October is Domestic Violence Awareness Month and an important time to draw attention to the alarming prevalence of intimate partner violence (IPV) among women and girls. This is particularly true for women living with HIV, over half of whom have experienced IPV in their lifetime. An HIV diagnosis can trigger or exacerbate violence, while trauma and abuse can negatively impact management of this illness. Thus, for women and girls affected by the intersecting epidemics of HIV/AIDS and IPV, the consequences for their health and well-being can be devastating.
As physicians who care for women, we see this intersection among our patients all too often; and, both data and experience have shown that women and girls of color are often disproportionately affected. Addressing the violence in our patients’ lives is therefore a critical part of supporting them to achieve optimal health outcomes, including improving their ability to adhere to treatment, achieve viral suppression, and live longer and fuller lives.
In an effort to respond to these complex problems, last year the Interagency Federal Working Group established in 2012 under President Obama’s memorandum released a report titled Addressing the Intersection of HIV/AIDS, Violence against Women and Girls, and Gender–Related Health Disparities. The report outlined five major recommendations and emphasized the need for cross-agency collaboration to better address how violence against women and girls influences HIV acquisition and negatively affects the health of women living with HIV.
Today, we are proud to announce two major accomplishments stemming from this report. The U.S. Department of Justice (DOJ) and the U.S. Department of Housing and Urban Development’s (HUD) Housing Opportunities for People with AIDS (HOPWA) program have provided an outstanding example of Federal interagency collaboration. This joint effort will specifically allocate funding and resources to support transitional housing for women living with HIV, and who are experiencing violence in their lives. The Substance Abuse and Mental Health Services Administration (SAMHSA) is also releasing a Trauma-Informed Approaches concept paper that identifies a new framework to address trauma experiences and victimization. This framework aims to help individuals, like women living with HIV, to modify negative behaviors resulting from trauma and ultimately improve health outcomes.
In addition, the Office of National AIDS Policy, in collaboration with the Office of the Vice President and Council on Women and Girls, is releasing a report today with the first annual update on activities taking place across the Federal government in response to these recommendations. Dozens of important cross-agency advances have occurred over the last year in the form of critical dialogue, resource sharing, coordination among agencies, and engagement with community partners. With strategic next steps and a call for continued action and momentum, the report also offers a blueprint for the year to come.
First, screening for HIV and IPV throughout Federal programs is now a greater priority. The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) are providing integrated training in HIV/IPV screening to their prevention workforce. HRSA is also collaborating with the Administration for Children and Families (ACF) to provide HIV/IPV counseling tools to Ryan White, rural health, maternal and child health, and National Health Service Corps programs. Additionally, the U.S. Department of Veterans Affairs (VA) is promoting screening for HIV for all women veterans, and IPV screening pilots in VA facilities are to begin in the next year.
Federal agencies have also focused on enhancing public outreach, especially to more marginalized communities. Futures Without Violence, a community partner, has educated DOJ’s Office of Violence Against Women (OVW) consolidated youth grantees on the intersection of violence and HIV through webinars and educational materials. Moreover, ACF is developing resources on HIV/IPV to assist reproductive health providers in improving prevention, testing, counseling, and safe partner notification for their patients.
Engaging men and boys is another critical strategy highlighted in the update. ACF and the U.S. Department of Health and Human Services’ Office of Minority Health are collaborating to support the development of resources for domestic violence and HIV providers to assist Black and Latino men and women recently discharged from correctional and inpatient substance abuse treatment programs. Futures Without Violence is also working with OVW on engaging grantees to focus on interventions that involve men.
Finally, the report stresses the importance of continued scientific investigation, community engagement, and partnership to achieve the goals of the initiative. The CDC and National Institutes of Health are both conducting research on HIV/IPV epidemiology and interventions. Another partner, AIDS United, recently hosted a Technical Summit that gathered researchers, local leaders, and activists to generate community recommendations to address trauma among women living with HIV.
The 2014 update demonstrates promising trends and marks the first step toward addressing the needs of women confronted with HIV/AIDS and IPV. In the next year, we look forward to Federal agencies and community partners continuing this momentum. By scaling up effective strategies, incorporating trauma-informed approaches, and expanding outreach to high-risk groups, the Interagency Federal Working Group hopes to witness both individual and broad societal-level impact — and to sustain that impact for the women and girls counting on us.
Maggie Czarnogorski, MD, MPH, a specialist in women’s health and infectious diseases, is a Senior Policy Advisor in the Office of National AIDS Policy, on detail from the Department of Veterans Affairs.
Tiffany McNair, MD, MPH, an obstetrician-gynecologist and preventive medicine physician, is a White House Fellow in the Office of the Vice President.