Which Traumas Proliferate and Intensify COVID-19 Stressors? The Differential Role of Pre- and Concurrent Continuous Traumatic Stressors and Cumulative Dynamics in Two Communities: USA and Syria

Using the continuous traumatic stress type III paradigm, the current study aimed to explore the proliferation of previous and concurrent continuous type III traumas to COVID-19 stressors. In two samples from the USA (N = 745) and the Syrian internally displaced (N = 891), we used COVID-19 stressors and cumulative trauma measures. Childhood adversities and intersected discrimination predicted higher COVID-19 stressors in the American sample. Intergroup conflict, intersected discrimination, and chronic, life-threatening health conditions predicted higher COVID-19 stressors in the Syrian sample. Cumulative trauma in both samples predicted higher COVID-19 stressors and accounted for slightly higher variance. The conceptual and clinical implications were discussed. © 2022 Taylor & Francis Group, LLC.

PILOT OF AN INDEPENDENT DOMESTIC AND SEXUAL VIOLENCE ADVOCATE (IDSVA) INTEGRATED WITHIN A CENTRAL LONDON SEXUAL HEALTH (SH) AND HIV SERVICE DURING COVID-19: 15 MONTHS OF DATA

Introduction During the COVID-19 pandemic and lockdowns, large increases in domestic abuse (DA) were reported1. A pilot project to evaluate the utility of a dedicated sexual health IDSVA was undertaken in a larger inner-city SH/HIV service. Methods Commissioners were approached with data highlighting high numbers of high-risk DA identified within SH. Funding to pilot an integrated Sexual health IDSVA was obtained. The pilot ran between August 2020 - November 2021. Referrals were made to the IDSVA by clinic staff who identified DA victim/survivors during routine enquiry. Results 121 referrals were received, of which 118 were accepted and 82% risk-assessed. Majority were cis-female (80%), heterosexual (81%) and aged 25-34yrs (37%). Five patients were aged under 18. 40% were for DA, 28% for SA, 22% for both DA/SA. 32% were assessed as high risk of harm. 44% was from ex-partner and 14% acquaintances. 21 cases involved child safeguarding considerations. IDSVA roles included face-to-face and telephone assessments, safety planning, arranging refuge, social care/safeguarding referrals, signposting and training/support for SH staff. Discussion Significant numbers of patients with complex safeguarding needs, at high risk of harm were identified within sexual health, engaged with, and were supported by the SH IDSVA. Patient acceptability was reflected by the high uptake of IDSVA support (88%). IDSVA expertise and support freed up clinic staff time and resources.

Domestic abuse screening in people living with HIV

Background: In 2019, 2.4 million adults reported domestic abuse (DA) in the UK. During the COVID-19 pandemic, DA organisations saw an increase by 25% in calls, and 150% in access to information online (Source: ONS). There is increasing evidence of DA in PLWH, with correlation to poor health outcomes including death. Studies have specifically reported on DA screening in PLWH, showing female heterosexuals as predominantly affected. BHIVA recommends asking about previous or current intimate partner violence at initial assessment, and six monthly. We aimed to improve routine DA routine inquiry of PLWH at a London HIV service and determine the DA prevalence in PLWH. Method: All clinicians conducting consultations were asked to routinely ask PLWH about DA. All staff were trained on how to screen and manage DA cases, including national guidance from BASHH. Weekly reminders with DA screening rates were circulated, with continued support and encouragement to continue asking. Disclosures were referred to health advisors, and reviewed by the safeguarding team. Results: Routine DA screening improved from an average of 8% (range 0-19%) pre-lockdown (3148 asked from 10/2019-02/ 2020), to 33% (range 0-56%) post-lockdown (2530 asked from 03/2020-09/ 20202) (figure 1). 17 patients (0.3%) reported DA. 59% were male, of whom 70% homosexual, 53% Caucasian and 47% Black African-Caribbean. Non-British Caucasians accounted for 60% of all those that reported DA. Pre-lockdown 35% (6/17) disclosed DA, rising to 65% (11/17) post-lockdown. 89% were asked twice before disclosure, one was asked four times. Conclusion: Routine DA screening for PLWH by clinicians within the HIV service improved from 8% to 33%, peaking at 56%. The increase in screening, almost doubled DA disclosure. The majority did not disclose on first DA inquiry. Education and training, with weekly continued support and encouragement were the main interventions used to drive improvement. The majority of DA survivors in PLWH were homosexual Caucasian males, different to previous studies. Screening needs to be a continuous process, with everyone being asked, if we are to truly impact preventing the consequences of DA. (Table Presented).