The Effects of Intimate Partner Violence Chronicity On Personal and Partner-Mediated Sexual Risk Behaviors

Objective: Intimate partner violence (IPV) is associated with STI/HIV risk among women, but less is known about mechanisms of this association and whether chronicity of violence is a factor. The purpose of this study was to explore the relationship between the chronicity of IPV and both personal and partner mediated sexual risk behaviors that may increase women’s risk for STIs and HIV.  

 Design: A retrospective review of existing medical record data.

Setting: Four reproductive health clinics in the northeast United States.

Sample: The final sample size was 2,000. The majority of the participants were between the ages of 15 and 26.

Methods: A bio-behavioral conceptual model exploring the relationship between IPV, coercion, control, and reproductive health provided the framework for the study and guided the selection of study variables. Data was extracted from a random sample of 2,000 charts. Inclusion criteria were: female, reproductive age (menarche through menopause), & seeking reproductive health services.  Two standardized questions from the medical record assessed for experiences of violence and were used to create a chronicity of violence variable. Adjusted logistic regression models examined the associations between chronicity of intimate partner violence and personal sexual risk behaviors (number sexual partners, drug/alcohol use, anal sex) and partner-influenced sexual risk factors (non-monogamy, STI risk, condom nonuse). IRB approval was granted for the study.   

Results: Approximately 29% (n=570) women reported a history of partner violence. Number of sexual partners during the past year, history of STIs, drug and/or alcohol use prior to intercourse, and anal sex were all significantly associated with partner violence and chronicity of violence. All lifetime experiences (as measured by chronicity) of partner violence were significantly associated (p≤ 0.05) with partner-mediated sexual risks (condom non-use, partner non-monogamy, and partner at risk for having a STI). Violence during the past year (OR=5.37, CI=2.7-10.8), past 5 years (OR=9.01, CI=2.2-37.7), and distant violence only (OR= 5.57, CI=3.4-9.2) all increased the odds of having sex without a condom.

Conclusion/Implications for nursing practice: The study findings extend the knowledge related to partner violence as a risk factor for STIs/HIV, highlighting the effects of partner violence chronicity on the health of women. Assessing for lifetime experiences of violence, in addition to current intimate partner violence will improve outcomes for women and their families. The study findings will guide future inquiry in the long-term consequences of IPV and improve our understanding how partner violence and specifically chronicity of partner violence relates to types of sexual risk behaviors/factors.

Keywords: Partner violence, women’s health, sexual risk behaviors, sexually transmitted infections