Reproductive stage and other risk factors associated with intimate partner violence: a multisite study of women with HIV in the United States

Abstract

Objective: The 2025 US National HIV/AIDS Strategy identifies intimate partner violence (IPV) as a key social determinant in the HIV response. Women with HIV (WHIV) face heightened IPV risk, especially during pregnancy. We evaluated the associations between reproductive stage, structural risk factors and past-year IPV among WHIV in the United States.

Design: We conducted a cross-sectional analysis using 2022-2025 baseline survey data from the HOPE prospective cohort of WHIV across 14 sites in nine 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/nonpregnant, 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 nonresponse to IPV questions.

Results: Among 742 participants, 538 (79%) had complete data on past-year IPV. Over one in four WHIV (26.4%) had experienced past-year IPV. Pregnant women had four times the prevalence of reproductive coercion [(aPR = 4.0; 95% confidence interval (95% 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/nonpregnant 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.

Conclusion: IPV is prevalent among WHIV, 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 with HIV.