An Exploration of Geographic Access to Substance Use Treatment Programs and Violence Against Women.

Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.

Centring the health of women across the HIV research continuum.

Despite tremendous advances in HIV research, women and gender diverse people-particularly women from racial and ethnic groups under-represented in research, transgender women, and young women-remain disproportionately affected by HIV. Women and gender diverse people face unique challenges and have been under-represented in HIV research. The National Institutes of Health (NIH) is tasked to apply fundamental knowledge about the nature and behaviour of living systems to enhance health, lengthen life, and reduce disability. Rigorous exploration of-and interventions for-the individual, social, biological, structural, and environmental factors that influence HIV prevention, transmission, treatment, and cure is crucial to advance research for women, girls, and gender diverse people across the lifespan. In this Position Paper, we introduce a framework for an intersectional, equity-informed, data-driven approach to research on HIV and women and highlight selected issues for women and gender diverse people, including HIV prevention, HIV cure, ageing with HIV, substance use and misuse, violence, pregnancy, and breastfeeding or chestfeeding. This framework underlines a new HIV and Women Signature Programme from the NIH Office of AIDS Research and Office of Research on Women's Health that advances the NIH vision for women's health, in which all women receive evidence-based HIV prevention, treatment, and care across their lifespan tailored to their unique needs, circumstances, and goals. The time is now to centre the health of women, girls, and gender diverse people across the HIV research continuum.

Factors correlated with pre-exposure prophylaxis (PrEP) awareness and use among black adults in the United States: implications for improving HIV prevention.

HIV remains a significant public health concern for Black adults (BA) in the United States. Pre-exposure prophylaxis (PrEP) is a highly effective prevention tool prescribed to protect the health of HIV-uninfected individuals. Yet, low rates of PrEP awareness and utilization persist among BA. Less is understood about the pathways that may promote PrEP uptake. The present study explored factors associated with PrEP awareness and use among BA. Using a cross-sectional sample of 666 BA, we employed multivariable logistic regression models to examine the relationship between PrEP and several covariates. Most participants were unaware of PrEP (71%). Reporting history of incarceration and lifetime sexually transmitted infection testing [aOR 1.76 (1.19, 2.59), p < 0.05] had greater odds of PrEP awareness. Only 6% of respondents had ever taken PrEP. Reports of incarceration history [aOR 9.96 (2.82, 35.14), p < 0.05], concurrent sexual partners [aOR 1.09 (1.00, 1.18), p < 0.05], and substance use during sex [aOR 4.23 (1.02, 17.48), p < 0.05] had greater odds of PrEP use. Interventions aiming to improve PrEP uptake among BA must consider the individual, social, and structural contexts associated with its awareness and use. Enhanced efforts by healthcare providers and institutions may better facilitate access to PrEP for HIV prevention and control transmission.

Attitudes Toward and Willingness to Engage in Consensual Non-Monogamy (CNM) Among African Americans Who Have Never Engaged in CNM.

Research on consensual non-monogamy (CNM) has largely focused on CNM behavior, while less attention has been given to attitudes toward and willingness to engage in CNM. Additionally, the study of CNM among African Americans is underexplored. Through an online survey study, we examined the correlates of attitudes toward and willingness to engage in CNM among African Americans who have never engaged in CNM, as attitudes and willingness provide insight into future behavior and stigmatization of CNM. We also assessed open-ended responses of reasons given for considering or not considering CNM engagement. A total of 904 African Americans between the ages of 18-40 participated in this study. Regressions were utilized to determine the correlates of attitudes toward and willingness to engage in CNM. Sexual orientation and gender were significant predictors of attitudes toward CNM. Age, sexual orientation, and gender were significant predictors of willingness to engage in CNM. Qualitative analyses revealed three themes among those who have considered engaging in CNM: (1) always been curious or had fantasies about trying a threesome, swinging, or open relationship, (2) thinks it would be fun, provides excitement, and can improve the relationship, and (3) would consider it under the right circumstances. Most participants reported never considering CNM engagement for the following reasons: (1) CNM is inconsistent with religious beliefs, morals, or values, (2) is just not for me, (3) it's the same as cheating, (4) committed to partner, (5) the belief that CNM increases risk of HIV/STIs, and (6) that CNM causes drama.

Dimensions of Sexual Health Conversations among U.S. Black Heterosexual Couples.

Sexual health communication is an important feature of healthy intimate relationships; however, some couples may avoid discussing difficult matters (e.g., HIV/STI testing, sexual satisfaction) to minimize interpersonal conflict. From October 2018 to May 2019 in New York State, we conducted a multi-method descriptive pilot study to characterize Black heterosexual couples' (N = 28) sexual health conversations. Partners individually completed an online sexual health/relationship survey before engaging in-person for a joint dyadic qualitative in-depth interview. Quantitative descriptive statistics demonstrated that most absolute score differences among couple's preferences for sexual health outcomes, communal coping and sexual relationship power were mainly small, but greatest regarding extra-dyadic sexual behaviors. A qualitative descriptive approach discerned, motivation and norms for sexual health conversations, and communication patterns. Thematic and content analysis revealed two central themes: initiating and sustaining sexual health conversations, and leveraging features of the couples to promote sexual health. Integrated findings indicate that couples possess varied communication patterns that operate with motivations for sexual health conversations toward subsequent sexual health promotion. Equitable and skewed communication patterns emerged as relationship assets that can be leveraged to optimize sexual health. There is also opportunity for future work to address communication regarding extra-dyadic behavior and preferences. Asset-based considerations are discussed.

An Analysis of Sex Practices and Behaviors Among African Americans in Sexually Concurrent and Sexually Exclusive Relationships.

Historically, sexually concurrent relationships have been associated with increased risk for sexually transmitted infections (STIs), including HIV. Due to socio-structural factors, African Americans (AAs) have higher rates of STIs compared to other racial groups and are more likely to engage in sexually concurrent (SC) relationships. Current research has challenged the assumption that SC is the only risky relationship type, suggesting that both SC and sexually exclusive (SE) relationships are at equal risk of STI and HIV acquisition and that both relationship types should engage in safer sex practices. This study aimed to compare sex practices and behaviors among AA men and women in SC and SE relationships (N = 652). Results demonstrate differences in sexual practices and behaviors between SC and SE men and women. Overall, SC and SE women report condom use with male partners less frequently than SC and SE men. SC men were more likely to report substance use during sex compared to SC and SE women. Pre-exposure prophylaxis (PrEP) use did not differ across groups. SE men were less likely to report STI testing and diagnosis compared to SC women. Findings support the need to focus on culturally and gender-specific safer sex interventions among AAs.

Betrayal Trauma and Barriers to Forming New Intimate Relationships Among Survivors of Intimate Partner Violence.

Many survivors of intimate partner violence (IPV) experience betrayal trauma, which affects future intimate relationships. Yet many services extended to victims of IPV focus on keeping the victim safe, not helping survivors establish new healthy intimate relationships. Using betrayal trauma as a lens, this phenomenological study incorporates semistructured interviews to explore the various ways betrayal trauma manifests itself and acts as barriers to forming new healthy intimate relationships among survivors of IPV. Thematic analysis with nine survivors of IPV revealed four ways betrayal trauma manifests and acts as barriers to establishing new healthy intimate relationships: (a) vulnerability/fear, (b) relationship expectations, (c) shame/low self-esteem, and (d) communications issues. This article has implications for those working with survivors of IPV.

The Who and Why of Consensual Nonmonogamy Among African Americans.

Prevalence rates of consensual nonmonogamy (CNM) demonstrate little difference across race. Yet, not much is known about CNM among African Americans. Through an online survey study, we examined the correlates of CNM among African Americans as well as the reasons why they engage. A total of 1050 African Americans between the ages of 18-40 years participated in this study. Binomial logistic regression was utilized to determine the correlates of CNM. Sexual orientation was the only significant predictor of CNM. The following variables were nonsignificant predictors of CNM: age, gender, household income, religiosity, and education. Qualitative analysis revealed several reasons for CNM engagement: (1) belief that it is natural; (2) excitement; (3) not meant for each other; (4) scared of losing partner; (5) bisexuality; (6) does not want commitment; and (7) maintain honesty, trust, and integrity. This study adds to the sparse knowledge base of CNM among African Americans.

'Some men just don't want to get hurt': perspectives of U.S. Virgin Islands men toward partner violence and HIV risks.

Objectives: Global evidence suggests that individuals who experience intimate partner violence (IPV) can have accelerated risk for HIV transmission. The U.S. Virgin Islands (USVI) has high per capita rates of HIV and IPV that can have devastating effects on women's health. Catalysts for these health disparities may be shaped by cultural and social definitions of conventional masculinity. Thus, understanding USVI men's perceptions about HIV risks and IPV are a necessary component of developing strategies to improve women's health. This study aimed to describe perceptions of HIV risks and IPV among USVI men.Design: We conducted two focus groups with 14 men living on St. Thomas and St. Croix, USVI. The focus group interview guide was culturally relevant and developed using findings from research conducted about these issues on USVI. Thematic analysis was used to analyze focus group data. Transcripts were coded and categorized by four research team members and discrepancies were reconciled. Themes were developed based on the emerging data.Results: Focus group participants were all US citizens born on the USVI, had a median age range of 20-25, 86% (12) were of African descent and 14% (2) were Hispanic. Themes emerging from the data were: (1) validating status, (2) deflecting responsibility, and (3) evoking fear and distrust. These ideas underscored the ways that attitudes and beliefs informed by gender and social norms influence IPV and sexual behavior between intimate partners.Conclusion: USVI society could benefit from interventions that aim to transform norms, promote healthy relationships, and encourage health-seeking behavior to improve the health of women partners.

Young Women's Sexuality in Black and White: Racial Differences in Appraisals of Sexually Active Young Women.

Evidence suggests that U.S. attitudes are increasingly accepting of young women's rights to sexual self-expression and activity. However, such support may not be unequivocal or uniformly offered and received. It is especially unclear how the endorsement of young women's sexuality varies by race, both in who holds these supportive views and in who benefits from them. We examined whether appraisals of a hypothetical sexually active young woman would vary by her race (Black or White) and/or a participant's (Black or White). Analyzing a sample of 416 U.S. adults (aged 18-40) comprised of equivalent numbers of Black women, Black men, White women, and White men, we found that across vignette subject and participant race, a sexually active young woman was rated as more competent than likable and that Black participants' appraisals of a sexually active woman (Black or White) were less favorable than White participants'. Against our hypothesis, we found no quantitative evidence of bias against a Black sexually active young woman; however, post-hoc qualitative analysis of participants' comments cast doubt on this apparent racial symmetry. We consider these findings in the context of ongoing racial/misogynist sexual stigmatization of Black women and the consequent attitudes held by - and about - them.

Preference, knowledge and utilization of midwives, childbirth education classes and doulas among U.S. black and white women: implications for pregnancy and childbirth outcomes.

This secondary analysis explored preference, knowledge and utilization of midwifery care, childbirth education and doula care among 627 black and white women at three Midwestern U.S. health clinics. Women who were white, more educated, not living in a high crime neighborhood, and privately insured were more likely to attend childbirth classes. Sociodemographic factors that predicted having heard about doula care included being more educated and having a partner. None of the sociodemographic variables predicted midwifery care. Education about existing childbearing resources and availability of low-cost options should be expanded, particularly for black women and those with low resources.

Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study.

Although pre-exposure prophylaxis (PrEP) requires a prescription from a health care provider, we lack unanimity in guidelines for the identification of the ideal provider type to prescribe PrEP. The purpose of our study was to understand clinician perspectives on provider categories to determine who is best suited to prescribe this medication to HIV-uninfected patients. We conducted 28 in-depth interviews between September 2017 and January 2018 with current prescribers of PrEP. Qualitative findings indicated that providers were split on recommended PrEP prescriber type. Five themes emerged that centered on the explicit identification of the issue of opportunity for providers to educate their patients on PrEP and offer this medication to at-risk populations. To effectively maximize presentation for care and subsequently amplify uptake of PrEP, growing the base of providers who offer PrEP to eligible patients can provide a meaningful public health impact on reducing HIV incidence.

Posttraumatic Slave Syndrome, the Patriarchal Nuclear Family Structure, and African American Male-Female Relationships.

African American marriages and relationships have strived to model the white patriarchal nuclear family model, but the experiences of slavery and contemporary structural racism have prevented the attainment of this model. Posttraumatic slave syndrome offers a framework that allows social workers to place African American experiences within a trauma-informed perspective and think about their implication for trauma-specific interventions. This article provides a brief overview of the traumatic experiences of African Americans as they relate to African American relationships, integrates the historical experiences of African Americans into a trauma-informed perspective to help social workers recognize the manifestations of trauma in African American relationships, and discusses implications for trauma-specific interventions to strengthen African American relationships.

A Qualitative Study of Survival Strategies Used by Low-Income Black Women Who Experience Intimate Partner Violence.

Women who experience intimate partner violence (IPV) are often portrayed as helpless victims. Yet many women who experience IPV implement strategies to help them survive the abuse. This qualitative study sought to explore the survivor strategies used by low-income black women who experience IPV. Authors used a semistructured interview guide to survey 26 survivors who reported being in an IPV relationship in the past two years. Thematic analysis revealed three types of survivor strategies used by low-income black women: (1) internal (use of religion and becoming self-reliant), (2) interpersonal (leave the abuser or fight back), and (3) external (reliance on informal, formal, or both kinds of sources of support). This article informs social work practitioners of the strategies used by low-income black women in surviving IPV so that practitioners can develop interventions that support these strategies.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora.

OBJECTIVE: This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). METHODS: We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. RESULTS: A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. CONCLUSION: There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

Racial and ethnic differences in factors related to workplace violence victimization.

Workplace violence (WPV) is a significant public health concern affecting all racial or ethnic groups. This study examined whether different racial/ethnic groups differed in vulnerability to WPV exposure and utilization of resources at the workplace. This cross-sectional research focused on White, Black, and Asian nursing employees (N = 2,033) employed in four health care institutions in a mid-Atlantic U.S. metropolitan area. Whereas childhood physical abuse was significantly related to risk of WPV among workers from all racial/ethnic backgrounds, intimate partner abuse was a significant factor for Asians and Whites. Blacks and Asians were found to be less likely than Whites to be knowledgeable about WPV resources or use resources to address WPV. Services to address past trauma, and education and training opportunities for new workers may reduce risk of WPV and promote resource utilization among minority workers.

A Culture of Mutual Support: The Impact of Giving and Receiving of Practical and Emotional Support on African American Marital Satisfaction.

While the literature has discussed the extensive family network ties of African Americans and its implications for marital satisfaction, few studies incorporate primarily African American samples in studies of marital satisfaction and social networks. This study draws on a sample of African American married couples from the National Survey of American Life and explores the impact of mutual support, giving and receiving of practical and emotional support, on the marital satisfaction of husbands and wives. Results from the ordinal logistic regression analyses reveal that emotional support received from family and support given to friends are significantly related to husbands' marital satisfaction while emotional support received from family and negative interaction with family contributes to wives' marital satisfaction. Research and practice implications with African American married couples are discussed.