A phenomenological study of the experience of domestic violence in Iranian women with HIV.

This study explores the lived experience of domestic violence in HIV-infected women in Iran using a qualitative phenomenological approach. Data were collected in 2014 through in-depth interview of twelve HIV-infected women purposefully selected from a counselling centre in Tehran. The qualitative data were analysed using a thematic analysis approach. The main theme that emerged was 'the sunset of life' - an emotional numbing and fragile marital relationship resulting from the violence suffered by the women. From this, three sub-themes expressing women's feelings of hopelessness were extracted: 'the destroyed life', 'being in the destiny prison' and 'living on the edge of annihilation'. The results revealed that although the experience of domestic violence had devastating effects on women's lives, HIV infection was the factor that forced them to remain trapped in violent relationships. The findings emphasize the importance of designing comprehensive violence prevention strategies tailored to meeting the needs of HIV-infected women in Iran.

Grupos reflexivos com homens para prevenção da violência conjugal: como organizá-los / Grupos reflexivos con hombres para la prevención de la violencia conyugal: cómo organizarlos / Reflective groups with men to prevent conjugal violence: how to organize them

Objetivo descrever a construção de um grupo reflexivo com homens com vistas à prevenção e ao enfrentamento da violência conjugal. Método estudo descritivo, tendo como referencial a Perspectiva Crítico-Libertadora de Paulo Freire. O público-alvo foram 44 homens que respondiam processo em Salvador, Bahia. Resultados o passo a passo da construção do grupo reflexivo teve os seguintes requisitos: definição do projeto didático-metodológico; obtenção de recursos humanos, materiais e financeiros; escolha do espaço para desenvolvimento do grupo reflexivo e captação do público-alvo. Conclusão a implementação desses espaços educativos apresenta viabilidade financeira e operacional, considerando seu potencial de redução de casos de violência conjugal, podendo ser replicado por profissionais de diferentes áreas de atuação, em diferentes cenários e com homens de todos os níveis socioculturais.

Objetivo describir la construcción de un grupo reflexivo para hombres con miras a prevenir y enfrentar la violencia conyugal. Método estudio descriptivo, tomando como referencia la Perspectiva Crítico-Emancipadora de Paulo Freire. El público fueron 44 hombres respondiendo proceso judicial en Salvador, Bahia. Resultados el paso a paso en la construcción de los reflejos en el grupo tuvo los siguientes requisitos: definición del diseño didáctico-metodológico; la obtención de recursos humanos, materiales y financieros; la elección del espacio para el desarrollo de grupo reflexivo y captura del público objetivo. Conclusión la implementación de estos espacios educativos es financiera y operacionalmente factible, considerando su potencial para reducir los casos de violencia conyugal, que pueden ser reproducidos por profesionales de diferentes campos de actividad, en diferentes escenarios y con hombres de todos los niveles socioculturales.

Objective to describe material the construction of a reflective group for men intending to prevent and cope conjugal violence. Method descriptive study, whose reference was the Critical-Emancipatory Perspective of Paulo Freire. The participants were 44 prosecuted men in Salvador, Bahia. Results the step by step to construct the reflective group had the following requirements: definition of the didactic-methodological project; human, and financial resources; location for the development of the reflective group; and the gathering of the target population. Conclusion the implementation of these educational spaces is financially and operationally feasible, considering their potential for reducing cases of conjugal violence, which can be replicated by professionals from different fields of activity, in different scenarios and with men from all socio-cultural levels.

Violencia infligida por la pareja / Violence inflicted by the couple

Introducción: La violencia provocada por el compañero sexual es el tipo más común de acto violento contra la mujer. Objetivo: Caracterizar la violencia contra la mujer infligida por la pareja en la población del consultorio médico 15 del Centro de Salud (CS) Pascuales, provincia Guayas, Ecuador. Métodos: Estudio observacional, descriptivo, transversal. Incluyó 153 mujeres mayores de 17 años, con relación de pareja en algún momento de su vida, pertenecientes al consultorio 15 del CS Pascuales, que acudieron al mismo entre junio de 2015 y julio de 2016. Variables: ocurrencia de violencia, tipo de violencia, edad, nivel escolar, ocupación, estado civil. La información se obtuvo de un cuestionario autoadministrado. Se utilizaron medidas de resumen descriptivas. Resultados: La prevalencia de violencia infligida por la pareja fue de 83,7 por ciento (128/153). La ocurrencia según tipos fue: psicológica (96,9 por ciento [124/128]), patrimonial (69,5 por ciento [89/128]), física (30,5 por ciento [39/128]) y sexual 20,3 por ciento [26/128]. El 64,1 por ciento (82/128) de las mujeres refirieron haber sufrido dos o tres tipos de violencia. Los cuatro tipos de violencia ocurren en mayor porcentaje en mujeres mestizas y con escolaridad primaria. Conclusión: La violencia infligida por la pareja es un acto de alta prevalencia en la población asignada al consultorio médico 15 del CS Pascuales; en el que coexisten diferentes formas, con preponderancia de la psicológica, pero matizado cada tipo por las características de las variables implicadas(AU)

Introduction: Violence by any sexual partner is the most common type of violent act against women. Objective: To characterize violence against women inflicted by her partner and within the population of the medical office 15 of Pascuales Health Center (HC), Guayas Province, Ecuador. Methods: Observational, descriptive, cross-sectional study including 153 women over 17 years of age and with an engagement at some point in their lives, belonging to the medical office 15 of Pascuales HC, and who attended the office between June 2015 and July 2016. Variables: violence occurrence, type of violence, age, school level, occupation, marital status. The information was obtained from a self-administered questionnaire. We used descriptive summary measures. Results: The prevalence of violence inflicted by the couple was 83.7 percent (128/153). Occurrence by types was: psychological (96.9 percent [124/128]), patrimonial (69.5 percent [89/128]), physical (30.5 percent [39/128]), and sexual 20.3 percent [26/128]. 64.1 percent (82/128) of the women reported having suffered two or three types of violence. The four types of violence occur in a greater percentage among mestizo women with primary school level. Conclusion: Violence inflicted by the couple is an act of high prevalence within the population assigned to the medical office 15 of Pascuales HC, and for which different forms coexist, with a preponderance of the psychological, but each type nuanced by the characteristics of the variables involved(AU)

Violencia hacia la mujer por su pareja. Centro de Salud Mental. Aguada de Pasajeros, 2014 / Violence toward woman from the part of her couple. Mental Health Center. Aguada de Pasajeros, 2014

Introducción: la violencia afecta a una de cada tres mujeres alguna vez en la vida. Cuando es producida por su pareja constituye un suceso destructor, generador de tensión, angustia y peligro para la vida. Objetivo: caracterizar la violencia hacia la mujer por su pareja en los casos asistidos en el Centro de Salud Mental de Aguada de Pasajeros, provincia de Cienfuegos, durante el año 2014. Materiales y métodos: se realizó una investigación descriptiva transversal, en 45 mujeres asistidas en el Centro de Salud Mental de Aguada de Pasajeros, provincia de Cienfuegos. Fueron utilizadas las técnicas de análisis documental, entrevistas, test de detección de tipos de violencia y de diagnóstico de violencia en la pareja. Resultados: predominaron las edades entre 26 y 35 años en un 46,6 %. En cuanto a nivel cultural el medio superior, con un 46,6 %. Se apreció un 66,6 %) de uniones consensuales. El 46,6 % ocupaban plazas técnicas. Estuvo presente la violencia física y psicológica en la totalidad de las féminas, la sexual en 15 mujeres y la económica en 38. La mayoría (23) estaban expuestas a un segundo grado de violencia. Prevalecieron sentimientos de culpa, temor a la soledad y relacionan la violencia con el consumo de bebidas alcohólicas. Conclusiones: se detectó en las mujeres estudiadas violencia psicológica, física, económica y sexual; de diferentes niveles, desde una relación violenta hasta una violencia peligrosa. Prevaleció el segundo nivel de violencia y creencias erróneas acerca de los roles de género de las mujeres maltratadas y de los hombres violentos (AU).

Introduction: violence affects one of every three women some time in her life. When it is caused by her couple it becomes a destructive fact, generating tension, anguish and danger for her life. Objective: to characterize violence toward women from the part of her couple in the cases attended at the Mental Health Center of Aguada de Pasajeros, province of Cienfuegos, during 2014. Materials and methods: a cross-sectional, descriptive research was carried out in 45 women attended at the Mental Health Center of Aguada de Pasajeros, province of Cienfuegos. The used techniques were documental analysis, interviews, tests for detecting the kind of violence, and tests for diagnosing violence in the couple. Results: ages between 26 and 35 years predominated for a 46,6 %. According to the scholarship, high school prevailed, with 46,6 %. A 66,6 % of consensual unions were found. 46,6 % of women worked as technicians. Physical and social violence was found in the total of women, the sexual one in 15 women, and the economic one in 38. Most of them (23) were exposed to a second degree of violence. The prevailing feelings were guiltiness, solitude fear and a link of violence with alcohol consumption. Conclusions: sexual, economic, physical and psychological violence was found in the studied women, in different levels, from a violent relationship to a dangerous violence. The second level of violence and erroneous beliefs on the genre roles of the abused women and the violent men prevailed (AU).

Talleres de promoción de buenos tratos en un hospital de alta complejidad / Workshop to encourage good manners in a tertiary care hospital

En los últimos años hubo un incremento en las consultas por violencia familiar en el Hospital de Pediatría Juan P. Garrahan. Reconociendo este hecho como un problema de salud, se decidió implementar talleres en salas de espera con el objetivo de visibilizar este fenómeno. En los mismos se realizan actividades de sensibilización y concientización con pacientes y sus familias sobre los buenos tratos en la infancia y vínculos respetuosos en la pareja. Se pretende con este escrito relatar la experiencia de los talleres de promoción de buenos tratos, planteando el desafío de coordinar acciones que permitan visibilizar la problemática y actuar en consecuencia, fomentando la reflexión de los profesionales de la salud (AU)

Over the past years there has been an increase in consultations at Hospital de Pediatría Juan P. Garrahan because of family violence. As the entity is recognized as a health problem, workshops were implemented in the waiting rooms to visualize this phenomenon. During these workshops, activities of sensitization and awareness building were conducted with the patients and their families about good manners in childhood and respectful bonds in the couple. The aim of this report was to present our experience with the workshops of good manners considering the challenge of coordinating actions that allow visualization of the problem and act on it, encouraging reflections of the health care professionals (AU)

Intimate partner violence screening in emergency department: a rapid review of the literature.

AIMS AND OBJECTIVES: The aim of the review was to identify intimate partner violence screening interventions used in emergency departments and to explore factors affecting intimate partner violence screening in emergency departments. BACKGROUND: Intimate partner violence against women is now clearly recognised as a global health and societal issue. Nurses working in emergency and urgent care settings can play a crucial role in identification, prevention and management of intimate partner violence. Research exploring optimal methods of intimate partner violence screening and factors affecting intimate partner violence screening in emergency departments are relatively limited. DESIGN: Literature review: Rapid Evidence Synthesis. METHODS: Literature published between 2000-2015 was reviewed using the principles of rapid evidence assessment. Six electronic databases: CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and Joanna Briggs Library. RESULTS: Twenty-nine empirical studies meeting the eligibility criteria were independently assessed by two authors using appropriate Critical Appraisal Skills Programme Checklists. Intimate partner violence screening in emergency departments is usually performed using electronic, face to face or pen- and paper-based instruments. Routine or universal screening results in higher identification rates of intimate partner violence. Women who screen positive for intimate partner violence in emergency departments are more likely to experience abuse in subsequent months. Factors that facilitate partner violence screening can be classified as healthcare professionals related factors, organisational factors and patient-related factors. CONCLUSIONS: Emergency departments provide a unique opportunity for healthcare professionals to screen patients for intimate partner violence. Competence in assessing the needs of the patients appears to be a very significant factor that may affect rates of intimate partner violence disclosure. RELEVANCE TO CLINICAL PRACTICE: Knowledge of appropriate domestic violence screening methods and factors affecting intimate partner violence screening in emergency can help nurses, and other healthcare professionals provide patient-centred and effective care to victims of abuse attending emergency department.

Intimate Partner Violence.

Intimate partner violence (IPV) is a prevalent worldwide health problem, affecting women more commonly than men. IPV is underreported and underrecognized by health care professionals. Even when IPV is recognized, it remains an underaddressed issue. In addition to physical injury and death, IPV causes significant physical and psychiatric health problems commonly treated by family physicians. The U.S. Preventive Services Task Force recommends screening all female patients of childbearing age for IPV. There are several brief screening tools that have been proven effective at detecting IPV and that can be used in the office setting. Identification of IPV allows the physician to provide better care and improves health outcomes for the survivor. Family physician offices should provide patients with local and national resources. Thorough documentation of injuries sustained from abuse is critical. Although caring for patients unready to leave an abusive relationship may be challenging for the physician, continuous, supportive care improves patient outcomes.

Reproductive Health Knowledge among African American Women Enrolled in a Clinic-Based Randomized Controlled Trial to Reduce Psychosocial and Behavioral Risk: Project DC-HOPE.

BACKGROUND: Washington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care. METHODS: Project DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored counseling sessions to address their psychosocial and behavioral risk(s) (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence). Women in the control group received usual PNC. Participants completed a 10-item reproductive knowledge assessment at baseline (n = 1,044) and postpartum (n = 830). Differences in total reproductive health knowledge scores at baseline and postpartum between groups were examined via χ(2) tests. Differences in postpartum mean total score by group were assessed via multiple linear regression. RESULTS: Women in both groups and at both time points scored approximately 50% on the knowledge assessments. At postpartum, women in the intervention group had higher total scores compared with women receiving usual care (mean 5.40 [SD 1.60] vs. 5.03 [SD 1.53] out of 10, respectively; p < .001). CONCLUSIONS: Although intervention participants increased reproductive health knowledge, overall scores remained low. Development of interventions designed to impart accurate, individually tailored information to women may promote reproductive health knowledge among high-risk pregnant African American women residing in Washington, DC.

Adherencia terapéutica a programas de reeducación para mujeres y hombres en relaciones de pareja violentas / Therapeutic adherence to retraining programs for women and men involved in abusive relationships in Mexico

Objetivo. Analizar la adherencia terapéutica en participantes de un programa de reeducación operado por los servicios estatales de salud en ocho estados de México en 2010. Material y métodos. Estudio transversal y descriptivo que evaluó la adherencia terapéutica de un programa de reeducación para hombres agresores y mujeres víctimas de violencia de pareja. La intervención fue coordinada por un equipo de profesionales previamente capacitados. La selección de los participantes se realizó con el cumplimiento estricto de criterios de inclusión/exclusión evaluados por una prueba de tamizaje. Con base en la asistencia, se clasificó en adherencia baja (1 a 12), media-alta (13 y más). Se realizó una prueba de t student, un análisis bivariado y un modelo de regresión logística para identificar la posibilidad de adherencia en cada programa. Resultados. Se aplicaron 5 539 tamizajes, 88.3% (n=4 891) fueron positivos; 85%(n=4 151) aceptó participar, 75% de los potenciales participantes asistió al menos a una sesión (n=3 699), siendo ésta la muestra del presente estudio. En el programa para mujeres hubo diferencias significativas por estado civil, religión y grupos de edad (p<0.05). En el programa para hombres hubo diferencias significativas por religión y grupos de edad (p<0.05). Conclusiones. En México son inexistentes los estudios que evalúan la adherencia a los programas de atención a la violencia; este estudio es una primera aproximación que abre la posibilidad de profundizar en el diseño y evaluación de este tipo de intervenciones, cruciales para desarticular la violencia contra las mujeres.

Objective. To analyze the therapeutic adherence among participants in the retraining program operated by the Ministry of Health of Mexico, in eight states in 2010. Materials and methods. This is a cross-sectional and descriptive study that assesses therapeutic adherence in a retraining intervention program for male perpetrators and female victims of intimate partner violence. The intervention was coordinated by a team of previously trained professionals. The selection of participants was made by means of a specific screening test. Overall performance for both groups was analyzed, and based on the attendance they were classified in low adhesion (1-12) medium to high (13 and>). To determine the possibility of adhesion, Student's t tests, a bivariate analysis, and a logistic regression model were performed for each program. Results. 5 539 screenings were applied, of which 88.3% (n = 4 891) were positive. 85% agreed to participate (n = 4 151), but only 75% of potential participants attended at least one session (n = 3 022). 78.5% attended between 1-12 sessions. In the women's program, significant differences in marital status, religion and age groups (p<0.05) were found. In the program for men, significant differences in religion and age groups (p<0.05) were found. Conclusions. In the Mexican context there are few studies that assess adherence to programs of care and retraining for partner violence. This study is a first approach that opens the possibility to enhance the design and evaluation of such interventions, which are crucial to dismantle violence against women.

Putting intimate partner violence on your radar.

Intimate partner violence is a preventable health problem that affects more than 12 million people in the United States each year. Those affected can be of any sex, race, ethnicity, socioeconomic status, religion, education level, or sexual orientation. All clinicians should screen for intimate partner violence as part of the routine history and physical examination. This article describes the dynamics of intimate partner violence and the 2013 screening guidelines from the US Preventive Services Task Force.

Young women's views on testing for sexually transmitted infections and HIV as a risk reduction strategy in mutual and choice-restricted relationships.

AIM: The aim of this study was to identify relationship dynamics that influences the use of STI/HIV testing among young, urban African American women. BACKGROUND: Increasing STI/HIV testing is a key prevention strategy, but more research is needed to identify barriers to testing for young women such as intimate partner violence (IPV). METHODS: Thirty semi-structured interviews were conducted with African American women ages 18-24. Content analysis was used. RESULTS: Women in choice-restricted relationships were unable to negotiate safer sex practices and testing was viewed as the best option. Women in relationships where the desire to use condoms was mutual used STI and HIV testing as a sign of trust building that preceded unprotected sex. CONCLUSIONS: STI/HIV testing must be viewed as one strategy within a package of possible risk reduction. For those in choice-restricted relationships, clinicians should screen patients for partner abuse and provide additional support and referrals as clinically appropriate.

Screening and intervening: evaluating a training program on intimate partner violence and reproductive coercion for family planning and home visiting providers.

Project Connect training aims to reduce barriers to screening for and intervening with women with histories of intimate partner violence and reproductive coercion. This study sought to assess the effectiveness of trainings, provider facility with Project Connect tools, and areas for improvement in a pilot state. Results indicated that providers found training useful, and those in supervisory roles particularly appreciated the universal tools and skill set given to participants. Providing these tools supports the provision of trauma-informed care. Areas for improvement included increased emphasis on initiating screening, enhancing training for different types of providers, and developing follow-up training.

Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach.

The Institute of Medicine, United States Preventive Services Task Force (USPSTF), and national healthcare organizations recommend screening and counseling for intimate partner violence (IPV) within the US healthcare setting. The Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women. Thus, IPV screening and counseling must be implemented safely and effectively throughout the healthcare delivery system. Health professional education is one strategy for increasing screening and counseling in healthcare settings, but studies on improving screening and counseling for other health conditions highlight the critical role of making changes within the healthcare delivery system to drive desired improvements in clinician screening practices and health outcomes. This article outlines a systems approach to the implementation of IPV screening and counseling, with a focus on integrated health and advocacy service delivery to support identification and interventions, use of electronic health record (EHR) tools, and cross-sector partnerships. Practice and policy recommendations include (1) ensuring staff and clinician training in effective, client-centered IPV assessment that connects patients to support and services regardless of disclosure; (2) supporting enhancement of EHRs to prompt appropriate clinical care for IPV and facilitate capturing more detailed and standardized IPV data; and (3) integrating IPV care into quality and meaningful use measures. Research directions include studies across various health settings and populations, development of quality measures and patient-centered outcomes, and tests of multilevel approaches to improve the uptake and consistent implementation of evidence-informed IPV screening and counseling guidelines.

Screening and intervention for intimate partner violence in healthcare settings: creating sustainable system-level programs.

Among the barriers to routine screening for intimate partner violence (IPV) are time constraints, a lack of protocols and policies, and departmental philosophies of care that may conflict with IPV screening recommendations. To address these barriers, systems-level interventions are needed; in this article, we describe one model that may overcome these obstacles. We discuss how this systemic approach may best be implemented in both out-patient clinics and emergency departments (EDs) and note that evidence for its success will be required.

Intimate partner violence during pregnancy: maternal and neonatal outcomes.

The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

[Systematic screening for domestic violence in the accident and emergency department]. / Dépistage systématique des violences conjugales an seirvice d'accueil des urgences.

The accident and emergency department is a place where female victims of domestic abuse may arrive with various symptoms. The systematic screening of female victims was studied and implemented by an A&E team in the Paris region and has now been extended to all the hospital's departments where female victims may arrive for treatment.