CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: Baseline survey data were analyzed for WLWH (≥16 years) enrolled in a community-based research cohort study in British Columbia, Ontario, and Québec. GBV was assessed through self-report of ever experiencing physical, sexual, emotional, or verbal abuse in adulthood (>16 years). Multivariable logistic regression identified socio- demographic, clinical and psychosocial factors associated with having experienced any adulthood GBV, and each type of violence separately. Results: Of 1320 participants, the median age was 43 (IQR=36-51) years; 22% identified as Indigenous, 28% African, Caribbean or Black (ACB), 42%White, and 8% other. Most (80%) women reported experiencing any adulthood GBV, including physical (62%), sexual (43%), verbal (73%), and emotional (46%). In adjusted analyses (n=1241), women who had ever experienced GBV had higher odds of marginalization across social axes, including: incarceration history (AOR: 6.03, CI: 3.47, 10.45), food insecurity (AOR: 2.96, CI: 1.48, 5.93), racial discrimination (AOR: 1.03, CI: 1.01, 1.05), and older age (1.02, 95% CI: 1.00, 1.04). GBV was associated with increased odds of substance use: recent cannabis use (AOR: 7.33, CI: 1.71, 31.47), current cigarette use (AOR: 4.31, CI: 2.50, 7.44) and past 3 months recreational drug use (AOR: 4.08, CI: 1.18, 14.07). GBV was associated with increased odds of poor health: previous cancer diagnosis (AOR: 3.66, CI: 1.55, 8.61), Hepatitis C co-infection (AOR: 2.48, CI: 1.64, 3.75), sub-optimal antiretroviral adherence (<80% vs. >95%) (AOR: 2.31, CI: 1.11, 4.81), current post-traumatic stress disorder (AOR: 2.30, CI: 1.53, 3.45), and delayed access to HIV medical care after diagnosis (AOR: 2.22, CI: 1.40, 3.53). Correlates varied for each type of violence. Sexual violence was associated with lower income, depression, Hepatitis B, gender discrimination, and sharing needles/syringes. Physical violence was higher among participants who were Indigenous, had lived in a group home, and had a history of sharing needles/syringes. Emotional violence was associated with HIV- related stigma. Conclusion: Most (80%) WLWH experienced violence in adulthood. Violence was associated with social marginalization and poorer clinical and psychosocial outcomes, demonstrating the need to address and screen for GBV in HIV care. 926 TRANS WOMEN WITH HIV IN CANADA: RESULTS OF A NATIONAL COMMUNITY-BASED COHORT STUDY Ashley A. Lacombe-Duncan 1 , Yasmeen Persad 2 , Greta R. Bauer 3 , Carmen H. Logie 1 , Angela Kaida 4 , Alexandra de Pokomandy 5 , Nadia O’Brien 5 , Mona Loutfy 6 , for the CHIWOS ResearchTeam 1 Univ of Toronto, Toronto, ON, Canada, 2 The 519, Toronto, ON, Canada, 3 Western Univ, London, Ontario, Canada, 4 Simon Fraser Univ, Vancouver, Canada, 5 McGill Univ, Montreal, Canada, 6 Women’s Coll Rsr Inst, Toronto, Ontario, Canada Background: Globally, transgender (trans) women are disproportionately affected by HIV. Drivers of HIV vulnerability, including gendered stigma and discrimination, poor social determinants of health (SDoH), and violence have been well documented. Less is known about the experiences of trans women with HIV in Canada. Our study’s purpose was to compare SDoH including healthcare access and mental health outcomes between trans and cisgender (cis) women living with HIV in Canada. We hypothesized that poor SDoH and HIV-related healthcare access would be higher among trans women with HIV compared to cis women with HIV in Canada. Methods: We analysed baseline survey data from the Canadian HIV Women’s Sexual and Reproductive Health Study (CHIWOS), a multi-province (British Columbia, Ontario, Quebec), community-based cohort study. We computed descriptive statistics and compared distribution among trans (n=53) and cis (n=1362) women using chi-square and ANOVA. Results: Transgender (trans) women in CHIWOS reported a mean age 41 years (SD=10). Most were heterosexual (57%), and born in Canada (71%), while ethnicity was Indigenous (36%), White (36%), Other ethnicity (20.8%) and Black (7.5%). Similar to cis women, many reported clinical depression (44%), PTSD (44%), past incarceration (45%), and food insecurity (64%). Compared to cis women, more trans women reported a household income <$20,000/year (92% vs. 64%,p<.001), unstable housing (25% vs. 10%,p<.001), current use of recreational drugs (45% vs. 17%,p<.001), sex work for income (9% vs. 2%,p<.05), childhood violence (88 vs. 68%,p<.001), and never accessing HIV healthcare (8% vs. 3%,p<.05). Over 80% of trans women reported sometimes/many times being made fun of or called names for being trans, hearing that trans people were not normal, and being fetishized sexually because they were trans. Conclusion: These descriptive findings highlight a multitude of factors across the SDoH that shape the health and wellbeing of trans women with HIV in Canada, including economic insecurity, mental health issues, violence, and stigma, adding to the growing body of literature about trans women and HIV globally. These findings inform an urgent need to work with multiple stakeholders (e.g., trans women, organizations, government) in order to address SDoH disparities and health outcomes for trans women with HIV. 927 THE HEALTH IMPACT OF SEXUAL VIOLENCE AMONG WOMEN IN A PLATINUM MINING BELT Meiwen Zhang 1 , Sarah Jane Steele 1 , Amir Shroufi 1 , Gilles van Cutsem 1 , Junaid Khan 2 , Garret Barnwell 2 , Julia Hill 1 , Kristal Duncan 1 1 MSF, Cape Town, South Africa, 2 MSF, Rustenburg, South Africa Background: Physical and sexual intimate partner violence (IPV) and forced-sex or sexual acts by non-partners (NP-rape) are common in South Africa. Access to effective medical services for survivors, such as post exposure prophylaxis (PEP) for HIV prevention and sexually transmitted infections (STIs), counseling and social services is often severely limited by individual (e.g. awareness) and service-level factors (e.g. location), leaving health consequences of rape and IPV largely unaddressed. Rustenburg Municipality (RM) is South Africa’s platinummining capital and one of Africa’s fastest growing cities, with a population of 301,795 men and 247,780 women living in informal settlements near the mines. We quantified the prevalence of IPV and NP-rape in this setting, and estimated the associated disease burden. By considering this alongside levels of access to services, we describe the extent to which opportunities to address this disease burden are realized. Methods: Cluster-randomized household survey of women 18-49 years living in RM conducted (Nov– Dec, 2015) to determine the prevalence of IPV and NP-rape. We used WHO estimates of disease risk to determine population attributable fractions (PAF) and applied the PAFs to the population distribution (2011 Statistics SA Census) and local disease prevalence estimates obtained through literature review to determine burden of disease. Results: Eighty-five percent (n=882) of eligible women participated. Lifetime prevalence of IPV was 45% – >82000 women. Lifetime prevalence of NP-rape was 18% – >28000 women and girls. Very few sought care – 5% told a health care professional about their experiences, 4% a counselor, and 3% a social worker. Of the estimated 35,680 women in RM living with HIV, 6765 cases can be attributed to IPV (19%; Table 1). The burden of IPV on induced abortion is 1296. IPV resulted in 5022 major depression disorder (MDD) cases and 2 suicides. An additional 2012 MDD cases are attributed to NP-rape. Conclusion: IPV and NP-rape were extremely common among women and girls living in RM, contributing to a large disease burden, including 1/5 of HIV prevalence and more than 1/3 of major depressive disorders. Much of this disease burden could be prevented, through improved access to quality medical services including PEP for HIV and STI prevention, counseling and social services. Current low levels of access mean that this is not achieved, leaving major opportunities for improved health of this very vulnerable population unrealized.

Poster and Themed Discussion Abstracts

CROI 2017 401