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.

As ecosystems that support human health, societies, and civilization change in the era of the Anthropocene, individuals with disproportionate balance of salivary hormones may be at greatest risk of morbidity and mortality. Vulnerable communities, in particular, are overburdened by inequities in features of built environments linked to health disparities. This study examined the cross-sectional association of greenness in the built environment with the ratio of cortisol to dehydroepiandrosterone (DHEA) in an urban-dwelling high-risk community sample of African American women (n = 84, age 18-44 years). Saliva samples, collected across 2 consecutive days, were assayed for cortisol and DHEA. Controlling for sexual violence, perceived stress, education, and income, as well as crime, traffic density, and vacant properties, we observed a significant positive cross-sectional association between greenness and the cortisol to DHEA ratio, (β = 7·5, 95% CI: 0.89, 14.19). The findings highlight environmental influence on stress response at waking when there is the greatest individual variation. Implications for advancing our understanding of the waking ratio of cortisol to DHEA as a potential marker of physiological resilience are discussed.

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.

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.