1. Reed AC Siemieniuk, BSc,1,2
Patricia Miller, MSW,1,3
Kate Woodman, PhD,4
Karen Ko, MA,1
Hartmut B Krentz, PhD,1,3
M John Gill, MB, ChB1,3
1. Southern Alberta HIV Clinic, Calgary, AB
2. Mount Royal University, Calgary, AB
3. University of Calgary, Calgary, AB
4. EndAbuse Canada, Edmonton, AB

2. Disclosure
There are no conflicts of interest.

3. Background
Intimate partner violence (IPV):
any behaviour in an intimate relationship causing
physical, psychological, or sexual harm.1
Not often studied among gay and bisexual men( which
might mean that we are more socially tolerant or
socially ignorant)
Our research looks to reconstruct the social health
discourse, specific to IPV/HIV/Gay/Bisexual Men’s
health.
1. World Health Organization. Intimate partner violence [Fact
sheet]. Available at:
http://www.who.int/violence_injury_prevention/violence/world_repor

4. Background
IPV:
A risk factor for HIV-acquisition among women2
and
increasingly recognized among gay and bisexual men3
Associated with behaviours conferring poor HIV-
related outcomes
Also, IPV’s impact is starting to be acknowledged as
impacting a HIV- pos. person’s quality of life.
2. Jewkes RK, et al. Lancet. 2010;376:41-8.
3. Parsons JT, et al. Am J Public Health. 2012;102:156-62.

5. Goals of study
Describe:
Prevalence and subtypes of IPV
Clinical associations
Outcomes
Health-related quality of life (HRQoL)
Psychiatric
Continuity of care
Clinical outcomes (AIDS, hospitalizations)
Information to develop preventative/intervention
health care strategies.

6. Methods
Routine screening implemented in Southern Alberta
for all HIV patients May 2009.
Screening tool modified from local Emergency
Department’s
Preliminary findings and protocol previously described4
Study inclusive to December 2011.
4. Siemieniuk RA, et al. AIDS Patient Care and STDs. 2010;24:763-70.

7. Methods
Inclusion criteria:
Self-reported sex is male and self-reported sexual
orientation is gay or bisexual

8. Figure 1: Screening Interview Algorithm
1. Screening Question
“Domestic violence and the threat of violence in the home is a problem for many people at SAC and in the community;
this can directly affect health. Abuse can be a problem in relationships from all cultures and sexual orientations, and
can take many forms: physical, sexual, emotional, isolation, neglect, intimidation or financial.
We routinely ask all patients about domestic abuse in their lives. This often brings up many strong emotions, including
different types of fear and uncertainty, but rest assured that this is a safe place to discuss this issue. Have you or your
child(ren) ever experienced domestic abuse in any way?”
2. If yes, continue semi-structured conversation:
• Identify when abuse occurred:
a) As an adult with current intimate
partner
b) As an adult with a previous intimate
partner
c) As a child (<16 years of age)
• Identify type(s) of abuse experienced:
a) Physical abuse
b) Sexual abuse
c) Emotional abuse
d) Isolation
e) Neglect
f) Intimidation
g) Financial abuse
2. If no, continue with regular HIV care.
3. Identify perceived safety:
“Do you feel safe in your current relationship?”
4. Offer professional
consultation
Methods

9. Methods
Clinical and demographic data is recorded
continually on all patients
Multivariable analysis conducted with Poisson
regression, adjusted a priori for
Age
Months living with HIV
Log of CD4 at initial presentation to care
Location of HIV diagnosis (local vs non-local)

10. Results
687 of 739 (93.0%) gay or bisexual males engaged in
care were screened for IPV
154 of 687 (22.4%) reported IPV
Current relationship: 23 (14.9%)
Previous relationship: 140 (90.9%)

11. Results
154 of 687 (22.4%) reported IPV
Current relationship: 23 (14.9%)
Previous relationship: 140 (90.9%)
Persons disclosing IPV were more likely Aboriginal,
younger, victims of childhood abuse, had depression
prior to diagnosis, use ongoing psychiatric resources, to
recently have participated in unprotected sex, have
poor to fair versus good to excellent quality of life.
Also, higher rates of clinically relevant interruptions in
care, more HIV-related hospitalizations.

12. Demographics
IPV (% or SD) No IPV (% or SD) APR (95% CI) P
Age (SD) 43.8 (9.7) 46.1 (10.7) 0.97 (0.95-0.99) 0.01
Years in care (SD) 5.5 (4.4) 5.7 (4.5) 1.03 (0.98-1.08) 0.28
Diagnosed elsewhere 39 (25.3) 126 (23.6) 1.11 (0.72-1.70) 0.6
Ethnicity
Aboriginal 13 (8.4) 18 (3.4) 2.48 (1.18-5.2) 0.02
Black 2 (1.3) 9 (1.7) 0.81 (0.12-3.79) 0.8
Other 14 (9.1) 48 (9.0) 0.97 (0.51-1.86) 0.9
Caucasian 125 (81.2) 458 (85.9) Ref
Childhood abuse 64 (41.6) 80 (15.0) 4.27 (2.84-6.41) <0.001
Lives alone 39 (31.0) 156 (35.5) 0.91 (0.59-1.41) 0.7

13. Demographics
IPV (% or SD) No IPV (% or SD) APR (95% CI) P
Age (SD) 43.8 (9.7) 46.1 (10.7) 0.97 (0.95-0.99) 0.01
Years in care (SD) 5.5 (4.4) 5.7 (4.5) 1.03 (0.98-1.08) 0.28
Diagnosed elsewhere 39 (25.3) 126 (23.6) 1.11 (0.72-1.70) 0.6
Ethnicity
Aboriginal 13 (8.4) 18 (3.4) 2.48 (1.18-5.2) 0.02
Black 2 (1.3) 9 (1.7) 0.81 (0.12-3.79) 0.8
Other 14 (9.1) 48 (9.0) 0.97 (0.51-1.86) 0.9
Caucasian 125 (81.2) 458 (85.9) Ref
Childhood abuse 64 (41.6) 80 (15.0) 4.27 (2.84-6.41) <0.001
Lives alone 39 (31.0) 156 (35.5) 0.91 (0.59-1.41) 0.7

14. Mental Health
IPV (%) No IPV (%) APR (95% CI) P
Alcohol abuse 11 (8.8) 31 (7.1) 1.16 (0.56-2.42) 0.7
Illicit substance use 36 (33.0) 86 (21.7) 1.54 (0.95-2.50) 0.08
Smoking
Current 75 (59.5) 171 (37.3) 2.53 (1.59-4.00) <0.001
Former 16 (12.7) 83 (18.1) 1.23 (0.64-2.38) 0.5
Never 35 (27.8) 204 (44.5) Ref
Depression prior to
HIV diagnosis*
35 (43.2) 77 (28.4) 1.87 (1.10-3.16) 0.02
Anxiety disorder prior
to HIV diagnosis*
22 (29.3) 48 (18.0) 1.82 (0.98-3.40) 0.06
HIV psychiatry
appointment in the
past year
11 (7.1) 16 (3.0) 2.67 (1.20-5.95) 0.02
HIV psychiatry
appointment ever*
35 (30.4) 51 (12.5) 3.53 (2.05-6.10) <0.001
*Local patients only

15. Sexual risk-taking
IPV (%) No IPV (%) APR (95% CI) P
Sex since last visit 58 (50.9) 198 (47.5) 1.08 (0.70-1.64) 0.9
Unprotected sex since
last visit
36 (33.0) 86 (21.7) 2.29 (1.10-4.77) 0.03

16. Health-related Quality of Life
IPV (%) No IPV (%) APR (95% CI) P
Poor 5 (4.1) 8 (1.8)
2.91 (1.57-5.39) 0.001
Fair 18 (14.8) 32 (7.2)
Good 56 (45.9) 180 (40.4)
1.60 (1.02-2.50) 0.04
Very Good 28 (23.0) 173 (38.8)
Excellent 15 (12.3) 53 (11.9) Ref
*Local patients only

17. Continuity of care
IPV (%) No IPV (%) APR (95% CI) P
Longest interruption
≥365 days
50 (32.5) 133 (25.0) 1.50 (0.97-2.32) 0.07
Clinically significant
interruption in care§ 41 (26.6) 87 (16.3) 1.95 (1.23-3.08) 0.004
§
Lost to follow up ≥365 days and returned with VL ≥200/mm3

18. Clinical Outcomes
IPV (%) No IPV (%) APR (95% CI) P
History of AIDS 41 (26.6) 126 (23.6) 1.40 (0.90-2.19) 0.14
History of AIDS,
presenting CD4 ≥200
22 (19.1) 44 (11.5) 2.06 (1.15-3.69) 0.02
§
Lost to follow up ≥365 days and returned with VL ≥200/mm3

19. Clinical outcomes
IPV No IPV RR P
Persons
hospitalized
Total
hospitalizations
Rate (/1000
patient-years)
(95% CI)
Persons
hospitalized
Total
hospitalizations
Rate (/1000
patient-years)
(95% CI)
All
hospitalizations
52 119
90.6
(75.4-108.1)
175 396
89.3
(80.9-98.5)
1.01
(0.83-1.23)
0.9
HIV-unrelated 42 89
67.8
(54.8-83.0)
143 330
74.4
(66.7-82.8)
0.92
(0.73-1.15)
0.45
HIV-related 21 30
22.9
(15.7-32.2)
55 66
14.9
(11.6-18.8)
1.55
(0.99-2.33)
0.05
HIV-related after
initial HIV
diagnosis
20 28
21.3
(14.5-30.4)
30 34
8.6
(6.1-11.6)
2.46
(1.51-3.99)
<0.001
Follow-up time
(patient-years)
1313 4433

20. Limitations
Self-reported outcomes
Gay and bisexual men were studied together – may
experience IPV differently

21. Conclusions
High prevalence of IPV (1/4.5)
Associated with:
Aboriginal ethnicity
Childhood abuse
Psychiatric disease
Risky sexual behaviour
Poor health-related quality of life
Interruptions in care
Progression to AIDS among those presenting early
HIV-related hospitalizations

22. Conclusions
IPV is an important (but underecognized) social
comorbidity among HIV-positive gay and bisexual
men
Prospective studies will help further clarify its impact
Evidence-based interventions to identify victims and
provide effective support may improve wellbeing for a
substantial proportion of HIV-positive gay and
bisexual men.
Knowledge transfer needed between helping
professionals in order to reduce the impact of IPV.

23. Acknowledgements
Alberta Health Services and its Information
Technology Department for support of the clinical
database that has allowed us to undertake this work.
The Southern Alberta HIV Clinic nurses and social
workers

24. Types of IPV
Type of abuse
Emotional 125 (81.2)
Physical 113 (73.4)
Sexual 30 (19.5)
Intimidation 22 (14.3)
Financial 21 (13.6)
Isolation 12 (7.8)
Neglect 8 (5.2)

25. Number of types of abuse
Number of abuse types
One 55 (35.7)
Two 52 (33.7)
Three 31 (20.1)
Four 6 (3.9)
Five 6 (3.9)
Six 3 (1.9)
Seven 1 (0.6)