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Addressing intimate partner violence may prevent HIV/STI, promote health of sexual minority men

Forcing condomless sex was described by service providers as a way of asserting power or control over one’s partner, and it has serious implications for the health and well-being of sexual minority men.

Main photo by Lareised Leneseur from Unsplash.com

Sexual minority men (SMM) who experience intimate partner violence (IPV) may also experience social and economic barriers to HIV and STI prevention and treatment resources. So dealing with one may also deal with the other.

This is according to a study – “Intimate Partner Violence and the Sexual Health of Sexual Minority Men” by Erik D. Storholm, Hannah E. Reynolds, Sandhya Muthuramalingam, Carrie L. Nacht, Jennifer K. Felner, Glenn J. Wagner, Rob Stephenson, and Daniel E. Siconolfi – published in LGBT Health.

This qualitative study hoped to explore the pathways by which various forms of IPV impact the sexual health behaviors of cisgender identified SMM. So here, semi-structured interviews were conducted with 23 SMM who recently experienced IPV, and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g. pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data.

The analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs).

The participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners.

For the researchers, forcing condomless sex was described by service providers as a way of asserting power or control over one’s partner, and it has serious implications for the health and well-being of SMM. This is because “sexual forms of IPV are also associated with higher rates of psychological distress, anxiety, and depression”; “forced condomless sex directly places SMM at greater risk for HIV or STI transmission”; and “finally, and more insidiously, sexual IPV may also undermine one’s sense of agency and ability to advocate for safety in sexual situations”.

Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners.

The findings “suggest that men experiencing IPV may also experience social and economic barriers to HIV and STI prevention and treatment resources,” the researchers noted. “For example, providers described how IPV can create financial dependence on an abusive partner, which can make it difficult for some SMM to access HIV/STI testing, PrEP, condoms, or other prevention tools. IPV can also lead to isolation from social networks, which can limit access to sexual health information and resources, including social and instrumental support from others which may aid access to HIV prevention.”

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Since HIV prevention strategies can be sources of relationship control and trigger abuse, the researchers stressed that “addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.”

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