{"id":1272,"date":"2017-03-30T16:00:05","date_gmt":"2017-03-30T15:00:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1272"},"modified":"2017-03-30T13:35:05","modified_gmt":"2017-03-30T12:35:05","slug":"health-interventions-can-change-systemic-and-cultural-determinants-of-stihiv-transmission","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/03\/30\/health-interventions-can-change-systemic-and-cultural-determinants-of-stihiv-transmission\/","title":{"rendered":"Health interventions can change systemic and cultural determinants of STI\/HIV transmission"},"content":{"rendered":"

The causal pathway linking intimate partner violence (IPV) and health may be two-way.\u00a0 We are used to thinking of IPV as a determinant of STI; but sexual health also has an impact on IPV. \u00a0This, at any rate, is the conclusion of a recently issued working-paper from the US National Bureau of Economic Research uniting a highly interdisciplinary team of researchers from a range of US universities and medical institutions.\u00a0 The researchers seek to demonstrate that health is kind of human capital, and that a technological advance in medicine can affect \u2018some of the most frustratingly persistent social problems\u2019.\u00a0 This finding will be particularly interesting to readers of this journal.\u00a0 Health, in the context of this study, happens to be sexual health, and the technological advance is the introduction of HAART in 1996.<\/p>\n

Papageorge & Pollack<\/a> (P&P) base their work on data from the Women\u2019s Intra-Agency HIV Study (WIHS), and compare a cohort of HIV+ women who were, in 1996, just beginning to experience immune system deterioration, with two control cohorts, using a \u2018difference in difference\u2019 approach.\u00a0 One control consisted in HIV+ women not experiencing such effects, another in HIV- women included in the same WIHS data.\u00a0 Much of the researchers\u2019 task consists in establishing the relative dependence\/independence of causal pathways linking IPV with drug use, perceived mental and physical health, and employment.\u00a0 Their headline finding is a c.10%<\/strong> reduction in IPV a c.15%<\/strong> reduction in IDU attributable to HAART introduction.<\/p>\n

The idea that the causative link could flow from STIs to IPV, as well as from IPV to STIs, may not be new to our readers.\u00a0 Indeed, an ongoing concern for sexual health interventions has been that STI\/HIV disclosure (a potentially important element of risk reduction) could result in domestic violence (Partner delivered STI self-testing (STI\/blogs)<\/a>). \u00a0This has not prevented other studies from pointing to a potentially positive role for sexual health clinics in relation to IPV (Lockart & McNulty (STIs)<\/a>; Decker and Silverman I (STIs)<\/a>; Decker & Silverman II (STIs)<\/a>).\u00a0 The nature of IPV itself is not always well understood, and probably varies with social and cultural context.\u00a0 For example, it is not restricted to short-term or casual relationships (Silverman & Raj (STIs)<\/a>), and may be reciprocal (Norris & Hindin (STIs)<\/a>) as well as man-on-woman.\u00a0 The nature of the causal link with HIV\/STI might be expected to vary with the nature of the IPV itself.<\/p>\n

So there is nothing new about the idea that a change in respect to sexual health could influence IPV.\u00a0 What P&P contribute to the debate is genuinely encouraging, for all that.\u00a0 Recent characterizations of the global efforts to curb the HIV epidemic (e.g. UNAIDS: On the Fast Track<\/a>) make a two-fold classification of interventions into, on the one hand, biomedical interventions such as PrEP or cART, and, on the other, vaguer, and longer-term non-biomedical interventions such as legislative or attitudinal change.\u00a0 The latter correspond to systemic or cultural determinants of sexual health that can seem to mark the ultimate limits on sexual health interventions rather than realistic targets for those interventions.\u00a0 However, P&P point in this report to the case of a biomedical intervention that would, for once, seem to have achieved something more than an immediate biomedical impact.\u00a0 HAART introduction, on P&P\u2019s interpretation, effectively provided an additional \u2018source of human value\u2019 \u2013 an enhancement of women\u2019s social \u2018capital\u2019.\u00a0 Thereby, it would seem to have impacted the fundamental social and cultural determinants of sexual health \u2013 those \u2018frustratingly persistent social problems\u2019 that constitute the constraints within which sexual health is normally compelled to operate.<\/p>\n","protected":false},"excerpt":{"rendered":"

The causal pathway linking intimate partner violence (IPV) and health may be two-way.\u00a0 We are used to thinking of IPV as a determinant of STI; but sexual health also has an impact on IPV. \u00a0This, at any rate, is the conclusion of a recently issued working-paper from the US National Bureau of Economic Research uniting […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16500,2783,16501],"tags":[],"class_list":["post-1272","post","type-post","status-publish","format-standard","hentry","category-cart","category-historical","category-intimate-partner-violence"],"yoast_head":"\nHealth interventions can change systemic and cultural determinants of STI\/HIV transmission - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/03\/30\/health-interventions-can-change-systemic-and-cultural-determinants-of-stihiv-transmission\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health interventions can change systemic and cultural determinants of STI\/HIV transmission - 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