Echoes of Violence: A Study Makes a Connection Between Recent Abuse and Mortality
Interview with Kathleen M. Weber, R.N. on the study, "The Effect of Gender-Based Violence (GBV) on Mortality: A Longitudinal Study of U.S. Women with and at Risk for HIV," at the 19th International AIDS Conference, July 2012 in Washington, D.C.
Enid Vázquez: Your findings were clear and fascinating, and I wanted to talk with you about the experiences and inspirations for the study, but let me start by asking if this is the first time there was a correlation found between abuse and survival?
Kathleen Weber, Cook County Health and Hospital Systems: This is the first time we saw a correlation between recent abuse and mortality. Even in this analysis, when we looked at just history of abuse alone without looking at current abuse separately, there was no correlation. And part of that is that 78% of our women have a history of abuse, so a sample of those who have never been abused is quite small. But the women who had experienced current abuse in addition to having a history of abuse were the women with whom we saw that increased mortality risk. It's been a long time and we really needed to have enough "dust," unfortunately, to occur to be able to actually look at this and then to control for all the other things that are associated with death like smoking, substance abuse, and depression. So in this model, all of those things are actually controlled for -- you need a longer period of time and a greater number of deaths to be able to do that, statistically. This is really the first time we've seen this in the WIHS data.
EV: In terms of the inspirations for the study, do you think they relate to critical consciousness as raised by Gwendolyn Kelso, for example, and why women stay in bad relationships after you give them referrals for help?
KM: When you look at the WIHS study and you look at the graphs, the abuse is definitely decreasing over time, which is a good thing. For women in the WIHS there was a reduction over the 17-year period in which this was looked at. It is telling us that women are accessing some services because every six months [when the women are seen], when they answer "yes" about being in an abusive relationship, they do get a referral. I think in the process of asking women regularly about abuse raises their awareness that maybe this isn't the experience other people are having -- otherwise they wouldn't see me here [at a referral site]. It brings the discussion to the table, not just in the WIHS study but in the provider relationship.
So we're thinking if over time you keep asking people about their experience, they start thinking about their experience, and then slowly seek access to available services or look for opportunities to get services. In a Cook County-related study in JAMA [Journal of the American Medical Association] in August, where they looked at whether referrals actually reduced violence, they didn't find any substantive randomized, controlled clinical trials, but we know from working with women that it takes a long time. You can't just say, "Here's a postcard and the address of a place where you can get help." It might take years and years of a relationship with a service provider and really concrete support to get women the help they need. You know, a postcard alone is better than nothing, but it's probably not the most effective approach to get women out of an abusive relationship, right?
EV: Some people don't get that. What are some other approaches?
KW: You asked about Gwen's research. She's looking at our Chicago WIHS in terms of racial and sexual discrimination. Sometimes, as you get a sense of what's happening and you become more involved socio-politically, things start to change for women as they become more empowered. Part of the study is an offshoot of a bigger study Mardge Cohen [M.D., CORE Center in Chicago, where WIHS is conducted] is conducting in collaboration with the Boston [University] group looking at gender roles and this concept of self-silencing, what women do in terms of a tendency to silence themselves to be in a relationship or caring for their children at the expense of taking care of themselves. If those are the expectations you feel you're supposed to fulfill as a woman, as a mother, as a partner, you can see where that might be setting yourself up for situations where you're more likely to be abused or in an abusive relationship and not able to get out. So that's been some of the work that's been happening here locally. It's starting to look more at women, gender roles, and particular cultures, what the norms might be, or the expectations. It gets complicated when women are single and they have HIV and the stigma of HIV might also play a part in that relationship.
EV: I was thinking your group started this study because there's a clear relationship between past abuse and addiction, HIV infection, and other concerns.
KM: Mardge had looked at the connection [of abuse, substance use, and race] to antiviral therapy in a study she did. In terms of WIHS, you ask questions and you get a sense of how much abuse has happened. In collaboration with the Boston University group, we started this study to have women do these biographical narratives. When the women started to tell their stories in an unscripted way, it was just incredible how many women had horrifying experiences as early as childhood and then beyond. We felt this was something to be aware of, and if you're not working with women closely you don't have an appreciation of how difficult these women's lives really are.
For us, on some level, people laugh. It's like, "Duh, stress is a bad thing. Abuse is a bad thing." But nobody ever really believes you until you show it.
EV: It needs to be documented.
Vulnerability and Empowerment: At the International AIDS Conference, an Examination of Sexual Abuse and Violence Against Women -- and Men
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