Intimate Partner Violence and HIV; Transgender Health Policies in the US

Intimate Partner Violence and HIV

As many of you know HIV is my specialty. I see several hundred patients a year in my small FQHC practice that I do once or twice a week. So naturally when a national study was recently released about intimate partner violence and individuals living with HIV, I seriously took notice.

What I read was disheartening, but as osteopathic internists our job is to understand our patients thoroughly and for those of us who treat HIV patients, lifestyle and threats to their safety are certainly a part of that. The study I am referencing here was from the CDC and assessed medical record data as well as results from interviews conducted with people living with HIV from 2015 to 2017. The survey, which included about 12,000 people, strives to produce nationally representative estimates of sociodemographic, behavioral, and clinical characteristics of people living with HIV in the United States.

To sum up the results, about 26% reported having experienced physical intimate partner violence in their lifetime. Looking at what groups experienced the most violence, here’s what was revealed:

• White and multiracial people reported more lifetime violence (31%) than Black and Hispanic people (23% and 24%, respectively).
• The 25–34-year-old age group had the highest rates of lifetime violence at 31%, followed by 35-44 years (30%).

Interestingly, responses differed by sexual orientation – a whopping 52% of bisexual women reported a history of violence – the most of any group. Compare that with 35% of heterosexual women, 28% of gay men, 25% of bisexual men, 22% of lesbian women, and 14% of heterosexual men – who all experienced intimate partner violence. Frankly all those numbers are too high in my opinion.

Another interesting revelation was that those reporting homelessness in the last 12 months were more likely to report a lifetime history of violence than those who weren’t. It is important to note that this study only looked at physical violence, not sexual or emotional violence…so the true impact of intimate partner violence among people living with HIV isn’t fully captured with this study.

As healthcare providers we need to screen for intimate partner violence during initial HIV testing, as well as during emergency room visits, and certainly during routine medical care. If we find patients reporting intimate partner violence, they should be offered supportive services and of course for marginalized groups like LGTBQ+ people and racial and ethnic minorities, programs to prevent violence prevention should be tailored for their needs.

In terms of HIV health outcomes, those reporting physical intimate partner violence had worse care retention, were less likely to be on HIV antiretroviral therapy and had more no-show medical appointments, a well as more emergency room visits and admissions. IPV leads to worse HIV outcomes- hence, we need to be more diligent with screening. As physicians we need to be familiar with resources in our area to recommend to our patients in order to prevent such violence and help them to pursue healthy relationships. The US Department of Veterans Affairs offers an Intimate Partner Violence Assistance Program since it turns out that veterans are twice a likely to experience IPV in relationships. Also, I’ll make mention of the national hotline to be aware of to pass on to your patients. The number is 800-799-SAFE (7233).

Transgender Health Expertise

Back in 2015 in a survey of trans people, it was discovered that there is an urgent need to prioritize transgender health policy in the US. Recommendations from this study include developing more med school faculty expertise in trans medicine, professional organizations requiring trans content on licensure exams, and state licensure boards requiring continuing education in trans health.

It turns out that the fields of medicine and professional education have created the majority of interventions and as students increase their knowledge, they are developing a higher comfort and greater confidence in working with trans people. But the gap that was discovered in trans care education is in schools of counseling, social work, and public health. Simply put, they are not adequately developing curriculum and interventions that prepare students to work with trans people.

In a report that just came out this week from the Center for American Progress it was revealed that trans people fear discrimination and that fear leads them to not seek out medical care. Nearly 70% of transgender people of color reported mistreatment by a medical professional. Consequently, many who do end up seeking healthcare have waited too long and they end up in the ER with conditions that wouldn’t have been considered an emergency had they been taken care of sooner. Additionally, trans people were more than twice as likely as cisgender adults to be told they had depressive disorders. They also have an increased likelihood of having asthma and developing cardiovascular disease, and to make matters worse, the COVID-19 pandemic has also aggravated the situation. 1 in 3 trans people reported having had suicidal thoughts during the pandemic. 1 in 2 reported that their access to gender-affirming health care was curtailed significantly during the pandemic.

So how do we get better at treating trans patients?

Certainly it falls on us a medical professionals to educate ourselves more. For me, I am looking for to hearing my colleague Dr. Mia Taormina host a lecture on LGBTQ health this fall the 2021 ACOI Annual Convention and Scientific Sessions. The good news is that by placing more emphasis on trans health for students and for those of us who have been practicing for decades, we will be working toward erasing discrimination in care that for too long has hurt our transgender patients.

Sources:

• Intimate partner violence associated with negative outcomes for people living with HIV
• Educating “Helping” Professional Students to “Help” Trans People Navigate Their Health Care Needs: A Review of Recent Literature: Journal of Homosexuality: Vol 0, No 0 (tandfonline.com) 
• Nearly half of trans people have been mistreated by medical providers, report finds (nbcnews.com)