04/19/2304/19/23 11

Violence Against Women Violence Against Women and HIV/AIDS Prevention: and HIV/AIDS Prevention:

Update from CDC’s Division of HIV/AIDS PreventionUpdate from CDC’s Division of HIV/AIDS Prevention

Linda J. Koenig, PhD, MS

Senior Scientist, Prevention Research Branch

Division of HIV/AIDS Prevention

HIV & Violence Against Women: A National Conference

August 22, 2009; Atlanta, GA

04/19/2304/19/23 22

Early activities: Early activities: Collaboration and agenda Collaboration and agenda settingsetting 1998-99: DHAP co-sponsored 2 meetings to 1998-99: DHAP co-sponsored 2 meetings to

bring attention to role of abuse/violence in bring attention to role of abuse/violence in HIV risk and preventionHIV risk and prevention

– ““Childhood Sexual Abuse and HIV Risk: Childhood Sexual Abuse and HIV Risk: Breaking the Link”, November, 1998, Atlanta, Breaking the Link”, November, 1998, Atlanta, GA (CDC/NIMH)GA (CDC/NIMH)

CSA as risk for HIVCSA as risk for HIV www.apa.org/books

– “ “National Conference on Violence and National Conference on Violence and Reproductive Health: Science, Prevention & Reproductive Health: Science, Prevention & Action”, June 1999, Atlanta, GA (CDC cross-CIO Action”, June 1999, Atlanta, GA (CDC cross-CIO collaboration)collaboration)

For HIV, co-occurring epidemics with For HIV, co-occurring epidemics with interrelationshipsinterrelationships

MCHJ, vol 4[2] June 2000MCHJ, vol 4[2] June 2000

Outgrowth: raise awareness about need Outgrowth: raise awareness about need to to bring disparate fields/services bring disparate fields/services togethertogether

04/19/2304/19/23 33

Developing the science Developing the science basebase Documenting the high prevalence of adult violence and Documenting the high prevalence of adult violence and

childhood abuse among women with or at high risk for HIV childhood abuse among women with or at high risk for HIV infection, and the impact of violence/abuse on safe sex practicesinfection, and the impact of violence/abuse on safe sex practices

– Henny KD, Kidder D, Stall R, Wolitski RJ. (2007). Henny KD, Kidder D, Stall R, Wolitski RJ. (2007). Physical and sexual abuse among homeless and Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior, 11, AIDS and Behavior, 11, 842-853.842-853.

– Koenig, LJKoenig, LJ, , Whitaker, DJ, Royce, R, et al. (2006). Whitaker, DJ, Royce, R, et al. (2006). Physical and sexual violence during pregnancy and Physical and sexual violence during pregnancy and after delivery: A prospective multistate study of women with or at risk for HIV infection.after delivery: A prospective multistate study of women with or at risk for HIV infection. American American Journal of Public Health, 96Journal of Public Health, 96,, 1052-1059. 1052-1059.

– Hamburger, ME, Moore, J, Koenig, LJ, et al. (2004). Hamburger, ME, Moore, J, Koenig, LJ, et al. (2004). Persistence of inconsistent condom use: Relation to Persistence of inconsistent condom use: Relation to abuse history and HIV serostatusabuse history and HIV serostatus. . AIDS and Behavior, 8,AIDS and Behavior, 8, 333-344 333-344

– Koenig, LJKoenig, LJ and Clark, Hand Clark, H (2004). (2004). Sexual abuse of girls and HIV infection among women: Are they Sexual abuse of girls and HIV infection among women: Are they related?related? In Koenig, LJ, Doll, L, O’Leary, A, and Pequegnat, W. (Eds.) In Koenig, LJ, Doll, L, O’Leary, A, and Pequegnat, W. (Eds.) From Child Sexual Abuse to Adult Sexual From Child Sexual Abuse to Adult Sexual Risk: Trauma, Revictimization, and InterventionRisk: Trauma, Revictimization, and Intervention.. American Psychological Association Books: Washington, DC. American Psychological Association Books: Washington, DC.

– Saul J, Moore J, Murphy ST, Miller LC (2004). Saul J, Moore J, Murphy ST, Miller LC (2004). Relationship violence and women’s reactions to male- and Relationship violence and women’s reactions to male- and female-controlled HIV prevention methods. female-controlled HIV prevention methods. AIDS and Behavior, 8AIDS and Behavior, 8, 207-214, 207-214

– Koenig, LJ, Whitaker, D., Royce, R., et al. (2002) Koenig, LJ, Whitaker, D., Royce, R., et al. (2002) Violence during pregnancy among women with or at Violence during pregnancy among women with or at risk for HIV infectionrisk for HIV infection. . American Journal of Public Health, 92American Journal of Public Health, 92: 367-370 : 367-370

– Koenig, LJ, and Moore, J (2000). Koenig, LJ, and Moore, J (2000). Women, Violence, and HIV: A Critical Evaluation with Implications Women, Violence, and HIV: A Critical Evaluation with Implications for HIV Services.for HIV Services. Maternal and Child Health Journal, 4Maternal and Child Health Journal, 4 , 103-109. , 103-109.

– Vlahav D, Wientge D, Moore J, et al. (1998). Vlahav D, Wientge D, Moore J, et al. (1998). Violence among women with or at risk for HIV infectionViolence among women with or at risk for HIV infection . . AIDS and Behavior, 2:AIDS and Behavior, 2:53-60. 53-60.

04/19/2304/19/23 44

Incorporating awareness into public Incorporating awareness into public health practice and HIV prevention health practice and HIV prevention programsprograms

Incorporated into partner services guidance (formerly PCRS)Incorporated into partner services guidance (formerly PCRS)CDC. CDC. Recommendations for partner services programs for HIV and other sexually Recommendations for partner services programs for HIV and other sexually transmitted diseasestransmitted diseases. . Morbidity and Mortality Weekly ReportMorbidity and Mortality Weekly Report, 2008; 57(RR9):1-63, 2008; 57(RR9):1-63. .

Diffusion of Effective Behavioral Interventions (DEBI):Diffusion of Effective Behavioral Interventions (DEBI):2 include promotion of violence screening, recognition and referral2 include promotion of violence screening, recognition and referral

Future is Ours (FIO):Future is Ours (FIO):group-intervention for women; promotes abuse awareness;group-intervention for women; promotes abuse awareness;

http://www.cdc.gov/hiv/topics/research/prs/resources/factsheets/FIO.htm

Project ConnectProject Connect : :

Couple’s based intervention promotes violence screening Couple’s based intervention promotes violence screening & referral & referral http://www.effectiveinterventions.org/go/interventions/connect

Gender ToolkitGender Toolkit (CBB with OWH) (CBB with OWH)– Modeled after PEPFAR/international approach for domestic audienceModeled after PEPFAR/international approach for domestic audience – promotes a gendered framework for HIV prevention, include role of promotes a gendered framework for HIV prevention, include role of

gender-based violencegender-based violence

04/19/2304/19/23 55

Current activities: HIV Current activities: HIV prevention for racial and ethnic prevention for racial and ethnic minority womenminority women

Program reviewProgram review::– Integrated services for Asian immigrant and refugee communities Integrated services for Asian immigrant and refugee communities – Leung M and Koenig LJ.Leung M and Koenig LJ. Integrated HIV and violence Integrated HIV and violence

prevention:Promising programs for Asian immigrant and prevention:Promising programs for Asian immigrant and refugee communities.refugee communities. Tuesday, 3:30-5:00, A707 Mariott MarquisTuesday, 3:30-5:00, A707 Mariott Marquis

Survey ResearchSurvey Research:: Understanding determinants of risk for African-American and Hispanic Understanding determinants of risk for African-American and Hispanic

women in the southeastern United States women in the southeastern United States

InterventionIntervention::Microenterprise: promoting HIV prevention by addressing povertyMicroenterprise: promoting HIV prevention by addressing poverty– Shown in Africa to reduce both HIV and violence victimizationShown in Africa to reduce both HIV and violence victimization– Current focus: poor African-American women in the southeastern Current focus: poor African-American women in the southeastern

U.S. U.S. – March 2006: CDC consultationMarch 2006: CDC consultation

Stratford D, Mizuno Y, Williams K et al. (2008) Stratford D, Mizuno Y, Williams K et al. (2008) Addressing Addressing poverty as a risk for disease: Recommendations from poverty as a risk for disease: Recommendations from CDC’s consultation on microenteprise as HIV prevention. CDC’s consultation on microenteprise as HIV prevention. Public Health Reports, 123, Public Health Reports, 123, 9-20.9-20.

– Currently developing intervention in collaboration with STD, DVP Currently developing intervention in collaboration with STD, DVP and othersand others

04/19/2304/19/23 66

Thank you. Thank you. For further information, contact For further information, contact LKoenig@cdc.gov

The findings and conclusions in this presentation are those of the author and don’t The findings and conclusions in this presentation are those of the author and don’t necessarily represent those of the Centers for Disease Control and Preventionnecessarily represent those of the Centers for Disease Control and Prevention