Intimate Partner Violence among HIV-seropositive and HIV-seronegative Pregnant Women Receiving Partner Services in Kisumu, Kenya: Correlates and Incidence during Postpartum

Thesis (Master's)--University of Washington, 2016-12Introduction: Intimate partner violence (IPV) is the most common form of violence amongst women. IPV experienced during pregnancy can expose women and their babies to fatal and non-fatal adverse outcomes. This study assessed socio-demographic factors associated with current or past intimate partner violence to better identify women who are at risk or those currently experiencing IPV. Methods: We evaluated the prevalence, incidence and correlates of lifetime IPV and IPV in the past 6 months and past month in pregnant women seeking antenatal care at the Kisumu County Hospital in Kisumu, Kenya. This study is a nested analysis within the Home-based Partner Education and Testing (HOPE) Study, which was a randomized trial with the aim of increasing the uptake of interventions to improve maternal and child health and reduce vertical and heterosexual HIV transmission. We conducted both a nested cross-sectional and cohort analysis, using data from standardized questionnaires to assess participant self-reported IPV by their current partner at baseline and at 6-months postpartum where women were asked about IPV that had happened after the baseline visit. A woman was classified as having experienced IPV if she reported that her husband/partner had physically hurt her or forced her to participate in sexual activities that made her feel uncomfortable. Associations between baseline IPV, incident IPV and the correlates were assessed using univariate and multivariate logistics regressions. Results: Overall, among 1101 women screened, 929 (84%) reported never having experienced IPV; 73 (7%) reported having experienced IPV at least once in their lifetime, but not in the past 6 months (Lifetime IPV); 45 (4%) reported IPV in the past 6 months, but not in the past month (6 month IPV); and 54 (5%) reported IPV in the past month (1 month IPV). Women who reported IPV in the past month were found to have a higher gravidity, reported more lifetime sexual partners, were more likely to be in a polygamous marriage, and were less likely to have completed secondary school or higher, had higher incomes, and were more likely to report having been threatened or frightened by their current partner. When assessing incident IPV we found that women who reported IPV in the past 6 months at baseline were at 4-fold higher risk of experiencing IPV in the 6-month post-partum period (OR=4.39; 95% CI: 1.61, 11.99). This association remained after adjustment for lifetime sexual partners, marital status, educational level, and being threatened or frightened by current partner (OR= 3.89; 95% CI:1.34-11.28; p = 0.01). A prior primary paper of the HOPE study found that home-based partner testing was not associated with IPV. Conclusions: Women who self-reported experiencing IPV within the past 6 months at their antenatal visit were at a 4-fold greater risk of incident IPV in the late antepartum and postpartum periods. Screening for recent IPV may be an effective means of identifying women at risk of IPV in the near future following an antenatal visit. It may be possible to target efforts to prevent IPV on these women. Further studies focused on assessing the incidence of IPV among pregnant women need to be conducted making sure to collect sociodemographic factors about the partner as these are very important in assessing the correlates of intimate partner violence

Awakening: The Unveiling of Historically Unaddressed Social Inequities During the COVID-19 Pandemic in the United States

The violence and victimization brought by colonization and slavery and justified for over a century by race-based science have resulted in enduring inequities for black, Indigenous and people of color (BIPOC) across the United States. This is particularly true if BIPOC individuals have other intersecting devalued identities. We highlight how such longstanding inequities paved the way for the disproportionate burdens of coronavirus disease 2019 (COVID-19) among the BIPOC populations across the country and provide recommendations on how to improve COVID-19 mitigation strategies with the goal of eliminating disparities

Increasing Black, Indigenous and People of Color participation in clinical trials through community engagement and recruitment goal establishment

Longstanding social and economic inequities elevate health risks and vulnerabilities for Black, Indigenous and People of Color (BIPOC) communities. Engagement of BIPOC communities in infectious disease research is a critical component in efforts to increase vaccine confidence, acceptability, and uptake of future approved products. Recent data highlight the relative absence of BIPOC communities in vaccine clinical trials. Intentional and effective community engagement methods are needed to improve BIPOC inclusion. We describe the methods utilized for the successful enrollment of BIPOC participants in the U.S. Government (USG)-funded COVID-19 Prevention Network (CoVPN)-sponsored vaccine efficacy trials and analyze the demographic and enrollment data across the efficacy trials to inform future efforts to ensure inclusive participation. Across the four USG-funded COVID-19 vaccine clinical trials for which data are available, 47% of participants enrolled at CoVPN sites in the US were BIPOC. White enrollment outpaced enrollment of BIPOC participants throughout the accrual period, requiring the implementation of strategies to increase diverse and inclusive enrollment. Trials opening later benefitted considerably from strengthened community engagement efforts, and greater and more diverse volunteer registry records. Despite robust fiscal resources and a longstanding collaborative and collective effort, enrollment of White persons outpaced that of BIPOC communities. With appropriate resources, commitment and community engagement expertise, the equitable enrollment of BIPOC individuals can be achieved. To ensure this goal, intentional efforts are needed, including an emphasis on diversity of enrollment in clinical trials, establishment of enrollment goals, ongoing robust community engagement, conducting population-specific trials, and research to inform best practices