1. N ORTHWEST AIDS E DUCATION AND T RAINING C ENTER Relationship Abuse and HIV/STI: Addressing Risks, Offering Support Laura Avellaneda-Cruz, LMSW Alaska Native Tribal Health Consortium Alaska Native Epidemiology Center Presentation prepared by: Laura Avellaneda-Cruz Last Updated: 3/31/15

2. Describe how IPV/SV impact HIV/STI risk Describe how IPV/SV impact health of + patients Learning Objectives, Part 1

3. Learning Objectives, Part 2 Reduce risks & improve response

4. Assess for IPV Routinely Educate Clients Recognize elevated risk of partner notification Identify most effective treatment options

5. “Success is measured by our efforts to reduce isolation and to improve options for safety.” - Futures Without Violence

6. Safe Environment + Education, Assessment, Response

7. Safe Environment: Privacy We respect our patients’ privacy. We always see patients alone at some point in their visit

8. Safe Environment: Send positive messages We respect our patients’ privacy. We always see patients alone at some point in their visit

10. Builds trust Removes fear re. gossip, reporting of drug use, etc. Avoids feelings of betrayal, coercion, taking away control Reviewing Confidentiality

11. The Safety Card Approach to Violence Prevention & Intervention

22. www.anthctoday.org/epicenter/healthyfamilies

25. Normalizing Lets patient know: Not being singled out or judged This is a major health issue Pt. is not alone Why to read the card Remember: Terms can be barriers

27. Visit-specific questions Because it happens to so many girls and women, we ask every patient who needs emergency contraception if someone has been trying to get them pregnant when they didn’t want to be. Any time patients come in for STI/HIV testing, we ask if they feel comfortable talking with their partners about using condoms, or if their partners will get mad. Are you able to talk with your partner about using condoms without feeling afraid?

28. Resources

30. Responding

31. Keep the door open

32. Validate and support

33. I’m sorry this is happening in your life. You don’t deserve this. It’s not your fault. That sounds really stressful. Thank you for telling me. That was a brave thing to do. Validate and support

34. Offer information and concern: You have the right to require that your partner uses a condom every time. I’m concerned about how this is affecting your health. Sometimes the stress from relationships can lead to some of the symptoms you are describing.

35. Health & Safety Issues to Consider: LARCs

36. Health & Safety Issues to Consider Long-lasting, reversible contraception (LARCs): Does partner monitor menstruation? Can patient return to clinic for shots? IUD strings? Nexplanon?

37. Health & Safety Issues to Consider Long-lasting, reversible contraception (LARCs): Does partner monitor menstruation? Can patient return to clinic for shots? IUD strings? Nexplanon? Emergency Contraception: In an unidentifiable envelope

38. Health & Safety Issues to Consider Long-lasting, reversible contraception (LARCs): Does partner monitor menstruation? Can patient return to clinic for shots? IUD strings? Nexplanon? Emergency Contraception: In an unidentifiable envelope STI treatment & partner notification: Ask if it’s safe to tell & treat partner Anonymous call from health dept. about “one of your partners in the last few years” Safety plan around partner notification Identify safest treatment options

39. Health & Safety Issues to Consider Long-lasting, reversible contraception (LARCs): Does partner monitor menstruation? Can patient return to clinic for shots? IUD strings? Nexplanon? Emergency Contraception: In an unidentifiable envelope STI treatment & partner notification: Ask if it’s safe to tell & treat partner Anonymous call from health dept. about “one of your partners in the last few years” Safety plan around partner notification Identify safest treatment options Is abuse affecting chronic conditions? Is abusive partner denying patient medication or treatment? Include needed treatments, medications, etc. in safety planning

40. Providing a warm referral If it’s okay with you, we could use the phone here in the clinic to call my colleague, [name] who is an expert in helping people who are in difficult relationships. She can help you think about and plan some ways to stay safe. Would you like me to call her for you?

41. Photo: Laura Avellaneda-Cruz, ANTHC

42. Thank you Quyana Gunalchéesh Háw’aa Quyanaq Taikuu Mahsi' choo Ana baasee' Qaĝaasakung Way dankoo Laura Avellaneda-Cruz, LMSW ldavellanedacruz@anthc.org (907) 729-2489 www.anthctoday.org/epicenter/healthyfamilies

43. References (in order of use) Chamberlain, L., & Levenson, R. (2013). Addressing Intimate Partner Violence, Reproductive and Sexual Coercion: A Guide for Obstetric, Gynecologic, Reproductive Health Care Settings (3 rd Ed). San Francisco: Futures Without Violence. Miller, E., Levenson, R., Monasterio, E., & Duplessis, V. (2014). Hanging Out or Hooking Up: An Integrated Approach to Prevention And Intervention. A Train the Trainers Curriculum On Responding to Adolescent Relationship Abuse. San Francisco: Futures Without Violence. Silverman JG, Raj A, Mucci LA, & Hathaway JE. (2001). Dating Violence Against Adolescent Girls And Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, And Suicidality. JAMA. 286(5):572-579. Miller, E., Decker, M., Raj A., Reed E., Marable, D., & Silverman, J.(2010). Intimate Partner Violence And Health Care-Seeking Patterns Among Female Users Of Urban Adolescent Clinics. Maternal Child Health Journal, 14:910–917 Ramachandran, S., Yonas, M. A., Silvestre, A. J., & Burke, J. G. (2010). Intimate Partner Violence among HIV Positive Persons in an Urban Clinic.AIDS Care, 22(12), 1536–1543. doi:10.1080/09540121.2010.482199 El ‐ Bassel, N., Gilbert, L., Wu, E., Chang, M., Gomes, C., Vinocur, D., & Spevack, T. (2007). Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening. Emergency Medicine Journal: EMJ, 24(4), 255–259. doi:10.1136/emj.2006.041541

44. References Raiford, J., DiClemente, R., & Wingood, G. (2009). Effects of Fear of Abuse and Possible STI Acquisition on the Sexual Behavior of Young African American Women. American Journal of Public Health: 99(6), 1067-1071. doi 0.2105/AJPH.2007.131482 Wingood, G., DiClemente, R., McCree, D., Harrington, K, & Davies, S. (2001). Dating violence and the sexual health of black adolescent females. Pediatrics. 107(5):E72. Gielen, A., McDonnell, K., Burke, Jessica, & O’Campo, P. (2000). Women’s Lives After an HIV- Positive Diagnosis: Disclosure and Violence. Maternal and Child Health Journal, 4(2). Gielen, A., Ghandour, R., McDonnell, K., Burke, Jessica, & O’Campo, P. (2000). HIV/AIDS and Intimate Partner Violence: Intersecting Women's Health Issues in the United States. Trauma, Violence, Abuse, 8(2), 178-198. doi: 10.1177/1524838007301476 Lang, D., Salazar, L., Wingood, G., DiClemente, R., & Mikhail, I. (2007). Associations Between Recent Gender-Based Violence and Pregnancy, Sexually Transmitted Infections, Condom Use Practices, and Negotiation of Sexual Practices among HIV-Positive Women. Journal of Acquired Immune Deficiency Syndrome. 1;46(2), 216-21. Lichtenstein, B. (2006). Domestic violence in barriers to health care for HIV-positive women. AIDS, Patient Care, STDS. 20(2), 122-32.