Fear of violent consequences and condom use among women attending an STD clinic

Intimate partner violence (IPV) has been associated with risk for HIV infection. This cross-sectional study tested the hypothesis that fear of violent consequences when negotiating condom use mediated the relation between IPV and condom use. Participants (n = 478) were recruited between March 1, 2004 and June 30, 2006 from a public clinic that treats sexually transmitted diseases in upstate New York as part of a randomized controlled trial. They completed an audio, computer-assisted, self-administered questionnaire with items on risky sexual behavior, intimate relationships, and related covariates and confounding variables. Seventeen percent of the sample reported IPV in the past three months. Recent IPV was associated with fear of violent consequences to requests for condom use, and such fear was associated with inconsistent condom use. Women who reported IPV also reported greater difficulties in negotiating safer sex behaviors with their abusers. So fear of violent consequences appeared to hinder their ability to protect themselves against HIV infection. The results were consistent with fear of violent consequences mediating the relationship between IPV and condom use. Health care providers involved in HIV prevention and sexual risk reduction interventions need to address IPV and, more specifically, fear of IPV when negotiating safer sex as part of their services for providing more comprehensive care to the women they serve.