'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.

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.

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.

Impact of Intimate Partner Forced Sex on HIV Risk Factors in Physically Abused African American and African Caribbean Women.

We examined associations between intimate partner forced sex (IPFS) and HIV sexual risk behaviors among physically abused Black women. Women aged 18-55 in intimate relationships were interviewed in health clinics in Baltimore, MD and St. Thomas and St. Croix, US Virgin Islands (USVI). Of 426 physically abused women, 38% experienced IPFS; (Baltimore = 44 and USVI = 116). USVI women experiencing IPFS were more likely to have 3+ past-year sex partners (AOR 2.06, 95% CI 1.03-4.14), casual sex partners (AOR 2.71, 95% CI 1.42-5.17), and concurrent sex partners (AOR 1.94, 95% CI 1.01-3.73) compared to their counterparts. Baltimore women reporting IPFS were more likely to have exchanged sex (AOR 3.57, 95% CI 1.19-10.75). Women experiencing IPFS were more likely to report their abuser having other sexual partners in Baltimore (AOR 3.30, 95% CI 1.22-8.88) and USVI (AOR 2.03, 95% CI 1.20-3.44). Clinicians should consider the influence of IPFS on individual and partnership HIV sexual risk behaviors.

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 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.

Disordered eating among African American and African Caribbean women: the influence of intimate partner violence, depression, and PTSD.

We assessed the influence of intimate partner violence (IPV), depression and post-traumatic stress disorder (PTSD) on disordered eating patterns (DE) among women of African descent through a comparative case-control study (N = 790) in Baltimore, MD, and St. Thomas and St. Croix, US Virgin Islands, from 2009-2011. IPV, depression and PTSD were independent risk factors in the full sample. The relationship between IPV and DE was partially mediated by depression. The influence of risk for lethality from violence was fully mediated by depression. IPV should be considered in research and treatment of DE and both IPV and DE should be assessed when the other or depression is detected.