The intersections of HIV and violence: directions for future research and interventions

The purpose of this paper is to review the available literature on the inte rsections between HIV and violence and present an agenda for future researc h to guide policy and programs. This paper aims to answer four questions: ( 1) How does forced sex affect women's risk for HIV infection? (2) How do vi olence and threats of violence affect women's ability to negotiate condom u se? (3) Is the risk of violence greater for women living with HIV infection than for noninfected women? (4) What are the implications of the existing evidence for the direction of future research and interventions? Together t his collection of 29 studies from the US and from sub-Saharan Africa provid es evidence for several different links between the epidemics of HIV and vi olence. However, there are a number of methodological limitations that can be overcome with future studies. First, additional prospective studies are needed to describe the ways which violence victimization may increase women 's risk for HIV and how being HIV positive affects violence risk. Future st udies need to describe men's perspective on both HIV risk and violence in o rder to develop effective interventions targeting men and women. The defini tions and tools for measurement of concepts such as physical violence, forc ed sex, HIV risk, and serostatus disclosure need to be harmonized in the fu ture. Finally, combining qualitative and quantitative research methods will help to describe the context and scope of the problem. The service implica tions of these studies are significant. HIV counseling and testing programs offer a unique opportunity to identify and assist women at risk for violen ce and to identify women who may be at high risk for HIV as a result of the ir history of assault. In addition, violence prevention programs, in settin gs where such programs exist, also offer opportunities to counsel women abo ut their risks for sexually transmitted diseases and HIV. (C) 2000 Elsevier Science Ltd. All rights reserved.