“Intersecting epidemics.” That is how the Obama Administration sees the health crises of intimate partner violence (IPV) and HIV (human immunodeficiency virus). More than half of HIV-positive women—double the national rate—experience violence from their partners.
In 2012, President Obama published a memorandum outlining plans to address the crises, including establishing the Interagency Federal Working Group on the Intersection of HIV/AIDS. In October 2014 (Domestic Violence [DV] Awareness Month), the Working Group released its report on how the effort is going: Update on Efforts to Address the Intersection of HIV/AIDS, Violence against Women and Girls, and Gender-Related Health Disparities. This update details how various federal agencies have been working to meet the president’s goals. The results have been far-reaching and comprehensive, ranging from programs to train health care professionals in screening and counseling to educate men and boys about their role in preventing violence.
The 5 core objectives for action, released in the September 2013 Working Group report, are (1) Improve health for women by screening for IPV and HIV; (2) Improve outcomes for women in HIV care by addressing violence and trauma; (3) Address contributing factors that increase the risk of violence for women and girls living with HIV; (4) Expand public outreach, education, and prevention efforts regarding violence against women and girls; and (5) Support research to better understand the scope of the intersection of HIV and violence against women and girls and develop effective interventions.
In an October 10, 2014, blog post for the Council on Women and Girls, Working Group member Maggie Czarnogorski, MD, MPH, a senior policy advisor in the Office of National AIDS Policy, on detail from VA, and Tiffany McNair, MD, MPH, a White House Fellow in the Office of the Vice President, pointed to 2 major accomplishments. One is the collaboration between the U.S. Department of Justice and the U.S. Department of Housing and Urban Development’s Housing Opportunities for People with AIDS, which allocates funding and resources to support transitional housing for women who are both living with HIV and experiencing violence in their lives. The second is the Substance Abuse and Mental Health Services Administration’s “trauma-informed approaches,” which aim to help people modify negative behaviors resulting from trauma and ultimately improve health outcomes.
Many of the projects discussed in the 2014 update are educational, focusing on training and disseminating information. For example, NIH created a special Internet portal for information from the HHS 2013 Symposium on the Intersection of HIV and IPV. The Administration for Children and Families (ACF) and the Office of Minority Health have collaborated to support resource centers that develop and disseminate the CORE Linkage to Life Program to both domestic violence and HIV/AIDS care providers, to improve health outcomes for African Americans and Latinos recently discharged form correctional and substance abuse inpatient facilities.
For each objective, the report outlined “concrete, nonexhaustive, recommended actions for specific federal agencies.” On the federal level, the Working Group stated, many goals have been met, while other activities have produced meaningful changes. Some highlights:
A new HRSA-CDC project, Partnerships for Care, is requiring IPV-related training for the HIV workforce. HRSA has also collaborated with ACF to disseminate HIV and IPV screening and counseling tools to a variety of programs, such as rural health programs, maternal and child health programs, and National Health Service Corps providers.
The Office of Population Affairs (OPA) has trained staff from Title X-funded family planning clinics about HIV/AIDS, IPV, and family planning, and the importance of screening. The OPA is also promoting screening for HIV and IPV in reproductive health clinics.
VA has several initiatives in the works, such as developing protocols for coscreening for HIV, IPV, and military sexual trauma. In 2014, VA launched the National DV/IPV Assistance Program in Care Management and Social Work Service, which will implement an IPV screening program and link women who are victims of violence to community organizations that can help them. VA is also promoting HIV screening for all veterans and has national recommendations for IPV screening. It will pilot the use of the Extended Hits Insults Threatens Screams (E-HITS) screening tool and Dangerous Assessment questions to screen for IPV.
The 2014 update demonstrates “promising trends” and marks the first step toward addressing the needs of women with HIV/AIDS who are victims—or may be victims—of violence, as noted by Dr. Czarnogorski and Dr. McNair. The Working Group is looking forward to building on the momentum by scaling up effective strategies, incorporating trauma-informed approaches, and expanding outreach to high-risk groups. They hope to witness, they conclude, “both individual and broad societal-level impact—and to sustain that impact for the women and girls counting on us.”