Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada

Transcription

1 Physical and Sexual Violence Linked to Increased Incarceration Among Women Living with HIV in Metro Vancouver: Need for Trauma-Informed HIV Care in Prisons and Post-Release Margaret Erickson 1, Neora Pick 4, Flo Ranville 1, Ruth Elwood Martin 3, Melissa Braschel 1, Mary Kestler 4, Andrea Krüsi 1, Kate Shannon 1,2, on behalf of the SHAWNA Project 1 Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada 2 Faculty of Medicine, University of British Columbia, Vancouver, Canada 3 School of Population and Public Health, University of British Columbia, Vancouver, Canada 4 Oak Tree Clinic, BC Women s Hospital and Health Centre, Vancouver, Canada

2 Longitudinal community-based research (CBR) project Sexual Health and HIV/AIDS: Women s Longitudinal Needs Assessment Eligibility: Women (Trans inclusive) living with HIV who reside or access services in Metro Vancouver, 14 years of age or older Recruitment through outreach by Peer Researchers, women HIV care providers (e.g. Oak Tree Clinic), ASOs, posters, self-referrals, social media Baseline and semi-annual interview-administered questionnaires by Peer/community interviewers: Women s experiences navigating HIV care, community supports, sexual and reproductive health, and treatment outcomes Clinical component including VL/ CD4 by sexual health research nurses to facilitate education, support, referrals at baseline & semi-annual visits Qualitative research & photo-voice with sub-set of women and trans persons Funded by CIHR ( ), CIHR CBR ( ), Vancouver Foundation, & MacAIDS, PIs: Shannon & Krüsi

3 SHAWNA Community Advisory Boards SHAWNA Positive Women s Advisory Board SHAWNA Community Advisory Board

4 Incarceration Women & HIV: Canadian Context 50% increase of federally incarcerated women between in Canada (The Correctional Investigator Canada, 2015) Racialized women overrepresented among women living with HIV (Public Health Agency of Canada 2014) and within the criminal justice system (Statistics Canada 2011) Women who are incarcerated at a federal level are more likely to report living with HIV compared to men (7.9% vs 4.5%) (Correctional Service of Canada, 2010)

5 Gender-Based Gaps in HIV Outcomes for WLWH In Canada incarceration has been linked to reduced medication adherence and retention in care for marginalized populations (Lin 2016; Milloy, 2011) SHAWNA findings indicate that for WLWH recent incarceration is linked to reduced odds of viral suppression (Erickson et al., forthcoming) These findings are echoed in the United States where WLWH experience worse HIV related health outcomes post-incarceration compared to men WLWH less likely to achieve VL suppression following release from prison (J. Baillargeon et al. 2009; J. G. Baillargeon et al. 2010; Beckwith et al. 2017; Spaulding, Messina, et al. 2013; Jaimie P. Meyer et al. 2014) WLWH less likely to be engaged in care compared to men, postincarceration (Althoff et al. 2013; Booker et al. 2013; Jaimie P. Meyer et al. 2014; Pai et al. 2009; Williams et al. 2013; Teixeira et al. 2015). Limited understanding of factors associated with incarceration among WLWH.

6 Statistical Analyses Longitudinal community-based data from SHAWNA cohort ( , baseline & 6 month follow-up visits) Time-Updated Outcome: Recent Incarceration, defined as being held overnight or longer in jail or prison in the last 6 months Independent Variables: time-fixed (i.e., socio-demographics characteristics), or time-updated (to reflect occurrences within the past 6 months) 289 WLWH included in analysis, descriptive statistics stratified by those who reported recent incarceration Multivariable logistic regression using generalized estimating equations (GEE) and a working correlation matrix was used to prospectively model correlates of recent incarceration exposure over the six-year period.

7 Results Among 289 WLWH, 76% had been incarcerated in their lifetime 17% of WLWH had been incarcerated over the follow up period ( ) Median age 43 years 57% identified as Indigenous, 31% as White, 12% as African/Caribbean/Black or other ethnic minority 11% of participants identified as transgender 23% of experienced recent homelessness and 50% reported recent injection drug use 93% WLWH had experienced lifetime physical and/or sexual violence, 19% reported recent physical and/or sexual violence 21% experienced lifetime physical and/or sexual violence from police

8 Multivariate Analyses: In multivariable GEE (adjusted analyses) factors correlated with recent incarceration: Younger Age (AOR= 0.92 per year older, 95% CI: ) Recent Homelessness (AOR: 2.81, 95% CI: ) Recent Opioid Use (AOR: 1.83, 95% CI: ) Recent Physical/Sexual Violence (AOR: 2.26, 95% CI: ) Lifetime exposure to physical and/or sexual violence by police (AOR: 1.97, CI: ) * *marginally correlated with increased odds of recent incarceration All variables time-updated (last 6mo as reference period)

9 Program & Policy Implications Women living with HIV are over criminalized Critical need for: Trauma-informed HIV care practices during and after prison. Foster collaborative, transparent, trusting, and supportive interactions with WLWH (Brezing et al 2015): (1) realizing the high rates of trauma (2) recognizing the effect of trauma on patients and providers (3) responding appropriately to trauma. Women-specific release plans that address intersection of gender-based violence, housing stability and substance use

10 Thank You! On Behalf of SHAWNA Project Questions:

11 SHAWNA Project Team PI: Dr. Kate Shannon co-pi: Dr. Andrea Krüsi Site PI: Dr. Mary Kestler, Oak Tree Clinic Sarah Moreheart, Coordinator; Brittany Udall, Assistant Coordinator Flo Ranville, Peer Mentor, PRAs & Interviewers: Lulu Gurney, Barb Borden, Sexual Health Research Nurses: Bridgette Simpson, Anita Dhanoa, Roisin Ban Heather, Emily Sarah Leake, Gail Madanayake, Anna Mathen Dr. Neora Pick, Oak Tree Clinic Dr. Putu Duff, GSHI Dr. Charlotte Loppie, Indigenous Health Centre, UVIC Dr. Gina Ogilvie, BC Women s Dr. Carmen Logie, UofT Dr. Deborah Money, BC Women s/ UBC Dr. Jeannie Shoveller, UBC, BCCfE Dr. Kathleen Deering, GSHI/ UBC Dr. Evan Wood, BC-CfE/ BCCSU Dr. Julio Montaner, BC-CfE Jill Chettiar, GSHI Dr. Sylvia Guillemi, BC-CfE/ IDC Dr. MeiLing, Bridge Clinic, GSHI Students/ RAs/ Fellows: Daniella Barreto, Meaghan Thumath, Margaret Erickson, Ofer Amran

12 Key components of by gender-centred, trauma-informed care for women living with HIV/AIDS Trauma-informed Care goals: Foster collaborative, transparent, trusting, and supportive interactions with WLWH. This can be done by educating all members of a HIV practice setting on the 3 R s, which include (Brezing et al 2015): (1) realizing the high rates of trauma (2) recognizing the effect of trauma on patients and providers (3) responding appropriately to trauma. Trauma-informed Care Principles: SAMHSA (Substance Abuse and Mental Health Services Administration) Safety Trustworthiness & transparency Peer support Collaboration and mutuality Empowerment Voice and choice Cultural, historical, and gender issues

13 SHAWNA Project Team PI: Dr. Kate Shannon co-pi: Dr. Andrea Krüsi Site PI: Dr. Mary Kestler, Oak Tree Clinic Sarah Moreheart, Coordinator; Brittany Udall, Assistant Coordinator Flo Ranville, Peer Mentor, PRAs & Interviewers: Lulu Gurney, Barb Borden, Sexual Health Research Nurses: Bridgette Simpson, Anita Dhanoa, Roisin Ban Heather, Emily Sarah Leake, Gail Madanayake, Anna Mathen Dr. Neora Pick, Oak Tree Clinic Dr. Putu Duff, GSHI Dr. Charlotte Loppie, Indigenous Health Centre, UVIC Dr. Gina Ogilvie, BC Women s Dr. Carmen Logie, UofT Dr. Deborah Money, BC Women s/ UBC Dr. Jeannie Shoveller, UBC, BCCfE Dr. Kathleen Deering, GSHI/ UBC Dr. Evan Wood, BC-CfE/ BCCSU Dr. Julio Montaner, BC-CfE Jill Chettiar, GSHI Dr. Sylvia Guillemi, BC-CfE/ IDC Dr. MeiLing, Bridge Clinic, GSHI Students/ RAs/ Fellows: Daniella Barreto, Meaghan Thumath, Margaret Erickson, Ofer Amran

14