Nichelle Lewis, MHSA, Ijeamaka Okoye, MPH & Nkem Osian, MPH

1. Understanding The Intersection Between Intimate Partner Violence and HIV: Providing Access to Healthcare Resources December 12, 2018 Nichelle Lewis, MHSA, Ijeamaka Okoye, MPH & Nkem Osian, MPH Division of Community HIV/AIDS Programs (DCHAP) HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA)

2. Health Resources and Services Administration (HRSA) Overview • Supports more than 90 programs that provide health care to people who are geographically isolated, economically or medically vulnerable through grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities • Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care

3. HIV/AIDS Bureau Vision and Mission Vision Optimal HIV/AIDS care and treatment for all. Mission Provide leadership and resources to assure access to and retention in high quality, integrated care, and treatment services for vulnerable people living with HIV/AIDS and their families.

4. Ryan White HIV/AIDS Program • Provides comprehensive system of HIV primary medical care, medications, and essential support services for low-income people living with HIV • More than half of people living with diagnosed HIV in the United States – more than 550,000 people – receive care through the Ryan White HIV/AIDS Program (RWHAP) • Funds grants to states, cities/counties, and local community based organizations • Recipients determine service delivery and funding priorities based on local needs and planning process • Payorof last resort statutory provision: RWHAP funds may not be used for services if another state or federal payer is available • 84.9% of Ryan White HIV/AIDS Program clients were virally suppressed in 2016, exceeding national average of 59.8% Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2016; CDC. HIV Surveillance Supplemental Report 2016;21(No. 4)

5. Today’s Presentation • HRSA HIV/AIDS Bureau • HRSA Office of Women’s Health • IPV Pilot Projects • IPV Health Partners Toolkit • Project Catalyst • The HRSA Strategy to Address IPV • Panel Discussion

6. Panelists • Dr. Sandra Ford DeKalb County Board of Health • Reginald Vicks New Orleans AIDS Task Force • Christina Lachance HRSA’s Office of Women’ s Health • Jane Segebrecht HRSA’s Office of Women’ s Health

7. Objectives • Understand the relationship between IPV and HIV and recognize the 4 priorities of HRSA's Strategy to Address IPV • Identify tools that RWHAP providers can use to address IPV in the healthcare setting • Recognize the power of partnerships in addressing IPV both at the federal level and in community-based settings

8. What is Intimate Partner Violence? Sexual Violence Psychological Aggression Stalking Physical Violence

9. Shedding A Light on the Intersection Between IPV and HIV Women and men who report a history of IPV are more likely than those who do not to report the following behaviors known to increase the risk for HIV: • Forced sex with an infected partner • Limited or compromised negotiation of safer sex practices • Increased sexual risk-taking behaviors • Injection drug use • Giving or receiving money or drugs for sex 1. Intersection of Intimate Partner Violence and HIV in Women, Centers for Disease Control and Prevention fact sheet.

10. Intersection Between IPV and HIV

11. IPV & HIV • HIV-positive women in the United States experience IPV at rates that are higher than the general population. • Across a number of studies: • Rate of IPV among HIV-positive women (55%) was double the national rate • Rates of childhood sexual abuse (39%) and childhood physical abuse (42%) were more than double the national rate.1 • IPV is associated with lower ART use, half the odds of self-reported ART adherence and significantly worsened viral suppression among women. 2 Machtinger et al. (2012a). Psychological trauma and PTSD in HIV-positive women: A meta-analysis. AIDS and Behavior16(8), 2091-2100. Hatcher AM, Smout EM, Turan JM, Christofides N, Stöckl H. Intimate partner violence and engagement in HIV care and treatment among women. AIDS. 2015;29(16):2183-2194. doi:10.1097/qad.0000000000000842.

12. IPV Among Other HIV Populations • Men who have sex with men (MSM), particularly within communities of color are among the U.S. populations with the highest incidence of HIV. • Trauma in the form of childhood sexual abuse is especially common among HIV-positive MSM. • History of trauma is common among MSM and other PLWH such as LGBTQ and transgender. 1. National LGBT Health Education Center (2017). Providing Trauma-Informed Care at Health Centers for HIV-Positive Men Who Have Sex with Men, The Fenway Institute,

13. Intimate Partner Violence as a Barrier to HIV Care and Treatment

14. Contact Information Nkem Osian Division of Community HIV/AIDS Programs (DCHAP) HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA) Email: nosian@hrsa.gov Phone: (301) 443-2751 Web: hab.hrsa.gov

15. The HRSA Strategy to Address Intimate Partner Violence Christina Lachance, MPH and Jane Segebrecht, MPH HRSA Office of Women’s Health December 12, 2018

16. The Office of Women’s Health https://www.hrsa.gov/about/organization/bureaus/owh/

17. FY18 Focus Areas

18. IPV and Health Source: Futures Without Violence Webinar 10/21/2015

19. An Opportunity to Address IPV

20. Community Health Center Pilot Projects The pilots assisted health centers, including dually funded Ryan White sites, in the implementation of a comprehensive approach to screening and counseling for IPV and create formal linkages to community social service organizations HHS Partners • Administration for Children and Families • HRSA Office of Women’s Health • HRSA Bureau of Primary Health Care • HHS Office on Women’s Health (Phase I) • Office of Adolescent Health (Phase II) Technical Assistance Partner • Futures Without Violence Photo Credit -- La Clínica Del Pueblo Futures Without Violence Webinar 10/21/2015

21. Health Center and Social Service SitesPhase I and II: 20 Partner Locations Brockton Neighborhood HC Family and Community Resources Family Care HC Branches DV Shelter Eastern Iowa HC AMANI Rhinehart Clinic Tillamook County WRC Thundermist HC Sojourner House CommuniCare HC Empower Yolo La Communidad Hispana DV Center of Chester County La Clinica Del Pueblo DC Safe Mariposa Community HC Catholic Community Services Family Oriented Primary Care Clinic Penelope House 5 Red Pin: Community Health Center Blue Pin: Social Service Site Partner

22. Futures Without Violence Virtual Toolkitipvhealthpartners.org 3 An online toolkit specifically developed for health centers by health centers

23. CUES Evidence Based Intervention • Confidentiality • Universal Education • Empower • Support 3 Source: http://ipvhealthpartners.org/adopt/

24. Project CatalystStates Leading Transformation for Health and Intimate Partner Violence • Leadership Teams: Arkansas, Connecticut, Idaho, Iowa • Primary Care Associations • State Departments of Health • State Domestic Violence Coalitions • Learning collaborative • Train-the-trainer model • Promote policy and systems changes to improve the response to human trafficking and IPV in community health centers and domestic violence programs

25. Project CatalystStates Leading Transformation for Health and Intimate Partner Violence

26. Available at: https://www.hrsa.gov/sites/default/files/hrsa/HRSA-strategy-intimate-partner-violence.pdf

27. The HRSA Strategy to Address IPV 4 Priorities 10 Strategic Objectives 27 Collaborative Activities 14 Bureaus & Offices

28. Activity Implementation Status – Oct 2018 3 24 27 Total Activities In Progress Completed

31. https://www.integration.samhsa.gov/clinical-practice/intimate-partner-violencehttps://www.integration.samhsa.gov/clinical-practice/intimate-partner-violence

34. Reach

35. Contact Information Jane Segebrecht, MPH Strategic Initiatives & Innovation Lead Office of Women’s Health HRSA/HHS jsegebrecht@hrsa.gov Christina Lachance, MPH Senior Advisor Office of Women’s Health HRSA/HHS clachance@hrsa.gov

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