Lifetime Interpersonal Violence and Self-Reported Chlamydia trachomatis Diagnosis among California Women

Reproductive and sexual health effects of intimate partner violence: A longitudinal and intergenerational analysis

OBJECTIVE

To examine the prevalence, pattern and predictors of sexual and reproductive adversity among Australian women who report intimate partner violence (IPV).

METHODS

Repeat measure design employing two cohorts (born between the years of 1973-78 and 1989-95) from the National Australian Longitudinal Study on Women's Health. Logistic regression was employed to examine the effects of reported IPV exposure on sexual and reproductive outcomes. The analysis conducted throughout 2021-2022 investigated both longitudinal prevalence and outcomes, and the intergenerational differences between these cohorts.

RESULTS

IPV exposure was associated with increased odds of experiencing a range of sexual and reproductive health outcomes, including STI, endometriosis, infertility, termination and miscarriage, which increased with greater exposure to IPV. Our longitudinal results suggest a dose-dependent effect of IPV on STI outcomes. Significant intergenerational trends were also identified in the nature of IPV exposure and dependent outcomes. Sexual orientation had a significant predictive value for IPV, with women who identified as bisexual significantly more likely to report IPV (OR = 2.91, 95% CI).

CONCLUSION

Women who experience IPV are at significant risk of adverse sexual and reproductive outcomes. Healthcare professionals working with women who have diagnosed sexual and reproductive issues should inquire about IPV. Likewise, women who are exposed to IPV should undergo sexual and reproductive healthcare assessments, along with appropriate preventive measures, to assure sexual health. Future research should explore in greater detail the association between IPV and the sexual and reproductive outcomes among sexual minority women.

Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

BACKGROUND

United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans.

OBJECTIVE

To examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019.

DESIGN

We performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019.

PARTICIPANTS

Women Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year.

KEY RESULTS

Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72/100,000.) CONCLUSIONS: Gonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.

Scoping Review of Access to Emergency Contraception for Sexual Assault Victims in Emergency Departments in the United States

OBJECTIVE

We conducted a scoping review of the literature to assess the prevalence of hospital policies regarding emergency contraception (EC) and the frequency that U.S. emergency departments (EDs) provide EC to sexual assault survivors.

STUDY DESIGN

We searched PubMed, Embase, the Cochrane Library, and CINAHL from inception to January 2019 for studies that assessed access to EC for sexual assault survivors in EDs. We included English-language studies that surveyed ED staff at U.S. hospitals and reported the weighted mean of the percentage of hospitals with an EC policy for sexual assault survivors and the percentage that provided EC counseling, offered or dispensed EC onsite. Secondary outcomes were rates of testing and prophylaxis for sexually transmitted infections (STIs) and HIV.

RESULTS

From 390 articles retrieved, 14 studies met the inclusion criteria; all studies were published between 2000 and 2013. Eligible studies surveyed staff at 3,314 hospitals. Overall, 60% (weighted mean) of hospitals had a policy on EC, 75% provided EC counseling, 44% offered EC, and 62% had EC available to dispense onsite. Four studies reported secondary outcomes: 81% of hospitals provided STI testing, 84% provided STI prophylaxis, 64% provided HIV testing, and 53% provided HIV prophylaxis.

CONCLUSION

Existing literature demonstrates significant variability in EC policies and practices for sexual assault survivors in U.S. hospital EDs. Future research should assess whether EC access for survivors has improved in ED settings as well as evaluate persistent or new barriers to access.

Lifetime Sexual Assault and Sexually Transmitted Infections Among Women Veterans

OBJECTIVE

Women veterans report a high prevalence of sexual assault. Unfortunately, there are limited data on the reproductive health sequelae faced by these women. Our objective was to evaluate the association between completed lifetime sexual assault (LSA) and sexually transmitted infections (STIs) among a cohort of women veterans, adjusting for sexual risk behaviors.

MATERIALS AND METHODS

We conducted a retrospective study among women veterans aged 51 years or younger who enrolled for care at two Veterans Administration (VA) healthcare sites between 2000 and 2008. Participants completed a telephone interview assessing reproductive health and sexual violence history. We compared the frequencies of past STI diagnoses among those who had and had not experienced LSA. We used logistic regression to assess the effect of sexual assault with history of an STI diagnosis after adjusting for age, sexual risk behaviors, and substance abuse treatment.

RESULTS

Among 996 women veterans, a history of STIs was reported by 32%, including a lifetime history of gonorrhea (5%), chlamydia (15%), genital herpes infection (8%), and human papillomavirus infection (15%), not mutually exclusive; 51% reported LSA. Women with a history of LSA were significantly more likely to report a history of STIs (unadjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45-2.50; adjusted OR 1.49, 95% CI 1.07-2.08).

CONCLUSIONS

Women veterans who have experienced LSA are at increased risk for lifetime STI diagnoses. To adequately address the reproductive health needs of the growing population of women veterans, STI risk assessments should include queries of military service and LSA histories.

Perspectives on expedited partner therapy for chlamydia: a survey of health care providers

There is a lack of research on health care providers' use of and perspectives on expedited partner therapy in a state where expedited partner therapy is not prohibited or explicitly allowed. The aim of our study was to understand if and how health care providers use expedited partner therapy, if specific demographic factors and knowledge contribute to increased use of expedited partner therapy, and to describe barriers and facilitators to the use of expedited partner therapy in Pittsburgh, Pennsylvania. A convenience sample of 112 health care providers from diverse disciplines who treat young women at risk for chlamydia completed an online survey. About 11% of health care providers used expedited partner therapy consistently. Those who self-reported that they were knowledgeable about expedited partner therapy were more likely to use expedited partner therapy (73% vs. 49%, p = .009) as were those who said no or were unsure about their institution's guidelines for expedited partner therapy (35% vs. 22%, p = 0.01) (62% vs. 57%, p = 0.01). The most commonly reported facilitator of expedited partner therapy was having clear legal guidelines (86%). This study finds that in a setting where expedited partner therapy is not expressly permitted, health care providers still use the practice but also experience barriers that limit uptake. Legislation expressly endorsing expedited partner therapy in the state and in medical institutions is needed to increase expedited partner therapy use.

Intimate partner violence, partner notification, and expedited partner therapy: a qualitative study

Over one-third of women experience intimate partner violence (IPV) in their lifetime. IPV increases the risk of infection and re-infection with sexually transmitted infections (STIs). The extent to which health care providers consider IPV when recommending partner notification and expedited partner therapy is unknown. The objective of this qualitative study was to understand health care providers' views on IPV and STIs when recommending partner treatment to patients with chlamydia. Using a purposive sampling strategy to include health care providers who treat young women at risk for chlamydia, 23 semi-structured, in-depth interviews were conducted. While some health care providers expressed concern for their patients' safety and believed assessing for IPV was needed before provision of expedited partner therapy, nearly a third had not considered the links between IPV and STIs. Strategies used by health care providers to assess for IPV did not include inquiry about specific behaviours related to IPV, STI risk, and sexual coercion. Many health care providers understand the risk for IPV in the setting of STI treatment, yet a significant portion of those interviewed failed to recognise the link between IPV and STIs. Provider education is necessary to increase knowledge and implement more effective inquiry and counselling about IPV to more safely recommend expedited partner therapy.

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.

Contraceptive provision in the VA healthcare system to women who report military sexual trauma

BACKGROUND

Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST.

METHODS

This retrospective cohort study included women Veterans aged 18-45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception.

RESULTS

Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen. Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.07-1.18) including an intrauterine device (odds ratio [OR] 1.29, 95% CI 1.17-1.41) or contraceptive injection (OR 1.17, 95% CI 1.05-1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception.

CONCLUSIONS

A minority of women Veterans of reproductive age receive contraceptive services from the VA. Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception.

The relationship between physical intimate partner violence and sexually transmitted infection among women in India and the United States

To investigate the association between physical intimate partner violence (IPV) and sexually transmitted infection (STI) in two national samples. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n=34,653) and the National Family Health Survey-3 (n=124 385). Ever-married women between the ages of 20 and 49 were asked if they had experienced physical violence by their partner in the past year. Outcomes were presence of doctor confirmed HIV and self-reported STI. Age at first intercourse was examined as a mediator of the relationship between IPV and STI. Logistic regression examined associations between IPV, age at first intercourse and STI. Compared to individuals with no physical IPV, risk for STI was higher for individuals who experienced past year IPV living in the United States and India, however once controlling for age at first intercourse, age, education, household wealth/income and past year sexual violence, the relationship between IPV, and STI was significant in the American sample [(AOR)=1.65, 95% (CI)=1.21-2.26], however not for individuals living in India [(AOR)=1.75, 95% (CI)=0.84-3.65]. Individuals with exposure to physical IPV are at increased odds for STI. Age at first intercourse although a marker of risk, may not be an accurate marker of risky sexual behavior in both samples.

Cumulative abuse: do things add up? An evaluation of the conceptualization, operationalization, and methodological approaches in the study of the phenomenon of cumulative abuse

For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.

Factors related to posttraumatic stress symptoms in women experiencing police-involved intimate partner violence

Relationships among intimate partner violence (IPV), Post Traumatic Stress Disorder (PTSD) symptoms, health, and danger, using M.A. Dutton's Empowerment framework, were examined among 423 ethnically diverse women in contact with police due to IPV. Significant predictors of PTSD symptoms in multivariate analysis included Danger Assessment score, poor overall health, abuse leading to pain, victim expectations of future injury victimization, feeling unsafe, and shame. Results provide further evidence supporting routine assessment for violent trauma and PTSD as well as the need for research testing holistic interventions for women traumatized by violence.