Transcript HIV and Domestic Violence - Southeast AIDS Training and

HIV and Intimate
Partner Violence
Skills You Will Need When HIV Affects Women
Exposed to Violence
August 22, 2009
Presented by:
Neena Smith-Bankhead, MS
Director, Department of Education and Volunteer Services
AID Atlanta, Inc.
"I have no real or perceived vested interests
that relate to this presentation nor do I have
any relationships with pharmaceutical
companies, biomedical device manufacturers,
and/or other corporations whose products or
services are related to pertinent therapeutic
areas."
Neena-Smith-Bankhead, MS
August 22, 2009
Disclaimer
At the end of this session, participants will
be able to:
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Discuss the relationship between intimate
partner violence and HIV among women
Discuss HIV risk and prevention with women
presenting to Community Service Agencies
Review how HIV prevention counseling is
conducted, and provide other HIV-related
services for women
Provide appropriate HIV care and prevention
referrals for women exposed to violence
Session Overview
Women and HIV/AIDS
Women and HIV/AIDS
Women and HIV Overview
Women and HIV Overview
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Leading cause of Death for black
women ages 25-34
Women are more than ¼ of all new
HIV/AIDS Diagnoses
Women and HIV
CDC, 2009
Blood
Semen
Vaginal Fluids
Breast Milk
BODY FLUID +
Piercings
Cuts, Tears, or
Rips in Skin
Mucous
Membranes
CUT = HIV
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Unprotected sex (anal,
vaginal, or oral) with
infected partner
Sharing needles with
someone with HIV
During pregnancy, birth,
or breast-feeding from an
infected mother
Getting a blood
transfusion from a person
with HIV
HIV
Transmission
More About Needle
Sharing:
Steroid use
Tatooing
Drug Use
Physiology
 Lack of Control in Relationships
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◦ Communication with partner
◦ Lacking negotiation skills
◦ Infidelity in relationships
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Socioeconomic Issues
Role as Caregivers
Substance Use and Abuse
Recognition of risk in partners
Psychological Issues
HIV Risk Factors for Women
RISE Coalition Training Manual, 2009
Sex with older, riskier men (younger
women) who are less likely to use
condoms
 Trading sex for drugs or money – can
make more when condoms are NOT used
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Why Women Are At Additional
Risk
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HIV Positive Women at increased risk of
abuse
◦ Disclosing to partner may enhance or initiate
violence
◦ Partner notification can put women at additional
risk
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Women who are abused are at higher risk
of contracting HIV
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Substance use to cope
Relationships with substance users
Fear of requesting safer sex or saying ‘no’
Rape or sexual assault
Women, IPV and HIV
“Violet’s
Story”
told by
an HIV
Case
Manager
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Stigma
◦ Gay disease
◦ Substance users
◦ “BAD” people
Fear of Getting tested/HIV Test Results
 Lack of Knowledge and Information about
HIV/AIDS and how it’s transmitted
 Lack of Knowledge and Information about
HIV Care and Treatment Services
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Challenges Addressing HIV in
Hard-to-Reach Communities
Considerations for
Providers
Conducting Screening, Providing Prevention Counseling,
and Making Referrals
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Agency/Service Intake
◦ Screen for risk behaviors
◦ Screening for abuse could indicate HIV Risk
activity as well
Case Management/Mental Health Services
 Medical Services
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◦ Examinations
◦ Sexual History
◦ Risk Assessment
When to Talk about HIV Risk?
Qualities of a Good
Motivational Interviewer
Accurate Empathy
Motivational
Interviewing
Respect
Warmth
Genuineness
Immediacy
Concreteness
Conclusive
Screening and Assessment
An intervention designed to help
individuals make behavior
changes that will reduce their risk
of acquiring or transmitting HIV
HIV Prevention Counseling
CDC, 2008
… communication, both verbal and nonverbal, made in
response to and in the presence of feelings.
… “client-centered” — that is, it is tailored to the
behaviors, circumstances, and special needs of the
person being served
… not solving the client’s problem for her/him or giving
advice; the counselor brings a set of skills to the
interaction that can enable the client to reach a better
understanding of the problem, deal with her/his related
feelings and concerns, and assume responsibility for
evaluating alternatives and making choices
HIV Prevention Counseling
CDC, 2008
HIV Prevention Counseling Steps
◦ Introduce and orient client to session
◦ Identify client risk behaviors and
circumstances
◦ Identify safer goal behaviors
◦ Develop action plan
◦ Make referrals and provide support
◦ Summarize and close the session
Prevention Counseling Steps
CDC, 2008
Introduce self
 Explain what will happen in this session
 Assess comfort and readiness to discuss
risk behaviors and activities
 Consent forms
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Step #1: Introduce and Orient Client
to Session
CDC, 2008
What risk activities is client engaging in
and when are these activities likely to
occur
 Address triggers or vulnerabilities that
lead to the client engaging in these
activities (Circumstances)
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Step #2: Identify client risk behaviors
and circumstances
CDC, 2008
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Discuss specific behaviors that directly prevent or
greatly reduce HIV transmission; harm reduction
Discuss with client goals that they want to
accomplish
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With which partners
In what settings
Under what circumstance
During what time periods; how often
Address behaviors that client is likely to
accomplish
Step #3: Identify safer goal
behaviors
CDC, 2008
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Develop a realistic, specific action plan to
help the client adopt the safer goal
behavior
◦ Support the changes that have already taken
place or have been attempted
◦ Discuss contributing factors that support or
hinder ability to implement an action
◦ Discuss benefits and barriers to
implementing new behaviors
Step #4: Develop Action Plan
CDC, 2008
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Refer to known and trusted resources
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Ensure that the client can access the
referral and help to eliminate any barriers
Step #5: Make Referrals
CDC, 2008
Briefly review highpoints of session,
including action steps and referrals
 Reminds the client of actions that they’ve
decided on and agreed to try
 List contracts or commitments for risk
reduction, referrals, and next steps
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Step #6: Summarize and Close the
Session
CDC, 2008
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Assess practice and
knowledge of current
prevention strategies
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Encourage methods of
HIV prevention that
can be used without
partner’s participation
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Communication
strategies
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Consider multiple
prevention options,
not only condom
use (harm
reduction)
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Workshops/
programs that
address gender,
power, and control
in relationships
Prevention Counseling
Focus on Feelings
Manage Your Own Discomfort
Set Boundaries
Counseling Concepts for
Prevention Counseling
CDC, 2008
Open Ended Questions
◦ Questions that require more than a ‘yes’ or ‘no’ response
 Attending
◦ Attending means physically showing the client that you are
listening. This means using positive nonverbal
communication.
 Offer Options, not Directives
◦ Often sets up a power struggle between counselor and
client.
◦ Can be avoided by giving the client firm control over change
decisions
 Give Information Simply
◦ use simple, non-technical words
◦ be brief and to the point
◦ address client needs specific to their concerns
◦ saying “I don’t know” is okay
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Basic Counseling Skills
CDC, 2008
HIV Counseling and Testing
N. Smith-Bankhead, 2009
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Rapid (15-20 minutes)
Conventional Testing (1-2 Weeks)
Free or Discounted
Non-Profit Agencies or Medical Facilities
Community Settings for Testing
Blood or Oral Solution
HIV Counseling and Testing
N. Smith-Bankhead, 2009
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What response would you anticipate from
your partner if he or she were notified of
possible exposure to HIV?
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What would you do if you were diagnosed
HIV positive/negative?
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Who knows you are here? What Support
systems do you have?
Assessing for Readiness for HIV
Counseling and Testing
N. Smith-Bankhead, 2009
Disclosure and Partner Notification
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Avoid exposing others to HIV without warning them ahead
of time.
The risk of violence may be greater if a person feels you
knowingly put them at risk or lied to them.
Disclose in a semi-public place like a public park with many
people around. It's private enough to have a conversation,
public enough to get help if you need it.
Consider disclosing with a third person present, like a
friend or a health professional.
If you feel at all threatened by the reaction you get, keep
meetings public for a few weeks.
The Well Project, Website, 2003-2006
HIV Counseling and Testing
Tips for Disclosing
Resources for HIV
Care/Prevention
Types of Resources or Referrals Needed
Effective Referrals
Help client define priorities
Discuss and offer options
Offer referrals
Refer to known and trusted services
(MOU’s that outline duties)
Assess client response to referral
Facilitate active referral
Develop a follow-up plan
(include referral sources in plan)
Making Referrals
CDC, 2008
Connecting with National, Regional, and Local Coalitions and
Collaboratives
◦ Helps to maximize access to resources available in your
area
◦ Also provides hints and tips on how to place hard-toplace clients
Know the treatment and care philosophy of the agency being
referred to
◦ Ensure that the needs of your client can be met by that
agency
◦ Very supportive vs. hard-line mentality
Best Practices for Resource
Development
N. Smith-Bankhead, 2009
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Ensure that your client is ready to make change and
accept your referral
◦ You can’t force change if a person is not ready for it or willing to accept it
◦ Transtheoretical Model (Stages of Change)
 Precontemplation - lack of awareness that life can be improved by a
change in behavior;
 Contemplation - recognition of the problem, initial consideration of
behavior change, and information gathering about possible solutions and
actions;
 Preparation - introspection about the decision, reaffirmation of the need
and desire to change behavior, and completion of final pre-action steps;
 Action - implementation of the practices needed for successful behavior
change (e.g. exercise class attendance);
 Maintenance - consolidation of the behaviors initiated during the action
stage;
 Termination - former problem behaviors are no longer perceived as
desirable (e.g. skipping a run results in frustration rather than pleasure).
Best Practices for Making a Referral
Case Management
 Legal Assistance
 Education/Information
 Medical Care
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◦ OB/GYN and STD Care
Housing (especially if in DV situation)
 Mental Health Services
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◦ Social/Emotional Support
◦ PTSD/Trauma care
Care Services for HIV+ Women
N. Smith-Bankhead, 2009
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Recognize risk activities and behaviors
◦ Ask questions at intake and check in
throughout relationship
Assist client in coming up with a plan and
prioritizing needs
 Consider financial needs and resources financial empowerment of women
 Consider children
 Get signed releases of information
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Case Management
N. Smith-Bankhead
During sexual history, ask questions
 Observe for discomfort
 Get signed release of information for
follow up
 Document physical abuse or rape
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◦ Take pictures, write statements, police reports
Primary Medical Care
N. Smith-Bankhead
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For HIV+ and HIV- Women
◦ Workshops/Programs
◦ One-on-One Prevention
◦ Focus on behavior change; community
support; empowerment
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Testing
◦ For women and their partners
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STD Screening and Treatment for STDs
◦ For women and their partners
Prevention Services
SEATEC Key Contacts Booklet
http://www.seatec.emory.edu/keycontacts/
National AIDS Hotline
1-800-CDC-INFO (1-800-232-4636)
TTY: 1-888-232-6348
Hours: 24 hours a day, 7 days a week
E-mail: [email protected]
GA AIDS/STD Hotline
1-800-551-2728
National Association of People With
AIDS Hotline
1-240-247-0880
Hours: Monday - Friday 9:00 am to 5:30 pm
(Eastern Time)
For More Information
Neena Smith-Bankhead
AID Atlanta, Inc.
[email protected]
404-870-7747
Thank You!