Objective: The 2025 US National HIV/AIDS Strategy identifies intimate partner violence (IPV) as a key social determinant in the HIV response. Women living with HIV (WLHIV) face heightened IPV risk, especially during pregnancy. We evaluated the associations between reproductive stage, structural risk factors and past-year IPV among WLHIV in the US.
Design: We conducted a cross-sectional analysis using 2022-2025 baseline survey data from the HOPE prospective cohort of WLHIV across 14 sites in 9 US states/territories.
Methods: The outcome was past-year experience of physical, sexual, or psychological IPV or reproductive coercion. Reproductive stage was categorized as nulliparous, postpartum, parous/non-pregnant, and pregnant. We used generalized estimating equations to estimate prevalence ratios for the association of each risk factor with IPV. We fit separate models for each risk factor, adjusting for age, race, education, income, marital status, and study region. We assessed the impact of non-response to IPV questions.
Results: Among 742 participants, 538 (79%) had complete data on past-year IPV. Over one in four WLHIV (26.4%) had experienced past-year IPV. Pregnant women had 4 times the prevalence of reproductive coercion (aPR = 4.0; 5%CI:1.7-9.5) and 1.7 times (aPR = 1.7; 95%CI: 1.3-2.3) the prevalence of psychological IPV, compared to parous/non-pregnant women. Early sexual debut (aPR = 2.3; 95%CI:1.2-4.5), transactional sex (aPR = 2.1; 95%CI:1.3-3.4), drug use (aPR = 1.7; 95%CI:1.1-2.6), and adverse childhood experiences (aPR = 1.2; 95%CI:1.1-1.2) were associated with past-year IPV.
Conclusions: IPV is prevalent among WLHIV, especially during pregnancy. Policies should prioritize comprehensive contraceptive access and IPV screening to address the intersecting epidemics of IPV and HIV.
Keywords: United States; intimate partner violence; pregnancy and postpartum; reproductive stage; risk factors; women living with HIV.
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