Researchers develop new metric, explore possible link to HIV infection
by Shaun Knittel -
SGN Associate Editor
Gay and Bisexual men who experienced domestic violence were twice as likely to not use condoms during their last sexual encounter, according to research presented July 27 at the 19th International AIDS Conference in Washington, D.C.
'What's more,' wrote Trenton Straube in a August 1 editorial that appeared in various publications, including POZ magazine, 'the research claims to provide for the first time a definition of domestic violence that is specific to Gay and Bisexual men, and this definition does include HIV-related violence.'
Previous research has suggested a link between domestic violence and unprotected sex in the general population, but much of the literature - information produced by the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC), for example - ignores a population at high risk for HIV: men who have sex with men (MSM).
'We're normally taking [research and data] derived from assumingly heterosexual women and applying it post hoc to MSM without any indication that it's valid,' said Catherine Finneran, M.P.H., of Rollins School of Public Health at Emory University in Atlanta.
According to Straube, 'the definitions and prevalence of domestic violence among MSM vary from study to study, which makes it difficult to explore HIV risk in this context.'
Finneran and her colleagues, notably Rob Stephenson, Ph.D., set out to answer the question, 'What do Gay and Bisexual men conceptualize as intimate partner violence?' Specifically, the researchers created the IPV-GBM Scale, which measures intimate partner violence among Gay and Bisexual men.
To create the scale, researchers held focus groups with a total of 83 MSM in Atlanta.
The men were presented with a list of actions - such as 'hit you,' 'damage your property,' and 'call you fat' - and were asked, 'Would you consider it violent if it happened to you from a male partner?'
Many of the items came directly from the widely accepted Conflict Tactic Scale (CTS), but participants added other items, compiling a total of 30. Of note, participants added five HIV-related items - the standardized CTS and the CDC scale did not include HIV items.
Next, researchers surveyed 1,074 Gay and Bisexual men in Atlanta (51% were non-white, 51% were college-educated, 27% were HIV-positive, and 10% identified as Bisexual).
The survey asked the men, 'If each of these 30 items happened to you from a male partner, would you consider it violence?'
Researchers applied other analyses to their data to look for underlying patterns.
The result, wrote Straube, was 'an IPV-GBM Scale of 23 items.'
The items can be broken down to five unique categories (in order of prevalence):
* Physical and sexual violence, such as hitting and raping, but also damaging property. This accounted for 32% of violence.
* Monitoring, such as demanding access to your cell phone or repeatedly posting on your social networking pages. This accounted for 14% of violence.
* Controlling, such as preventing you from seeing friends. This accounted for 5% of violence.
* HIV-related violence. This included three items: 'Lie to you about his status,' 'Not tell you he had HIV before you had sex,' and 'Intentionally transmit HIV to you.' This also accounted for 5% of violence.
* Emotional violence, such as calling you fat or telling you to 'act straight.' This accounted for 4% of violence.
To explore how the new scale compared with the standardized CTS and CDC models, researchers asked survey participants if they had experienced or perpetuated each of the 23 items in the past year.
'It turns out that the CDC model captured 14% of those instances, the CTS captured 28%, and the IPV-GBM Scale captured 46%,' reported Straube.
Finally, the researchers looked at the link between IPV and HIV risk, which they measured as having unprotected anal intercourse.
'We found that men who reported any experience of IPV in the last year were about twice as likely to have not used a condom the last time they had sex,' Finneran said.
She noted that the CTS and CDC definitions of IPV were not associated with unsafe sex among MSM and that, based on other research, such an association is expected to exist.
'The new scale,' Finneran concluded, captures a higher prevalence of domestic violence and 'reflects the lived realities of Gay and Bisexual men.'
'But questions remain,' said Straube.
After the AIDS 2012 presentation, someone inquired whether researchers asked if the condomless sex occurred between main partners or casual partners - the underlying idea being that unsafe sex between long-term partners isn't as risky.
According to Straube, Finneran said they did distinguish between the two but that the results were the same for both categories. Finneran also pointed out that about 60% of HIV infections occur from main partners, a statistic that raises questions about the true level of HIV risk among long-term couples.
Another concern voiced from the audience was that defining items such as 'calls me fat' as violence would pathologize Gay relationships and also maximize the research findings. In response, Finneran stressed that Gay men, not the researchers, created the definitions. But, she said, 'We wanted to demonstrate that there are multiple forms of violence.'
However, Straube said the biggest issue brought up 'was the fact that the category of HIV-related violence only included acts that were perpetuated by HIV-positive men, and none that were done to HIV-positive men.'
In other words, people with HIV were always the aggressors, never the victims.
'I share that concern,' Finneran said. 'I am uncomfortable with that aspect of the report's conclusions, but I have to respect what the data says.'
Other areas of HIV-related violence were brought up but not maintained in the final analysis, she said, adding that perhaps a subanalysis could shed light on the topic, as would surveying MSM outside the Atlanta area.
'In short,' concluded Straube, 'more research is needed.'
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