Domestic Violence & HIV Connection

Domestic Violence & HIV Connection Stony Brook University Center for Public Health Education Debra Brown, J.D. May 7, 2009

Your favorite coffee is? • 7-11 • Dunkin’ Donuts • Starbucks • I don’t like coffee • None of the above

Domestic Violence is: • A coercive pattern of behavior that can include many different types of abuse • A domestic dispute that can include physical violence • An intimate partner exerting a pattern of abusive behavior over another to maintain power and control • 1 & 3 • None of the above

A Power and Control Perspective PHYSICAL ABUSE PSYCHOLOGICAL ABUSE POWER AND CONTROL SEXUAL ABUSE ECONOMIC ABUSE EMOTIONAL ABUSE

PHYSICAL Slapping, Biting, Pinching, Burning, Shooting, Stabbing, Forcing drugs /alcohol, Sleep depravation, Withholding medicine or food, etc… SEXUAL PSYCHOLOGICAL Rape, Prostitution, Forced sex after beating, Accusations, Infidelity, Unprotected sex Intimidation, Threats, Blackmail, Harassment, Isolation POWER AND CONTROL ECONOMIC EMOTIONAL Control of finances, Forced labor, Forbidding labor or Education, Fraud, Theft, Harassment at work, Debt. Etc. . . Criticism, Belittling, Insults, Name calling, put downs, Silent treatment, Guilt, Subverting partner’s relationships

Power and Control Perspective • An abuser’s pattern of coercive behavior may include physical violence, but does not always include physical violence • Abuser’s coercive behaviors are intentional and deliberate • The goal of abusers’ pattern of coercion is to establish and maintain control over their victims • Abusers batter because they believe they have a right and entitlement to control their intimate partners

Domestic Violence Adult domestic violence is a pattern of coercive behavior which can include physical, sexual, economic, emotional, and/or psychological abuse exerted by one intimate partner over another with the goal of establishing and maintaining power and control.

DV occurs: • Occurs in hetero relationships mostly, a little bit with same-sex couples • Same-sex relationships really do not count (i.e., cat fight, etc.) • At about 20% across the board • None of the above

The only known risk factor for being a victim of DV is: • Having low self esteem • Being uneducated • Being a female • Being co-dependent

Causes of DV are: • Stress & anger management issues • Substance and/or alcohol abuse • Mental Illness • Can be all of the above • None of the above

Roots of Domestic Violence • Domestic Violence does not result from poor communication skills, stress, anger, addiction, mental illness, victims behavior or external events • The roots of domestic violence are firmly embedded in sexism and other ideologies of group oppression • There are historic legal and social traditions that permit and support male domination over women and children

Dynamics of abuse include: • Hostility, frustration, injury • Unhealthy relationship, nagging, anger • Isolation, jealousy, apologies, blaming • Jealousy, nagging, inapprop. behavior

The Dynamics of Abuse • Isolation: • Early Relationship • Frequent communication throughout the day, seeing each other everyday • Wanting to know everything partner does and says • As relationship progresses, behavior continues • Jealousy: • Perception of concern, normal emotion, varying degrees of possessiveness • Anticipated in early relationships • Can be used to justify other forms of abuse

The Dynamics of Abuse • Minimizing, Denying and Blaming • Abuser minimizing an abusive episode, victims concerns are an overreaction • Insisting that love motivates behavior, blames victim for abuse • Apologies • Apologies instill hope • Appears remorseful, appears willing to change behavior • Pleas for forgiveness • Some may never apologize

The Dynamics of Abuse • Conflicts in the Relationship • Conflicts are not unusual • Women are socialized to take responsibility for well-being of partner and the relationship • This socialization contributes to the “Make it Work” idea (further entrapment) • Women often blame themselves for conflict • Reluctance to confide in others • Take the “good with the bad,” may be a good father, there are good times, they love them

The pattern of abuse can be: • Tactics typically escalate • Can progress slowly making it hard to identify • Escalation is necessary in order to maintain P & C. • The escalation is because the abuser has lost control • All of the above • 1 & 2 only • 1, 2, & 3 only

The Pattern of Abuse • An abuser’s pattern of coercion can progress very slowly making it hard to identify in the early stages • The escalation of domestic violence is often necessary in order for an abuser to continue to maintain power and control over partner, not because he “loses control” of his violence

No two victims experience is the same • Tactics can be interchangeable • It is often difficult to identify DV in the absence of physical violence • The victim is the expert regarding their situation.

Children who witness DV may: • Can be profoundly affected • In an attempt to cope may act out to divert attention, may run away, • May become the hero child: • May intervene during physical violence by attacking the abuser • May become the direct target when they attempt to defend or protect their mother • May take on caregiver role

DOMESTIC VIOLENCE:The HIV/AIDS Connections • Domestic Violence can put victims at risk for contracting HIV • Abusers often use their own HIV+ status or the HIV+ of the victim as a mechanism of control • Being HIV+ can create additional obstacles to victims in their efforts to achieve health and safety

Domestic Violence can put victims at risk for contracting HIV • Unable to negotiate safer sex practices • Abuser may rape partner or purposefully infect • Force partner to engage in sex with others • Added stress negatively impacts on health • Abuser may prevent partner from seeking medical care/testing

Abusers often use their own HIV+ status or the HIV+ of the victim as a mechanism of control • Threat to reveal HIV+ status • Refuse to assist when victim is sick • Abuser may fake HIV illness in order for victim to stay • Blaming victim for infecting the abuser • Threaten to cut off health insurance

Being HIV+ can create additional obstacles to victims in their efforts to achieve health and safety • Abuser often controls finances • Victim may be on a fixed or limited income • A victim with children may be concerned about becoming ill • Victim may be fearful to disclose HIV status to DV provider

As a provider what should we tell our patients/victims to do: • LEAVE! • Defend themselves! • Try to do everything that the abuser wants! • All of the above • None of the above

Risk of Seeking help or Deciding to Leave • There are risk attached to every decision a victim makes • Safety (most women are murdered when they have left or in the process of leaving) • Responses from family and friends • Lack of information/resources • Lack of support/external pressures • Economic pressures • Value of relationship

Risk of Seeking help or Deciding to Leave • The risks of leaving often outweigh the risks of staying • Seeking help or leaving only makes sense to the victim when it reduces overall risk • Getting the victim to leave is not the appropriate goal of intervention

Risk of Seeking help or Deciding to Leave • There are many things service providers can do to provide supportive assistance • Counteract the negative experiences by providing support, information and resources • Engage victim in non-judgmental, non-blaming problem solving that draws on their expertise and resources

Risk of Seeking help or Deciding to Leave • Acknowledge the risks attached to leaving and staying and help victim to weigh them and make decisions • Safety Planning is the process of evaluating risks and benefits of different options and identifying ways to reduce the risk • Refer to the Experts!

In order to find out if someone is being abused the provider should: • Look them over from head to toe • Ask them “are you a victim of DV” • Ask vague, general and closed ended questions • None of the above

Screening for DV • Ask about Domestic Violence • Screen early to avoid using interventions which may place victim at risk • “Victims don’t want to talk about it”, is a myth

Screening for DV • Avoid asking, “Are you a victim of domestic violence?” • Victims often times do not realize what they are experiencing is domestic violence • Always screen in a confidential setting with no children present • Use simple and direct questions

Screening for DV – Sample questions • Have you ever felt afraid of your partner? • Has your partner currently/ever: • Pushed, grabbed, slapped, choked or kicked you? • Forced you to have sex or made you do sexual things you didn’t want to do? • Threatened to hurt you, your children or someone close to you? • Stalked, followed or monitored you?

Helpful provider behaviors • Must meet w/ pt. in private and assure confidentiality • Know that anyone can commit DV and anyone can be a victim of DV • Ask direct, concrete, behavioral questions • Be non-judgmental and validate the pt. and their decisions • Help them with safety planning and REFER TO THE EXPERTS!

Batterer Intervention programs (BIPS) are: • Great! • Waste of time! • Sometimes work

Intervention with Abusers • Abusers need to be held accountable for their behavior, a role that lies primarily with the justice system • BIPS may provide educational classes for abusers. BIPS are not mental health or counseling programs • Generally recommended that BIPS be used by the courts only in combination with other legal sanctions • Although BIPS are not available in most communities, other mechanisms for monitoring abusers are available, such as probation supervision • Even if abusers are involved in a BIP, it is not a guarantee that they will stop the abuse. Victims should be informed of this fact and encouraged to plan for their safety

Resources • Domestic Violence NYS Office for the Prevention of Domestic Violence www.opdv.state.ny.us • HIV Training Center for Public Health Education/Stony Brook Univ. www.stonybrook.edu/cphe

Domestic Violence & HIV Connection