University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Background: Intimate partner violence (IPV) victimization is associated with numerous adverse health outcomes, including suboptimal HIV treatment. Violence against female sex workers (FSW) perpetrated by intimate partners outside of sex work (e.g. boyfriends or husbands) has received little attention. Stigma negatively influences economic resources, social relationships, and psychological and behavioral outcomes of the stigmatized, which may increase IPV risk. Informed by stigma, economic, and alcohol use motivation theories, I assessed relationships between HIV and sex work stigma and IPV among FSW living with HIV, including indirect effects via income, savings, and alcohol use. Methods: I analyzed cross-sectional and longitudinal survey data from a cohort of FSW living with HIV in Santo Domingo, Dominican Republic (n=266). I used multivariable logistic regression to assess relationships between enacted, anticipated, and internalized HIV and sex work stigma and recent IPV victimization (Aim 1), and path analysis to examine mediated relationships between stigma and IPV via income, savings, and alcohol use (Aim 2). Results: Participants reporting HIV-related job loss had 5.6-times the odds of IPV compared to others (95% CI: 1.9, 16.2). A higher level of fear of family exclusion due to HIV was associated with a 1.8-fold increase in IPV odds (95% CI: 1.12, 2.82), and a higher level of fear of colleagues taking your clients if you revealed your status was associated with a 1.7-fold increase in IPV odds (95% CI: 1.2, 2.6). Indirect effects were insignificant. Social HIV discrimination was negatively associated with income, and alcohol use and savings were positively associated with IPV.Conclusions: HIV stigma may undercut economic resources, social ties, and mental health, creating barriers to ending abusive relationships, or causing stress and couple conflict leading to IPV. Stigma-driven economic precarity may heighten the importance of maintaining intimate partner relationships, despite violence. Fears of family rejection may discourage HIV disclosure, diminishing social support that protects against IPV, or create a specter of isolation that hampers ending abusive relationships. Curbing workplace HIV discrimination could reduce IPV vulnerability by protecting against economic losses and precarity. Community mobilization interventions could address IPV by increasing peer support and providing the experience of supportive community.Doctor of Philosoph
