History of intimate partner violence is associated with sex work but not sexually transmitted infection among HIV-positive female drinkers in Russia

Abstract

Summary

This paper assesses the associations between intimate partner violence (IPV) and sexually transmitted infections (STIs) and sexual risks among HIV-positive female drinkers in St Petersburg, Russia. Survey and STI data were analysed from 285 women in HERMITAGE, a secondary prevention study of HIV-positive heavy drinkers. Logistic and Poisson regression analyses assessed associations of IPV with STI and risky sex. Most women (78%) experienced IPV and 19% were STI positive; 15% sold sex. IPV was not significantly associated with STI, but was with selling sex (adjusted odds ratio = 3.56, 95% confidence interval = 1.02–12.43). In conclusion, IPV is common and associated with sex trade involvement among Russian HIV-positive female drinkers.

Keywords

HIV AIDS Russia sex work substance use sexually transmitted infections (STI)interpersonal partner violence (IPV)

INTRODUCTION

Male partner-perpetrated intimate partner violence (IPV) and its association with sexually transmitted infection (STI) and STI/HIV risk taking behaviours (e.g. sex trade involvement) among women has been well described in multiple national contexts.^1–12 IPV was associated with sex work or multiple sexual partners, prior STIs and lower condom use in Australia and the Ukraine.¹ Married women in India experiencing husband-perpetrated IPV were more likely to have HIV infection than those who did not experience IPV from their husbands.⁴ Methadone-maintained women in New York with an increased risk for IPV had higher self-reported STIs.⁵ Higher rates of IPV victimization were found among HIV-positive women compared with HIV-negative women in four sub-Saharan African countries.^8–12 IPV is particularly pervasive in Russia, with approximately one-third of women reporting such victimization in their lifetime.^12–15 Injection drug use (IDU) and alcohol use, higher in Russia than in other national contexts,^13,16–20 have additionally been associated with increased risk for both HIV/STI^21–24 and IPV.^2,13,23 For example, in St Petersburg, alcohol misuse and certain drinking contexts (e.g. on the street) were associated with male IPV perpetration.^13,25 In St Petersburg, IDU has been strongly associated with HIV/STIs.²⁶

Despite the extensive research on IPV and STI risks among women in cross-national settings including Russia, there has, to date, been no published research examining whether history of IPV is associated with increased risk for STI and related risky sexual behaviours among substance using HIV-positive women in Russia. As the epidemic in Russia increasingly includes cases of sexually transmitted HIV,^{20,23,25–27} research on sexual risk factors for HIV becomes more important. This study addresses this gap in the field by examining whether history of IPV increases risk for STI and related sexual risk behaviours among HIV-positive female drinkers in Russia. Specifically, we hypothesize that victims of IPV are more likely to have an incident sexually transmitted infection (STI) than those reporting no such history. Secondly, we hypothesize that victims of IPV are more likely to have increased sexual risk factors (selling sex, recent multiple sexual partners, a higher number of unprotected sexual encounters) than those who report no history of IPV victimization.

METHODS

Data for this study came from baseline female participants (N = 285) of the HERMITAGE (HIV Evolution in Russia – Mitigating Infection Transmission and Alcoholism in a Growing Epidemic) study, an HIV intervention study that enrolled HIV-positive heavy drinking adults from October 2007–April 2010 from five inpatient/outpatient HIV and substance use care sites in St Petersburg, Russia (see further details on methods elsewhere²⁸). Participants were at least 18 years old, Russian-fluent and HIV-positive; reported past six-month unprotected anal or vaginal sex; provided stable local addresses and a telephone number; and met criteria for NIAAA ‘at risk’ drinking levels in the prior six months.²⁹

In the overall study, 702 were screened and 483 were enrolled. Among the 27% who were screened but did not enter the study, the following exclusion criteria were involved. Those with unconfirmed HIV infection (n = 2), missing contact information (n = 40), attempting to get pregnant or have their partner get pregnant (n = 4), having a pending legal issue (n = 17), alcohol criteria not met (n = 110), sex criteria not met (n = 134), refusal to participate (n = 29) or too ill to participate (n = 1) were excluded. For those with contact information lacking, those living outside of 150 km of St. Petersburg (n = 2) or failing to provide contact info for two other people (n = 23), or without a telephone (n = 14) were excluded. In addition, any individuals with severe cognitive impairment or anticipated incarceration were excluded, but none met these criteria in the sample. Trained clinician research associates recruited participants, assessed their eligibility in private rooms and obtained written informed consent from those eligible and willing to participate. Participants were then surveyed via face-to-face interviews in Russian and participated in a self-administered questionnaire for particularly sensitive questions (e.g. trauma, IPV). Participants underwent STI testing by providing urine (gonorrhoea, Chlamydia, trichomoniasis) and blood (syphilis) samples. If they tested positive for gonorrhoea, Chlamydia, trichomoniasis, they were offered treatment, but they were referred to the STI clinic for syphilis. Participants received 300 rubles (US $7) for their baseline assessment participation. Procedures were approved by the Institutional Review Boards of Boston Medical Center and St Petersburg Pavlov State Medical University.

Measures

Single items assessed participants’ age, marital status and education. Depression was measured by using the Beck Depression Inventory II (BDI-II).^30,31 Alcohol assessments asked about the quantity and frequency of alcohol consumption using a 30-day timeline follow-back (TLFB) instrument. Heavy drinking was defined as either reporting >7 drinks per week or any binge drinking (> 3 drinks in a day), in the past 30 days.³² Drug use assessments included any use of heroin, prescription analgesics, marijuana, sedatives, tranquilizers or stimulants over the last year, and drug dependence according to the CIDI-SF.³³ Any past 30-day IDU was assessed using an item from the Risk Behavior Survey (RBS).^34,35

Our primary independent variable, IPV victimization, was assessed via items based on the Conflict Tactics Scale-2³⁶ (Has a partner ever threatened you with violence, pushed or shoved you, or thrown something at you that could hurt? Have you ever had an injury, such as a sprain, bruise, or cut because of a fight with a partner? Has a partner ever insisted on or made you have sexual relations with him/her when you didn't want to?). A participant was classified as ‘yes’ for IPV victimization if a positive response was recorded.³⁶

The primary outcome, current STI, was assessed via urine testing for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and blood testing for syphilis (including confirmatory ELISA testing). Details on STI diagnostics are described elsewhere.²⁸ A secondary outcome, STI ever, was assessed via self-report on survey items asking whether the participant in their lifetime had ever had syphilis, gonorrhoea, Chlamydia and trichomonas.

Additional secondary outcomes included sex risk behaviour variables which asked participants about their sexual episodes and number of unprotected sex encounters (inconsistent condom use) in the past three months.³⁷ They were asked about alcohol and drug use before sex in the past 30 days (for their last 5 partners in the past 3 months). Two sex trade involvement items from the Risk Assessment Battery (RAB)³⁸ measured how often in the past three months the participant ‘had sex so they could get drugs’, and ‘were paid money to have sex with someone’.

Data analysis

Descriptive statistics were obtained for demographics, STI, sex risk behaviours and substance use behaviours for the overall sample and stratified by IPV victimization status. Bivariate associations were assessed via chi-square tests, t-tests or the non-parametric Wilcoxon rank sum test as appropriate.

Simple and multiple logistic regression analyses were used to assess the association between IPV victimization and the primary outcome, STI. Separate analyses were performed to assess each of the secondary outcomes, multiple sex partners and selling sex, reporting odds ratios (OR), and crude and adjusted over-dispersed Poisson regression analyses reporting incidence rate ratios (IRR) for the number of unprotected sex episodes. All adjusted analyses controlled for demographics (age, marital status and education), IDU, heavy alcohol use and depressive symptoms. Adjustments were not made for multiple comparisons due to the exploratory nature of the study. All analyses used two-sided tests and a significance level of 0.05. All statistical analyses were conducted using SAS version 9.3 (SAS Institute, Inc., Cary, NC, USA).

RESULTS

Sample characteristics

The women participants (N = 285) were aged 18–54 years, with a median age of 28 (interquartile range = 26–32), and 42.1% were married or living with a partner (Table 1). Nearly half (46.7%) had not completed high school. Over the past 30 days, over three quarters (76.5%) reported heavy drinking, less than half (41.1%) reported injection drug use, and nearly half reported alcohol or drug use before sex (49.5%). Their BDI-II scores ranged from 26.3% having no depression, 21.4% having mild depression, 27% having moderate depression and 25.3% having severe depression. Less than one in six women (14.7%) had sold sex in the past three months, 18.5% currently had an STI based on biological testing and 49% reported a history of having an STI. Overall, 22% of the female participants reported having multiple sexual partners over the past three months; 25% of those with a history of IPV had multiple sexual partners.

Table 1

Demographic and HIV/STI risk profile of female HIV-infected heavy drinkers in St Petersburg, Russia (N = 285) and stratified by history of IPV victimization

	Total sample (N = 285), n (%)	No history of IPV victimization (N = 63), n (%)	History of IPV victimization (N = 222), n (%)	P value
Age range (years)	(18–54)	(19–53)	(18–54)	0.68
Mean (SD)	29.3 (5.7)	29.6 (6.1)	29.2 (5.6)
Married or living with partner	120 (42.1%)	25 (39.7%)	95 (42.8%)	0.66
Education				0.07
≤11 Grades	133 (46.7%)	23 (36.5%)	110 (49.5%)
>11 Grades	152 (53.3%)	40 (63.5%)	112 (50.5%)
Heavy drinking	218 (76.5%)	47 (74.6%)	171 (77.0%)	0.69
IDU past 30 days	117 (41.1%)	20 (31.7%)	97 (43.7%)	0.09
Multiple sex partners, past 3 months	62 (21.8%)	7 (11.1%)	55 (24.8%)	0.02
Selling sex	42 (14.7%)	3 (4.8%)	39 (17.6%)	0.01
BDI-II severity
No depression	75 (26.3%)	23 (36.5%)	52 (23.4%)
Mild	61 (21.4%)	12 (19.0%)	49 (22.1%)	0.06
Moderate	77 (27.0%)	19 (30.2%)	58 (26.1%)
Severe	72 (25.3%)	9 (14.3%)	63 (28.4%)
Alcohol and drug use before sex	141 (49.5%)	25 (39.7%)	116 (52.3%)	0.08
Number of unprotected sex episodes, past 3 months				0.21
(Range)	(0–483)	(0–93)	(0–483)
Mean (SD)	19.4 (44.6)	13.2 (21.3)	21.2 (49.1)
Median (IQR)	6.0 (1–20)	3 (0–20)	8 (1–22)
Current STI	51 (18.5%)	11 (18.0%)	40 (18.6%)	0.92
Self-report STI ever	139 (48.8%)	25 (39.7%)	114 (51.4%)	0.10

STI = sexually transmitted infection; IPV = intimate partner violence; SD = standard deviation; IDU = injection drug use; IQR = interquartile range

Over three-quarters of participants (78%, N = 222) reported a history of IPV victimization (Table 1). Bivariate analyses suggested that participants reporting a history of IPV victimization were significantly more likely to report multiple sexual partners (P = 0.02) and selling sex (P = 0.01). Also, it is worth noting that albeit not statistically significant, participants reporting a history of IPV victimization appeared more likely to report any history of STI (P = 0.10).

Associations between IPV and STI

Multiple logistic regression analyses, adjusted for age, marital status, education, ever having an STI, any alcohol or drug use before sex in the past 30 days, and multiple sex partners, selling sex and number of unprotected sexual encounters in the past three months, found no significant associations between lifetime IPV victimization and current STIs (adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.47, 2.16) (Table 2).

Table 2

Logistic and Poisson regression analyses assessing associations between IPV victimization and the outcomes – STI and sex risk behaviours

Outcomes	Crude OR (95% CI)	Adj^† OR (95% CI)
Current STI	1.04 (0.50, 2.17)	1.01 (0.47, 2.16)
Self-reported STI (ever)	1.60 (0.91, 2.83)	1.69 (0.94, 3.05)
Multiple sex partners	2.63 (1.13, 6.12)	2.39 (0.99, 5.81)
Selling sex	4.26 (1.27, 14.29)	3.56 (1.02, 12.43)*
Alcohol or drug use before sex	1.66 (0.94, 2.94)	1.46 (0.78, 2.73)
	Crude IRR (95% CI)	Adj^† IRR (95% CI)
Number of unprotected sex encounters (past 3 months)	1.61 (0.78, 3.32)	1.66 (0.93, 2.96)

OR = odds ratio; STI = sexually transmitted infection; IRR = incidence rate ratio; IPV = intimate partner violence

^†Adjusted for age, marital status, education, IDU, past 30-day heavy drinking, BDI-II

*P < 0.05

Associations between IPV and sex risk behaviours

The multivariable analyses demonstrated that lifetime IPV victimization was associated with higher odds of having the secondary outcome of selling sex (AOR = 3.56, 95% CI = 1.02, 12.43) (Table 2). Among the covariates, past 30-day IDU was positively associated with selling sex (AOR = 3.44, 95% CI = 1.57, 7.55) while being married or living with a partner was negatively associated with it (AOR = 0.38; 95% CI = 0.17, 0.87). Self-report STI ever was not significantly associated with IPV victimization (AOR = 1.69; 95% CI = 0.94, 3.05). No significant associations between lifetime IPV victimization and other secondary outcomes of sex risk behaviours were observed in adjusted analyses (Table 2). However, although not statistically significant, notable effect sizes were observed for each of the other sexual risk behaviours: having multiple sex partners (2.39; 95% CI = 0.99–5.81), alcohol and drug use before sex (1.46; 95% CI = 0.78, 2.73) and the number of unprotected sex encounters (1.66; 95% CI = 0.93, 2.96).

DISCUSSION

History of IPV victimization is common among female HIV-positive Russian heavy drinkers and is significantly associated with increased risk for sex trade involvement, but not having a current STI. The apparent lack of an association between history of IPV and current STI is surprising given the extensive evidence of this association previously found in non-infected but at risk women in Russia³⁹ and HIV-positive women in other national contexts;^4,40,41 this may be attributable to use of different timeframes for these variables of focus and possibly a lack of study power. Nonetheless, findings of heightened risk for IPV among those engaged in sex work is consistent with previous research across national contexts,^42–45 including Russia.³⁹ Research suggests that IPV increases risk for entry into sex work,⁴⁶ but also is more likely to occur in the context of sex work and with regular paying and non-paying partners.⁴⁷ These findings support ongoing work documenting the synergistic effects of violence against women, substance use and sex work involvement, which appears to be present among HIV-positive women. Such a phenomenon has been well documented in other women who use drugs or engage in sex work in Africa, Southeast Asia, Canada, Mexico and the USA,^48–52 and effective interventions for women have been developed that simultaneously address these synergistic health concerns.⁵³ The findings in this paper emphasize the need to consider the long term and synergistic effects of IPV and substance use and sex work involvement among women living with HIV.

Recent sex work involvement was reported by more than one in seven of the HIV-positive women in this study, demonstrating that further exploration of sexual risk (e.g. unprotected sex) may be required for this population. In addition to the observed association between IPV and recent sex work involvement, recent IDU was also associated with greater involvement in sex work. Again, this association between sex work and IDU has been well documented,^54–56 and other studies from Russia have demonstrated a significant association between IPV and IDU.^45,57,58 Furthermore, women may experience IPV as a result of stigma from their HIV-positive status, having multiple partners or from their involvement in sex work.^59–61 Current findings support the potential utility of targeting violence prevention interventions towards HIV-positive substance using women in Russia, especially those engaged in sex work. The notable prevalence of IPV victimization in this HIV-positive sample (78%) is higher than that seen in other populations of women in Russia, including those recruited from STI clinics.^13,19,62,63 These findings of IPV being more common among HIV-positive women have also been seen in South Africa and Bangladesh.^64,65 However, previous research from Russia and elsewhere also documents a strong association between substance use and IPV victimization;^13,19,63 hence, high prevalence of IPV findings may also be attributable to this study's focus on heavy drinkers and inclusion of a large proportion of injection drug users.

The sample of heavy drinkers, many of whom also reported recent injection drug use, may use substances as a means to cope with trauma acquired during past experiences of IPV or current engagement in sex work.^66,67 The high percentage of women who report either moderate or severe depression also supports the potential that women may self-medicate using alcohol or injection drugs. Findings from this study should be considered in light of study limitations. Most participants’ characteristics were based on self-reported data; as such, the data used are subject to recall and social desirability biases. Attempts to mitigate this risk included using trained assessors and self-completed portions of the assessment for particularly sensitive data. As noted previously, use of differing time frames across some of our variables of interest (e.g. lifetime IPV sexual victimization, unprotected sex in past three months, current STI) may have affected some study findings. Cross-sectional data analyses do not allow an interpretation of the findings in terms of causality. Findings of this study should also be interpreted with caution because the study cannot be generalized beyond HIV-positive individuals, women and those identified as ‘at risk’ drinkers. However, the findings contribute to understanding the associations of IPV with an important population in Russia, HIV-positive female drinkers. Of note, this sample was largely comprised of those who were in clinical care, limiting generalizability to HIV-positive Russian female drinkers who do not obtain health care. Furthermore, we did not collect data on income or employment that distinguishes between sex work and non-sex work employment. This is as an area that requires further exploration in future research because of the potential significance of HIV-positive women's economic and financial needs on the associations between IPV, substance use and sexual risk for this population.

Nonetheless, findings from this work support previous research from Russia and elsewhere, highlighting the synergistic relationship among gender based violence, substance use and sex work involvement in heightening risk for HIV and HIV transmission among women.^{48,50,68–70} Secondary HIV prevention efforts must consider the effects of IPV on likelihood of ongoing sex trade involvement for substance using HIV-infected women in Russia.

Footnotes

ACKNOWLEDGEMENTS

The authors wish to acknowledge the participants in the HERMITAGE study, as well as the clinical and administrative study staff, and the Data Coordinating Center at Boston University. Support for this work came from the National Institutes of Health R01AA016059, K24-AA015674, U24AA020778, U24AA020779 and T32 DA023356.

References

Dude

. Intimate partner violence and increased lifetime risk of sexually transmitted infection among women in Ukraine. Stud Fam Plann 2007;38:89–100

Kayibanda

Bitera

Alary

. Violence towards women, men's sexual risk factors and HIV infection among women: findings from a national household survey in Rwanda. J Acquir Immune Defic Syndr 2012 Jan 5 [Epub ahead of print)

Jewkes

Dunkle

Nduna

Shai

. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet 2010;376:41–8

Silverman

Decker

Saggurti

Balaiah

Raj

. Intimate partner violence and HIV infection among married Indian women. JAMA 2008;300:703–10

El-Bassel

Gilbert

Hill

. HIV and intimate partner violence among methadone-maintained women in New York City. Soc Sci Med 2005;61:171–83

Lockart

Ryder

McNulty

. Prevalence and associations of recent physical intimate partner violence among women attending an Australian sexual health clinic. Sex Transm Infect 2011;87:174–6

Williams

Larsen

McCloskey

. The impact of childhood sexual abuse and intimate partner violence on sexually transmitted infections. Violence Vict 2010;25:787–98

Campbell

Baty

Ghandour

Stockman

Francisco

Wagman

. The intersection of intimate partner violence against women and HIV/AIDS: a review. Int J Inj Contr Saf Promot 2008;15:221–31

Maman

Mbwambo

Hogan

Kilonzo

Campbell

Weiss

. HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. Am J Public Health 2002;92:1331–7

10.

Dunkle

Jewkes

Brown

Gray

McIntryre

Harlow

. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 2004;363:1415–21

11.

Fonck

Leye

Kidula

Ndinya-Achola

Temmerman

. Increased risk of HIV in women experiencing physical partner violence in Nairobi, Kenya. AIDS Behav 2005;9:335–9

12.

Jewkes

Dunkle

Nduna

Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. Int J Epidemiol 2006;35:1461–8

13.

Zhan

Shaboltas

Skochilov

Kozlov

Krasnoselskikh

Abdala

. Alcohol misuse, drinking contexts and intimate partner violence in St. Petersburg, Russia: results from a cross-sectional study. BMC Public Health 2011;11:629

14.

Gondolf

Shestakov

. Spousal homicide in Russia. Gender inequality in a multifactor model. Violence Against Women 1997;3:533–46

15.

Horne

. Domestic violence in Russia. Am Psychol 1999;54:55–61

16.

Lokhmatkina

Kuznetsova

Feder

. Prevalence and associations of partner abuse in women attending Russian general practice. Fam Pract 2010;27:625–31

17.

Stickley

Timofeeva

Sparén

. Risk factors for intimate partner violence against women in St. Petersburg, Russia. Violence Against Women 2008;14:483–95

18.

Walley

Krupitsky

Cheng

Implications of cannabis use and heavy alcohol use on HIV drug risk behaviors in Russian heroin users. AIDS Behav 2008;12:662–9

19.

Lysova

Hines

. Binge drinking and violence against intimate partners in Russia. Aggress Behav 2008;34:416–27

20.

Krupitsky

Zvartau

Lioznov

Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad Region, Russia. Eur Addict Res 2006;12:12–9

21.

Raj

Saitz

Cheng

Winter

Samet

. Associations between alcohol, heroin, and cocaine use and high risk sexual behaviors among detoxification patients. Am J Drug Alcohol Abuse 2007;33:169–78

22.

Urada

Morisky

Hernandez

Strathdee

. Social and structural factors associated with consistent condom use among female entertainment workers trading sex in the Philippines. AIDS Behav 2013;17(2):523–535

23.

Cohen

. Late for the epidemic: HIV/AIDS in Eastern Europe. Science 2004;329:160–164

24.

Rhodes

Donoghoe

Hunter

Soteri

Stimson

. Sexual behaviour of drug injectors in London: implications for HIV transmission and HIV prevention. Addiction 1994;89:1085–96

25.

Raj

Kidd

Cheng

, et al. Associations between partner violence perpetration and history of STI among HIV-infected substance using men in Russia. AIDS Care 2013;25(5):646–651

26.

Summary Country Profile for HIV/AIDS Treatment Scale-up: Russian Federation. World Health Organization, 2005. See http://www.who.int/hiv/HIVCP_RUS.pdf (accessed 6 February 2013)

27.

Goliusov

Dementyeva

Ladnaya

Country Progress Report of the Russian Federation on the Implementation of the Declaration of Commitment on HIV/AIDS, Adopted at the 26th United Nations General Assembly Special Session, June 2001. Report period: January 2006 – December 2007; 2008. See http://data.unaids.org/pub/Report/2008/Russia_2008_country_progress_report_en.pdf (accessed 3 April 2011)

28.

Pace

Dmitry

Cheng

Sexually transmitted infections among HIV-positive heavy drinkers in St. Petersburg, Russia. Int J STD AIDS 2012;23(12):853–8

29.

Kessler

Andrews

Mroczek

Ustun

Wittchen

H-U

. The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF). Int J Methods Psychiatric Res 1998;7:171–85

30.

Beck

Steer

Brown

. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation, 1996

31.

Beck

Steer

Brown

. Beck Depression Inventory – Second Edition. Russian translation. San Antonio, TX: Pearson Education, Inc, 2007

32.

Sobell

. Alcohol Timeline Followback (TFLB) Users' Manual. Toronto, Canada: Addiction Research Foundation, 1995

33.

The Physicians’ Guide to Helping Patients with Alcohol Problems. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995

34.

Petry

. Reliability of drug users' self-reported HIV risk behaviors using a brief, 11-item scale. Subst Use Misuse 2001;36:1731–47

35.

Weatherby

Needle

Cesari

Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Eval Program Plann 1994;17:347–55

36.

Straus

Hamby

Boney-McCoy

Sugarman

. The revised conflict tactics scales (CTS-2): development and preliminary psychometric data. J Fam Issues 1996;17:283–316

37.

Kalichman

Rompa

Cage

Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. Am J Prev Med 2001;21:84–92

38.

Navaline

Snider

Petro

Preparations for AIDS vaccine trials. An automated version of the Risk Assessment Battery (RAB): enhancing the assessment of risk behaviors. AIDS Res Hum Retroviruses 1994;10:S281–283

39.

Zhan

Hansen

Shaboltas

Partner violence perpetration and victimization and HIV risk behaviors in St. Petersburg, Russia. J Trauma Stress 2012;25:86–93

40.

Illangasekare

Tello

Hutton

Clinical and mental health correlates and risk factors for intimate partner violence among HIV-positive women in an inner-city HIV clinic. Womens Health Iss 2012;22(6):e563–9

41.

El-Bassel

Gilbert

Witte

Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics – challenges and implications for prevention and treatment. Subst Use Misuse 2011;46:295–306

42.

Carlson

Chen

Chang

Intimate and paying partner violence against women who exchange sex in Mongolia: results from a randomized clinical trial. J Interpers Violence 2012;27(10):1911–31

43.

Srikrishnan

Parker

High prevalence of forced sex among non-brothel based, wine shop centered sex workers in Chennai, India. AIDS Behav 2011;15:163–71

44.

Karandikar

Próspero

. From client to pimp: male violence against female sex workers. J Interpers Violence 2010;25:257–73

45.

Raj

Santana

La Marche

Perpetration of intimate partner violence associated with sexual risk behaviors among young adult men. Am J Public Health 2006;96:1873–8

46.

Dunkle

Jewkes

Brown

Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med 2004;59:1581–92

47.

Panchanadeswaran

Johnson

Sivaram

Intimate partner violence is as important as client violence in increasing street-based female sex workers’ vulnerability to HIV in India. J Drug Policy 2008;19:106–12

48.

El-Bassel

Fontdevila

Gilbert

Voisin

Richman

Pitchell

. HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue. J Subst Abuse 2001;13:29–43

49.

Strathdee

Lozada

Martinez

Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US Border Region. PLoS One 2011;6:e19048

50.

Pauw

Brener

. ‘You are just whores – you can't be raped’: barriers to safer sex practices among women street sex workers in Cape Town. Culture Health Sex 2003;5:465–81

51.

Shannon

Kerr

Allinott

. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med 2008;66:911–21

52.

Urada

Morisky

Pimentel-Simbulan

Silverman

Strathdee

. Condom negotiations among female sex workers in the Philippines: environmental influences. PLoS One 2012;7:e33282. (Epub ahead of print) PMID: 22448241

53.

Wechsberg

Luseno

Lam

Parry

Morojele

. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria. AIDS Behav 2006;10:131–7

54.

Platt

Rhodes

Lowndes

Impact of gender and sex work on sexual and injecting risk behaviors and their association with HIV positivity among injecting drug users in an HIV epidemic in Togliatti City, Russian Federation. Sex Transm Dis 2005;32:605–12

55.

Strathdee

Philbin

Semple

Correlates of injection drug use among female sex workers in two Mexico-U.S. border cities. Drug Alcohol Depend 2008;92:132–40

56.

Kozlov

Shaboltas

Toussova

. HIV incidence and factors associated with HIV acquisition among injection drug users in St Petersburg, Russia. AIDS 2006;20:901–6

57.

Solomon

Srikrishnan

Celentano

The intersection between sex and drugs: a cross-sectional study among the spouses of injection drug users in Chennai, India. BMC Public Health 2011;11:39

58.

El-Bassel

Gilbert

Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening. Emerg Med J 2007;24:255–9

59.

Davis

. Understanding and addressing stigma and attachment insecurity in HIV-positive women who experience intimate partner violence: a model of medical and psychosocial care. Soc Work Health Care 2012;51:213–31

60.

Amuri

Mitchell

Cockcroft

Andersson

. Socio-economic status and HIV/AIDS stigma in Tanzania. AIDS Care 2011;23:378–82

61.

Servin

Muñoz

Strathdee

Kozo

Zúñiga

. Choosing sides: HIV health care practices among shared populations of HIV-positive Latinos living near the US-Mexico border. J Int Assoc Physicians AIDS Care (Chic) 2012;11(6):348–55

62.

Serbanescu

Goodwin

. Domestic Violence in Eastern Europe: Levels, Risk Factors and Selected Reproductive Health Consequences. Paper presented at: European Conference on Interpersonal Violence, 2005

63.

Intimate partner violence and alcohol fact sheet. World Health Organization, 2011. See http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/ft_intimate.pdf (accessed 22 April 2013)

64.

Dunkle

Jewkes

Nduna

Gray

McIntryre

Harlow

. Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. AIDS 2006;20:2107–14

65.

Silverman

Decker

Kapur

Gupta

Raj

. Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men. Sex Transm Infect 2007;83:211–5

66.

Asberg

Renk

. Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories. Subst Use Misuse 2012;47:799–808. doi: 10.3109/10826084.2012.669446. Epub 2012 Apr 2

67.

Leeies

Pagura

Sareen

Bolton

. The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depress Anxiety 2010;27:731–6

68.

Kurtz

Surratt

Inciardi

Kiley

. Sex work and ‘date’ violence. Violence Against Women 2004;10:357–85

69.

Lowman

. Violence and the outlaw status of (street) prostitution in Canada. Violence Against Women 2000;6:987–1011

70.

Sanders

Campbell

. Designing out vulnerability, building in respect: violence, safety and sex work policy. Br J Sociol 2007;58:1–19