Sexual violence against women living with or at risk for HIV infection

This study investigates factors associated with sexual violence against adult women living with and at risk for HIV infection.

Women at least 18 years old and living in Rhode Island or southeast Massachusetts enrolled from 1987 to 1992 in a cohort study of heterosexual HIV risk. A total of 408 women provided interviews on lifetime experiences of rape and HIV-related risk exposures. Data are presented on 96 women reporting experiences with rape as adults, and 231 women who reported never experiencing rape or forced sex.

Lifetime prevalence of sexual abuse was 43%. Over half occurred during adulthood. Thirty-five percent of women with HIV were raped as adults. Among women with HIV, adult rape experiences were associated with earlier age of first sex, more sexual partners, unprotected sex involving drugs, earlier age of injection drug use, teen pregnancy, STDs, and serious gynecologic surgery than those reporting they were never raped (prevalence odds ratios ranged from 2.8 to 11.2). Among women without HIV, adult rape was associated with similar experiences, although with some exception, the relative odds estimates were less pronounced. Women engaged in sex work were more likely to report rape.

The high prevalence of rape reported in this cohort of mostly economically poor women living with and at risk for HIV infection is consistent with other studies. Economic and social vulnerability that frames HIV risk and subsequent infection in women includes rape. Clinicians caring for women with HIV and counseling women at risk for infection need to screen routinely for sexual abuse.