Abuse by partner may be common in HIV-positive gay men

The majority of a sample of HIV-positive gay men had recently been abused by a partner, US investigators report in the online edition of AIDS and Behavior.

Half the men participating in the study had experienced some form of psychological abuse from a partner in the previous twelve months. Physical, sexual, and HIV-specific abuse were also common.

“The high prevalence of partner abuse we discovered…is alarming, and indicates the importance of systematic screening for all patients in HIV care settings – including men – despite common perceptions that only women are victims and men are perpetrators,” comment the investigators. However, they acknowledge that their study only looked at a small sample of men, and that further research is needed.

A total of 168 HIV-positive men attending two specialist HIV out-patient clinics were recruited to the study. All identified as men who have sex with men.

The investigators noted that little research has examined the prevalence and consequences of partner abuse in HIV-positive men. The few studies that have looked at this issue were conducted in the 1990s and found that abuse was widespread and had a damaging impact on both mental and physical health.

Therefore, the men participating in the current study were asked to complete a validated questionnaire enquiring about experiences of physical, psychological, sexual, and HIV-specific abuse which was perpetrated by a partner.

Further questions enquired about the possible impact of abuse, and assessed anxiety, depression, thoughts of suicide, social support mechanisms, stigma, substance abuse, and health-related quality of life.

The investigators expected that, “compared with non-abused participants, HIV-positive MSM who experience each type of partner abuse will have poorer mental and physical health across various measures.”

Most (63%) of the men were white and their mean age was 44 years. The majority (75%) were unemployed and 46% were living in poverty with an income below $738 per month.

Over a third (37%) were presently partnered and 69% of these men reported that they had been in a relationship for over a year.

Overall, almost two-thirds (61%) reported having had sex with both men and women during their lifetime.

Approximately half (54%) reported some form of partner abuse in the previous twelve months, 66% in the past five years, and 78% ever being abused.

Psychological abuse was the most common, with 51% saying they had experienced this in the previous year (73% ever).

Physical abuse in the past twelve months was reported by a fifth of participants (38% ever) and 17% said they had recently experienced sexual abuse such as forced intercourse or rape (30% ever). HIV-specific abuse in the past year was reported by 10% of men (16% ever).

Individuals reporting physical abuse by a partner were significantly more likely than men not reported this abuse to be younger (39 vs. 45; p < 0.001), of non-white race (52% vs. 29%; p = 0.02), on a low income 78% vs. 40%; p < 0.001), live with someone else (48% vs. 24%; p < 0.01), and have a history of sex with both men and women (78% vs. 59%; p = 0.04).

Methamphetamine use was more common among physically abused men (47% vs. 25%; p = 0.02) as was use of cocaine (p < 0.01).

Anxiety scores were significantly higher for the men reporting recent physical abuse (p < 0.01). These men were also more likely to have symptoms of depression (p < 0.01), and report thoughts of suicide (p = 0.01).

In addition, physically abused men also had poorer coping strategies (p < 0.001), were more likely to report feeling stigmatised (p = 0.02) and to have poorer health-related quality of life (p = 0.05).

Recent sexual abuse was associated with stigma (p < 0.02). Men who reported sexual abuse were younger than men who did not experience this type of abuse (p < 0.05), were more likely to be non-white (p = 0.01) and to have a low income (p = 0.03).

Psychologically abused men were more likely to be living with someone else than men who did not experience this form of abuse (52% vs. 36%; p =  0.04), and were also younger (42 vs. 45 years; p < 0.01) and to be on a low income. Surprisingly, psychological abuse was not associated with poorer mental health outcomes.

Abuse was not associated with poorer adherence to HIV therapy. The investigators speculate that abused men may have focused on adherence as a control mechanism.

“We believe that our work both makes a contribution and highlights the need for additional, ongoing work in this area,” comment the authors.

They conclude, “collaborative efforts with clients, providers, and public health officials will be needed to address partner abuse in a comprehensive manner. Given the extent of partner abuse and its deleterious effects, work on such interventions cannot begin too soon.”

Pantalone DW et al. Investigating partner abuse among HIV-positive men who have sex with men. AIDS and Behavior, online edition, doi: 10. 1007/s10461-011-0011-2, 2011 (free abstract available here).