A Psychometric Evaluation and a Framework Test of the HIV Stigma Mechanisms Scale Among a Population-Based Sample of Men and Women Living with HIV in Central Uganda.

HIV stigma is a critical barrier to HIV prevention and care. This study evaluates the psychometric properties of the HIV Stigma Mechanisms Scale (HIV-SMS) among people living with HIV (PLHIV) in central Uganda and tests the underlying framework. Using data from the PATH/Ekkubo study, (n = 804 PLHIV), we assessed the HIV-SMS' reliability and validity (face, content, construct, and convergent). We used multiple regression analyses to test the HIV-SMS' association with health and well-being outcomes. Findings revealed a more specific (5-factor) stigma structure than the original model, splitting anticipated and enacted stigmas into two subconstructs: family and healthcare workers (HW). The 5-factor model had high reliability (α = 0.92-0.98) and supported the convergent validity (r = 0.12-0.42, p < 0.01). The expected relationship between HIV stigma mechanisms and health outcomes was particularly strong for internalized stigma. Anticipated-family and enacted-family stigma mechanisms showed partial agreement with the hypothesized health outcomes. Anticipated-HW and enacted-HW mechanisms showed no significant association with health outcomes. The 5-factor HIV-SMS yielded a proper and nuanced measurement of HIV stigma in central Uganda, reflecting the importance of family-related stigma mechanisms and showing associations with health outcomes similar to and beyond the seminal study.

Perceived Barriers to HIV Care and Viral Suppression Comparing Newly Diagnosed Women Living with HIV in Rural Uganda with and without a History of Intimate Partner Violence.

Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial (n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1-2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0-2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0-2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL.

The Relationship Between Maternal Domestic Violence and Infant and Toddlers' Emotional Regulation: Highlighting the Need for Preventive Services.

In an effort to further understand the impact of domestic violence (DV) on infant and toddlers' development, this research utilized data from the second cohort of National Survey of Child and Adolescent Well-Being (NSCAW II) to examine the relationship between maternal DV and infant and toddlers' emotional regulation, and determine whether mothers' receipt of DV services mediated this relationship. The sample was limited to children aged 0 to 3 years and included (a) infants less than 1 year old (n = 603), (b) infants 1 to less than 2 years old (n = 310), and (c) toddlers 2 to 3 years old (n = 268). Infant/toddlers' emotional regulation was measured using mothers' response on the How My Infant/Toddler/Child Usually Acts questionnaire. In addition, data were collected to assess whether (a) active DV was present during the time of the Child Protective Services (CPS) investigation and (b) mothers received DV services during the past year. Study research questions were examined using a series of multiple regression analyses. Mediation was tested based on Baron and Kenny's recommended model for establishing mediation. The mediational model was not found to be significant; however, a positive relationship existed between maternal DV and emotional regulation among infants aged less than 1 year old (ß = 1.61, p = .039). There were no statistically significant relationships between DV and emotional regulation in the other age groups. These findings highlight the need to provide CPS-involved families victimized by DV with services that focus on preventing poor infant emotional regulation.

The Role of Acculturation and Intimate Partner Violence on Post-Traumatic Stress Symptoms Among Hispanic Youth With Child Welfare Contact.

Research suggests that Hispanic youth with intimate partner violence (IPV) exposure report fewer trauma symptoms compared with youth from other racial/ethnic groups. However, no study has examined possible explanations for this finding. Our objective was to study the association between acculturation, IPV, and post-traumatic stress (PTS) symptoms among Hispanic youth and to test whether acculturation moderates the relationship between IPV and PTS symptoms. This analysis used data from 271 Hispanic youth aged 8 years or older participating in the second cohort of the National Survey of Child and Adolescent Well-being (NSCAW II). We conducted multiple linear regression analyses to achieve our study aims. We did not find a statistically significant relationship between IPV exposure and PTS symptoms among Hispanic youth (B = 0.21, 95% confidence interval [CI] = [-0.09, 0.52]), or that acculturation moderated this relationship (B = 0.04, 95% CI = [-0.23, 0.32]). However, we found a significant relationship between PTS symptoms and acculturation level. Specifically, higher levels of acculturation were associated with more reports of PTS symptoms (B = 1.03, 95% CI = [0.13, 1.93]). These study results highlight the need to consider the role of acculturation when working with Hispanic youth involved with child welfare.

Domestic Violence and Sexual Assault Service Providers' Perspectives on Nigerian Immigrants' Domestic Violence Experiences.

We investigated 13 domestic violence (DV) and sexual assault agency directors' perspectives regarding Nigerian immigrants' experiences of violence, DV-related service needs, and best strategies for providing those needs. Directors across five U.S. states were surveyed. Descriptive analyses showed the most common DV types were controlling behavior and cultural/traditional. The most important DV support needs were informational, informal, and legal. Formal support from DV agencies, support groups, and law enforcement was rated the most helpful strategies. Participants wanted to learn more about Nigerian immigrants' DV experiences. Findings highlight implications for the development of Nigerian-specific DV services.

Intergenerational Transmission of Abusive Parenting: Role of Prospective Maternal Distress and Family Violence.

Parents who were abused as children are at increased risk for perpetuating maladaptive parenting practices, yet the mechanisms underlying this relationship remain unclear. This study prospectively examined maternal distress (a latent variable consisting of depressive symptoms and daily stress) and family violence as potential mediators in the intergenerational transmission of abusive (i.e., psychologically aggressive and physically assaultive) parenting. Participants included (N = 768) mother-child dyads identified as being at-risk for family violence and maltreatment prior to children's age four. More maternal childhood abuse was associated with more distress and increased risk for family violence exposure in adulthood. However, only maternal distress mediated the association between mothers' history of abuse and their use of abusive parenting strategies. This study provides critical information about ecological mechanisms underlying the intergenerational transmission of abusive parenting and suggests the importance of targeting depression and stress management among mothers with abuse histories to curtail the cycle of violence.

Parenting intervention outcomes for kinship caregivers and child: A systematic review.

BACKGROUND: Kinship foster caregivers often face serious challenges but lack adequate parenting capacities and resources. The importance of parenting interventions for kinship foster caregivers has been recognized, and researchers have assessed the effect of various parenting interventions on the caregivers and children. However, no systematic review has been conducted to summarize findings related to parenting interventions targeting kinship care. OBJECTIVES: This study systematically summarizes the effect of parenting interventions on kinship foster caregivers and their cared for children, and examines the intervention strategies and research methods used in order to provide a context in which to better understand effects of interventions. METHODS: From six academic databases, 28 studies were identified for review. A data template was used to extract the following information from each study: intervention targets, research design, settings, intervention description, outcome measures, and main results for each study. RESULTS: Various parenting interventions targeting kinship foster care families have been developed to improve parenting capacities and reduce parental stress. Most of the interventions had a positive impact on the outcomes of both caregivers and children, although the assessed outcomes often differed across studies. Parenting interventions improve caregivers' parenting competency, reduce parental stress, and advance child wellbeing. However, some interventions appear less promising in achieving targeted goals. DISCUSSION: The findings suggest that promoting evidence-based parenting interventions with a special focus on kinship care is important for child welfare. Future directions for research are also discussed in this study.

Prevalence of and Risk Factors for Intimate Partner Violence in the First 6 Months Following HIV Diagnosis Among a Population-Based Sample in Rural Uganda.

Research in Uganda examining HIV-positive status disclosure and IPV victimization is scarce, and existing findings may not generalize to community-based samples of men and women newly diagnosed with HIV in Uganda. We investigated the prevalence of lifetime IPV, IPV experienced between HIV diagnosis and 6 months following diagnosis (recent IPV), and IPV specifically related to a partner learning one's HIV-positive status among a sample of men and women newly diagnosed with HIV in a population-based study in rural Uganda. We also examined correlates of recent IPV, including HIV-positive status disclosure. The sample included 337 participants followed for 6 months after HIV diagnosis. Lifetime IPV findings showed that over half of the sample reported experiencing emotional IPV (62.81% of men, 70.37% of women), followed by physical IPV (21.49% of men, 26.39% of women) then sexual IPV (7.44% of men, 17.59% of women). For recent IPV, men and women reported similar rates of physical (4.63% and 8.29%, respectively) and emotional (19.44% and 25.91%, respectively) IPV. Women were more likely than men to report recent sexual IPV (8.29% vs. 1.85%); however, this relationship was no longer significant after controlling for other risk factors associated with sexual IPV (AOR = 3.47, 95% CI [0.65, 18.42]). Participants who disclosed their HIV-positive status to their partner had 59% lower odds of reporting emotional IPV (AOR = 0.41, 95% CI [0.21, 0.81]) than participants who did not disclose their HIV-positive status. Younger age, non-polygamous marriage, lower social support, and greater acceptance for violence against women were also significantly associated with experience of recent IPV. Overall, 12.20% of participants who experienced recent IPV reported that the IPV was related to their partner learning their HIV-positive status. Findings highlight the need for IPV screening and intervention integrated into HIV diagnosis, care, and treatment services.

The role of co-occurring intimate partner violence, alcohol use, drug use, and depressive symptoms on disciplinary practices of mothers involved with child welfare.

BACKGROUND: Evidence suggests intimate partner violence (IPV), substance use, and depression adversely affect the disciplinary practices of caregivers involved with child welfare; however, it remains uncertain whether the combined effects of these conditions are syndemic. OBJECTIVE: The purpose of this study was to examine the (1) associations between IPV, problematic drug use, problematic alcohol use, and depressive symptoms and self-reported disciplinary practices among a sample of mothers with child welfare contact; and (2) effect of co-occurrence of these conditions on child disciplinary practices. PARTICIPANTS AND SETTING: We used data from the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). The analysis focused on 965 biological mothers with children who were subjects of child abuse/neglect investigations between February 2008 and April 2009 in the United States. METHOD: We conducted multiple linear regression analyses. RESULTS: Our findings showed that IPV (B = .28; 95% CI = [.04, .53]) and depressive symptoms (B = .27; 95% CI = [.03, .52]) were independently associated with psychologically aggressive disciplinary practices. Also, IPV was independently associated with physically aggressive disciplinary practices (B = .64; 95% CI = [.18, 1.11]); and IPV (B = .21; 95% CI = [.06, .35]) and depressive symptoms (B = .22; 95% CI = [.07, .37]) were independently associated with neglectful parenting strategies. A significant effect was found for the interaction between problematic drug use and depressive symptoms with physically aggressive practices as the outcome. As the number of conditions caregivers had increased, so did their propensity for self-reporting each of the disciplinary practices (p < .05). CONCLUSIONS: The findings highlight the need for using a more holistic/multidisciplinary approach to child maltreatment prevention research, policy, and intervention.

The Effect of Intimate Partner Violence on the Psychosocial Development of Toddlers.

This study used data from the National Survey of Child and Adolescent Well-Being II to examine the effects of intimate partner violence (IPV) on child-welfare-involved toddlers' psychosocial development. The sample was limited to toddlers aged 12 to 18 months with mothers who did ( n = 102) and did not ( n = 163) report IPV physical victimization. Multiple linear regression analyses showed, when compared with mothers who did not report IPV physical victimization, mothers who reported IPV physical victimization were more likely to have toddlers with higher levels of socioemotional and behavioral problems ( B = 5.06, p < .001). Conversely, delayed social competence was not associated with IPV ( B = -1.33, p > .05). Further analyses examining only toddlers with mothers who reported IPV physical victimization revealed, when compared with IPV-exposed toddlers who had a child welfare report of physical abuse as the primary maltreatment type, those with IPV as the primary maltreatment type were at lower risk of having socioemotional and behavioral problems ( B = -12.90, p < .05) and delayed social competence ( B = 3.27, p < .05). These findings indicate a significant concern regarding toddler psychosocial development when a mother has experienced IPV. This concern is even greater among IPV-exposed toddlers who experience physical abuse. We recommend child welfare workers assess for IPV. Once identified, early prevention and intervention services should be offered and tailored to the specific needs of IPV-affected families.

Profiles of Child-Welfare-Involved Caregivers Identified by Caseworkers as Having a Domestic Violence Problem: Then and Now.

Over the past 10 years, there has been a significant decline in the rate of domestic violence (DV) experienced among caregivers involved with the child protective services (CPS) system. It is unclear whether this shift is related to changes in caregiver characteristics. Furthermore, despite evidence that suggests CPS caseworkers poorly identify DV and fail to link families to DV services, limited research exists on whether the current CPS interventions that are known to improve caseworkers' DV identification will also improve chances for DV service receipt. The present study uses data from the first and second cohorts of the National Survey of Child and Adolescent Well-Being (NSCAW) to compare differences in demographic characteristics and DV experiences between caregivers in NSCAW I (1999-2000; n = 2,758) and NSCAW II (2008-2009; n = 2,207). We also examine the effects of CPS interventions on NSCAW II caregivers' receipt of DV services external to the CPS agency (i.e., external DV services). Caregivers with caseworker reports of active DV in NSCAW I and II were similar in their demographic characteristics and external DV service experiences. However, caregivers in NSCAW II generally reported lower rates of victimization for specific types of violence than NSCAW I caregivers. Finally, caregivers with active DV involved with an agency that used DV assessment tools were 7.03 times more likely to receive external DV services than those in agencies without DV tools (95% confidence interval [CI] = [2.33, 21.22]). Whereas caregivers in agencies that sometimes (odds ratio [OR] = 0.16, 95% CI = [0.03, 0.99]) or always (OR = 0.15, 95% CI = [0.02, 0.98]) had a DV specialist available were less likely to receive external DV services than those in an agency that never/rarely had a DV specialist available. We recommend CPS agencies use specialized assessment tools to identify DV-affected families and link them to services. Additional research is needed to understand what types of services DV specialists offer within CPS agencies and whether these services meet caregivers' needs.

What Do Domestic Violence and Sexual Assault Service Providers Need to Know About Survivors to Deliver Services?

Using survey data, we investigate perspectives of 80 program directors of domestic violence and/or sexual assault agencies regarding whether gathering specific information at intake is helpful in determining survivors' needs for five service areas: legal advocacy, medical advocacy, support group, counseling, and shelter. We explore whether directors' opinions of information-type usefulness differ by type of service agency (single- or dual-focus). Findings show directors perceive the information most helpful to early service provision includes survivors' goals, experiences of violence and trauma, and health status. MANOVA results show no significant differences among directors from single- or dual-focus agencies.

Providers' perspectives about helpful information for evaluating domestic violence and sexual assault services: a practice note.

This practice note presents findings from a statewide survey of domestic violence and sexual assault agency directors (n = 80; 77% response rate), regarding their opinions about the outcome information that should be collected from victims during evaluations of five commonly provided services: legal advocacy, medical advocacy, group services, individual counseling, and shelter. The findings showed that four information types were repeatedly ranked among the most important to collect to understand whether services helped victims including victims' satisfaction with services, victims' progress toward meeting their goals, changes in the extent of violence and/or trauma that victims experienced, and changes in victims' knowledge.

Domestic violence and immigration status among Latina mothers in the child welfare system: findings from the National Survey of Child and Adolescent Well-being II (NSCAW II).

Many children involved with the child welfare system witness parental domestic violence. The association between children's domestic violence exposure and child welfare involvement may be influenced by certain socio-cultural factors; however, minimal research has examined this relationship. The current study compares domestic violence experiences and case outcomes among Latinas who are legal immigrants (n=39), unauthorized immigrants (n=77), naturalized citizens (n=30), and US-born citizen mothers (n=383) reported for child maltreatment. This analysis used data from the second round of the National Survey of Child and Adolescent Well-being. Mothers were asked about whether they experienced domestic violence during the past year. In addition, data were collected to assess if (a) domestic violence was the primary abuse type reported and, if so, (b) the maltreatment allegation was substantiated. Results show that naturalized citizens, legal residents, and unauthorized immigrants did not differ from US-born citizens in self-reports of domestic violence; approximately 33% of mothers reported experiences of domestic violence within the past year. Yet, unauthorized immigrants were 3.76 times more likely than US-born citizens to have cases with allegations of domestic violence as the primary abuse type. Despite higher rates of alleged domestic violence, unauthorized citizens were not more likely than US-born citizens to have these cases substantiated for domestic violence (F(2.26, 153.99)=0.709, p=.510). Findings highlight that domestic violence is not accurately accounted for in families with unauthorized immigrant mothers. We recommend child welfare workers are trained to properly assess and fulfill the needs of immigrant families, particularly as it relates to domestic violence.

Intimate partner violence and depressive symptoms before pregnancy, during pregnancy, and after infant delivery: an exploratory study.

Women who experience intimate partner violence (IPV) during pregnancy also tend to experience depressive symptoms. Unfortunately, little is known about how victimized women's levels of depressive symptoms change longitudinally before pregnancy, during pregnancy, and after infant delivery. In addition, few studies have used a comparison group of women to determine if levels of depressive symptoms among victimized women differ from depressive symptom levels in women who have not experienced IPV. To help address these knowledge gaps, we examined longitudinal trends in levels of depressive symptoms among a sample of 76 women who did (n = 33) and did not (n = 43) experience physical IPV during pregnancy. Using multilevel analysis, we estimated the relationship of physical IPV victimization and women's depressive symptom levels across six time periods: (a) the year before pregnancy, (b) first and second trimesters, (c) third trimester, (d) the first month postpartum, (e) Months 2 to 6 postpartum, and (f) Months 7 to 12 postpartum. Women who experienced physical IPV victimization during pregnancy had significantly higher levels of depressive symptoms during each time period (p < .05). No significant difference between the two groups was found in the rate of change in levels of depressive symptoms over time. These findings point to the importance of screening for IPV within health care settings and suggest that women physically abused during pregnancy need safety interventions that are coordinated with interventions targeting symptoms of depression.