use Disorder Identification Test. HIV risk behaviors were assessed using self-report on injection drug use and inconsistent condom use. Covariates included gender, education, income, and employment. We used multiple logistic regression as the main modeling strategy.

Results: Experiencing intimate partner violence (IPV) was associated with higher odds of unhealthy alcohol use (OR= 2.98, p< .05), compared to no IPV history. Exposure to verbal or physical violence by police was marginally associated with higher odds of being involved in HIV risk transmission behaviors (OR= 2.68, p< .10). Similarly, although marginally significant, exposure to sexual violence by police was associated with higher odds of being involved in HIV risk transmission behaviors (OR= 7.61, p< .10). We found no evidence of gender differences in the effect of violence exposure on substance use and its associated HIV risk behaviors. 

Conclusion and Implications: Our findings suggest that violence exposure at an individual level may cast deleterious effects on problematic substance use for both men and women. Further, findings suggest that violence exposure at a higher ecological level may carry salience for HIV risk transmission behaviors among HIV-positive people in Ukraine. Taken together, the present study’s findings indicate that social work efforts seeking to promote healthy substance use and reduce HIV risk behaviors should consider screening for violence exposure at both an individual and higher ecological level. Such an approach might benefit those embedded in different cultural and ecological contexts with known exposure to violence at a higher ecological level.