'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.

Culturally Anchoring an Intervention for Gender-Based Violence.

Haitians continue to rebuild following the devastating earthquake in 2010, as many also strive to recover and heal from associated horrific events. Immediately following the earthquake, domestic and international agencies reported dramatic increases in violence against women and girls in this small Caribbean nation that shares the island of Hispaniola with the Dominican Republic. In this article we highlight one segment of a situational analysis used as groundwork for developing an intervention to address gender-based violence (GBV). We sought to rapidly identify existing and needed resources and services for internally displaced women and girls in Haiti and to facilitate an immediate and sustainable response. During an eight-day period, we convened focus groups in Port au Prince. Displaced women and older girls, directors of nongovernmental organizations (NGOs), healthcare providers and administrators, and community youth leaders participated in the focus groups. Findings from these focus groups illuminate the multiple influences of GBV on displaced women and girls. Gaps, strengths, and limitations of existing resources, capacities, systems, and services for internally displaced Haitian women and girls were identified. In addition, factors that could potentially support or hinder effective implementation of preventive and response interventions were revealed. Our findings provided a foundation and structure for developing a culturally- specific educational and safety plan which was used in Haiti following the earthquake and continues to have relevance for use, today.

Violence and abuse of internally displaced women survivors of the 2010 Haiti earthquake.

OBJECTIVES: Limited research following disasters suggests that internally displaced women are disproportionately vulnerable to violence and abuse. An interdisciplinary collaborative of researchers and practitioners in Haiti, the US Virgin Islands, and the US Mainland investigated gender-based violence (GBV) pre- and post-earthquake and health outcomes among Haitian women living in tent cities/camps following the 2010 earthquake. METHODS: A comparative descriptive correlational design using culturally sensitive and language appropriate computer-assisted interviews of 208 internally displaced women 2011-2013. RESULTS: Found high rates of violence and abuse both before (71.2 %) and after (75 %) p = 0.266, the earthquake primarily perpetrated by boy friends or husbands. Significantly more mental and physical health problems were reported by abused than non-abused women. The majority (60-78 %) of abused women did not report personal or community tolerance for violence and abuse, but acknowledged a community context of limited involvement. CONCLUSIONS: Coordinated planning and implementation of needed interventions are essential to provide a balanced approach to the care of displaced women after natural disasters with sensitivity to the abusive experiences of many women both before and after the disasters.

Cumulative Violence Exposures: Black Women's Responses and Sources of Strength.

Black women with cumulative violence exposures (CVE) may have unique needs for health care and safety. Qualitative data was analyzed from interviews with nine Black women with CVE to explore factors that motivated women to leave abusive relationships, women's sources of strengths, and their responses to abuse. Quantitative data (N = 163) was analyzed to examine relationships between CVEs by intimate partner and health among Black women to further characterize the challenges these women face in making changes and finding their sources of strengths. Findings highlight the need to assess for CVE and identify multiple motivators for change, sources of strengths and coping strategies that could be potential points of intervention for women with CVE.

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.

Barriers and Facilitators to Engaging Communities in Gender-Based Violence Prevention following a Natural Disaster.

Humanitarian workers in disaster settings report a dramatic increase in gender-based violence (GBV). This was true after the 2010 Haiti earthquake when women and girls lost the relative security of their homes and families. Researchers from the United States Virgin Islands and the United States mainland responded by collaborating with Haitian colleagues to develop GBV-focused strategies. To start, the research team performed a situational analysis to insure that the project was culturally, ethically, and logistically appropriate. The aim of this paper is to describe how the situational analysis framework helped the researchers effectively approach this community. Using post-earthquake Haiti as an exemplar, we identify key steps, barriers, and facilitators to undertaking a situational analysis. Barriers included logistics, infrastructure, language and community factors. Facilitators included established experts, organizations and agencies. Researchers in such circumstances need to be respectful of community members as experts and patient with local environmental and cultural conditions.

Factors associated with increased risk for lethal violence in intimate partner relationships among ethnically diverse black women.

The purpose of this study was to identify factors associated with increased risk for lethal violence among ethnically diverse Black women in Baltimore, Maryland (MD), and the U.S. Virgin Islands (USVI). Women with abuse experiences (N = 456) were recruited from primary care, prenatal, or family planning clinics in Baltimore, MD, and St. Thomas and St. Croix. Logistic regression was used to examine factors associated with the risk for lethal violence among abused women. Factors independently related to increased risk of lethal violence included fear of abusive partners, posttraumatic stress disorder (PTSD), symptoms, and use of legal resources. These factors must be considered in assessing safety needs of Black women in abusive relationships.

Intimate partner violence among African American and African Caribbean women: prevalence, risk factors, and the influence of cultural attitudes.

BACKGROUND: Women of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories. OBJECTIVE: In this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse. DESIGN: Between 2009 and 2011, we recruited African American and African Caribbean women aged 18-55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis. RESULTS: Most of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas. CONCLUSIONS: Variance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships.

Victimization experiences, substance misuse, and mental health problems in relation to risk for lethality among African American and African Caribbean women.

The purpose of this study was to investigate the association of intimate partner victimization experiences, mental health (MH), and substance misuse problems with the risk for lethality among women of African descent. Data for this cross-sectional study were derived from a large case-control study examining the relationship between abuse status and health consequences. Women were recruited from primary care, prenatal, or family planning clinics in Baltimore and the U.S. Virgin Islands. Logistic regression was used to generate the study findings. Among 543 abused women, physical and psychological abuse by intimate partners, comorbid posttraumatic stress disorder (PTSD) and depression symptoms, and PTSD-only problems significantly increased the likelihood of lethality risk. However, victims' substance misuse and depression-only problems were not associated with the risk for lethality. In addition, PTSD symptoms mediated the relationship between severe victimization experiences and risk for lethality. Practitioners should pay attention to victimization experiences and MH issues when developing treatment and safety plans. Policies to fund integrated services for African American and African Caribbean women with victimization and related MH issues, and training of providers to identify at-risk women may help reduce the risk for lethality in intimate partner relationships.

Intimate partner violence, depression, PTSD, and use of mental health resources among ethnically diverse black women.

This study examined exposure to violence and risk for lethality in intimate partner relationships as factors related to co-occurring MH problems and use of mental health (MH) resources among women of African descent. Black women with intimate partner violence (IPV) experiences (n = 431) were recruited from primary care, prenatal or family planning clinics in the United States and the U.S. Virgin Islands. Severity of IPV was significantly associated with co-occurring MH problems, but was not associated with the use of MH resources among African-American women. Risk for lethality and co-occurring problems were also not significantly related to the use of resources. African Caribbean women with severe physical abuse experiences were significantly less likely to use resources. In contrast, severity of physical abuse was positively associated with the use of resources among Black women with mixed ethnicity. Severe IPV experiences are risk factors for co-occurring MH problems, which in turn, increases the need for MH services. However, Black women may not seek help for MH problems. Thus, social work practitioners in health care settings must thoroughly assess women for their IPV experiences and develop tailored treatment plans that address their abuse histories and MH needs.

Factors influencing resource use by African American and African Caribbean women disclosing intimate partner violence.

Many victims of intimate partner violence (IPV) do not access services. Education and severity of physical violence have previously been shown to predict resource utilization, but whether these hold true specifically among women of African descent is unknown. This article furthers our understanding of the relationship between IPV and resource use, considering sociodemographics and aspects of IPV by presenting results from a study conducted with African American and African Caribbean women in Baltimore, Maryland, and the U.S. Virgin Islands. Of the 545 women included in this analysis, 95 (18%) reported emotional abuse only, 274 (50%) reported experiencing physical abuse only, and 176 (32%) had experienced both physical and sexual abuse by an intimate partner. Resource utilization was relatively low among these women, with only 57% seeking any help. Among those who did, 13% sought medical, 18% DV, 37% community, and 41% criminal justice resources. Generalized linear model results indicated that older age and severe risk for lethality from IPV and PTSD were predictive of certain types of resource use, while education, insurance status, and depression had no influence. Perceived availability of police and shelter resources varied by site. Results suggest that systems that facilitate resource redress for all abused women are essential, particularly attending to younger clients who are less likely to seek help, while building awareness that women accessing resources may be at severe risk for lethality from the violence and may also be experiencing mental health complications. In addition, greater efforts should be made on the community level to raise awareness among women of available resources.

Intimate partner violence and HIV risk factors among African-American and African-Caribbean women in clinic-based settings.

Despite progress against intimate partner violence (IPV) and HIV/AIDS in the past two decades, both epidemics remain major public health problems, particularly among women of color. The objective of this study was to assess the relationship between recent IPV and HIV risk factors (sexual and drug risk behaviors, sexually transmitted infections [STIs], condom use, and negotiation) among women of African descent. We conducted a comparative case-control study in women's health clinics in Baltimore, MD, USA and St. Thomas and St. Croix, US Virgin Islands (USVI). Women aged 18-55 years who experienced physical and/or sexual IPV in the past two years (Baltimore, n=107; USVI, n=235) were compared to women who never experienced any form of abuse (Baltimore, n=207; USVI, n=119). Logistic regression identified correlates of recent IPV by site. In both sites, having a partner with concurrent sex partners was independently associated with a history of recent IPV (Baltimore, AOR: 3.91, 95% CI: 1.79-8.55 and USVI, AOR: 2.25, 95% CI: 1.11-4.56). In Baltimore, factors independently associated with recent IPV were lifetime casual sex partners (AOR: 1.99, 95% CI: 1.11-3.57), exchange sex partners (AOR: 5.26, 95% CI: 1.92-14.42), infrequent condom use during vaginal sex (AOR: 0.24, 95% CI: 0.08-0.72), and infrequent condom use during anal sex (AOR: 0.29, 95% CI: 0.09-0.93). In contrast, in the USVI, having a concurrent sex partner (AOR: 3.33, 95% CI: 1.46-7.60), frequent condom use during vaginal sex (AOR: 1.97, 95% CI: 1.06-3.65), frequent condom use during anal sex (AOR: 6.29, 95% CI: 1.57-25.23), drug use (AOR: 3.16, 95% CI: 1.00-10.06), and a past-year STI (AOR: 2.68, 95% CI: 1.25-5.72) were associated with recent IPV history. The divergent results by site warrant further investigation into the potential influence of culture, norms, and intentions on the relationships examined. Nonetheless, study findings support a critical need to continue the development and implementation of culturally tailored screening for IPV within HIV prevention and treatment programs.

Health and health care in the U.S. Virgin Islands: challenges and perceptions.

This research was designed to discover how residents of the United States Virgin Islands think about their health, health status, health problems, and the quality of the health care delivery system. Six focus groups were organized--one for males and one for females on each of the largest, islands (St. Thomas, St. Croix, and St. John). Results indicated that Virgin Islanders see a large role for personal responsibility in achieving and maintaining good health, although there are cultural and economic barriers that prevent taking full advantage of available health services. Residents are especially concerned about privacy and threats to confidentiality of patient information that could occur among professionals.

Developing an effective HIV/AIDS response for women and girls in the U.S. Virgin Islands.

This article focuses on specific culturally and socially based gender issues that enhance HIV risk and complicate access to care and services for women and girls in the U.S. Virgin Islands (USVI). Literature review and interviews with clinicians providing HIV care in the USVI were used to examine causative factors for the high HIV prevalence rates among USVI women. Although the USVI population is almost evenly split between men (48%) and women (52%), females represent 46% of all USVI residents living with HIV and 33% of all people with AIDS. A primary barrier to adequate HIV/AIDS care for these women and girls is the insufficient number of clinicians available to provide that care. A primary barrier to adequate HIV prevention is the fact that, although the USVI are a territory of the United States, their cultural practices are those of the Caribbean. Thus, HIV programs developed on the U.S. mainland are often ineffective in USVI. A lack of consistent and accurate reporting to HIV/AIDS surveillance staff on the part of clinicians also hinders early trend detection efforts, as well as effective HIV management. Strategies to address HIV among USVI women and girls include: 1) increasing awareness of issues that impact them negatively and increase their vulnerability to HIV, 2) developing and funding delivery of effective, culturally appropriate HIV-related interventions, and 3) increasing the size and technical capacity of the USVI clinical workforce. Simultaneously updating current health care professionals on best practices for HIV screening, treatment, risk-reduction counseling and support could also substantially strengthen the USVI's response to HIV among women and girls.