Bidirectional Intimate Partner Violence and HIV Sexual Risk Among Justice Involved Couples: Implications for Including IPV in HIV Interventions

Background and Significance: Rates of bidirectional intimate partner violence are increasing in the United States, which increases the risk of mortality and lasting trauma. Literature suggests that IPV increases risk of HIV infection and from accessing treatment. Intimate partners who use drugs are disproportionately impacted by both HIV and IPV and involvement in the criminal justice system, which further heightens risk of HIV infection for this population. Despite these concerns research on risk factors associated with IPV, including HIV among justice-involved couples who use drugs is limited. To address these concerns, this study examined the effects of a couple-focused HIV prevention intervention on HIV risk reduction including condomless sex, intentions to use condoms, and self-efficacy with using condoms in a sample of couples who use drugs with histories of IPV.

Methods: We used an intent-to-treat approach on a sample of 230 men who use drugs in community supervision settings in New York City and their main female sexual partners, (N=460 individuals). Measures of IPV consisted of verbal, minor and severe physical abuse. Risk reduction consisted of having 1) condomless sex (number of unprotected sexual acts), 2) multiple partners, 3) scales of condom efficacy (alpha=) and 4) HIV risk reduction communication. Hypothesis testing for intervention effects was based on incident rate ratios (IRR) from multilevel mixed-effects Poisson regression for the number of condomless sex acts, number of sex partners and number of times discussing how to prevent HIV; and the differences indicated by regression coefficients (b) from mixed-effects linear regression were used for the scales of condom use intentions and condom use self-efficacy.

Results: Couples reporting any physical, injurious and/or sexual IPV - 20.1% reported IPV from the male partners only, 18.3% reported from the female partners only, and 28.4% reported IPV from both male and female partners. Among the participants and/or their partners who reported history of IPV, PACT participants had 36% fewer acts of condomless vaginal and/or anal intercourse with all partners (IRR = 0.64, 95% CI = 0.41 – 0.98, p = 0.041) and 25% fewer sex partner (IRR = 0.75, 95% CI = 0.61 – 0.93, p = 0.008), higher scores for condom use intentions (b = 0.85, 95% CI = 0.18 – 1.53, p = 0.013) and condom use self-efficacy (b = 2.22, 95% CI = 0.88 – 3.56, p = 0.001), and 2.41 times more frequently discussing with study partner how to prevent HIV infection (IRR = 2.41, 95% CI = 1.18 – 4.93, p = 0.016) compared to control participants over the entire 12-month period.

Conclusions: Findings highlight the effectiveness of this couples-based approach to HIV risk reduction among couples experiencing bidirectional IPV and the intersection of experiencing IPV and HIV risk. There is an urgent need to address the effectiveness of combined IPV and HIV in prevention interventions, which can lead to sensitive and innovative approaches to addressing violence perpetrated by both partners. Further research is needed to identify factors that contribute to IPV and HIV risk among people in community corrections.