Animal Abuse as a Type of Trauma: Lessons for Human and Animal Service Professionals.

Animal abuse frequently occurs at the same time and the same place as other types of violence, particularly family violence. Because of that close association, this article proposes that it is the responsibility of both animal service and human service professionals to be aware of its occurrence, understand its significance, and promote appropriate professional and policy responses to it. Research literature addressing the link between animal abuse and other forms of violence ("the link") is discussed. Articles selected for review were published in a peer-reviewed journal, relevant to some aspect of the link between animal abuse and child abuse and/or domestic violence, used either a national or a longitudinal database, or relied on random sampling or a comparison group. If a study was retrospective or drawn from a convenience sample, it had to have been replicated by another study for inclusion. Finally, any measurement instruments used by the study under review must have had acceptable reliability and validity. Legal databases, such as LexisNexis, were used to identify legislation that has been passed and/or court cases that have been decided that were relevant to the topic of "the link." Strong associations were found between domestic violence, child abuse, and animal abuse; animal abuse, whether witnessed or committed, is a form of trauma. Severe animal abuse as a predictor for severe domestic violence recently emerged as a promising association. However, some of these findings on "the link" have not been translated into practice, for example, domestic violence advocates and child protection workers frequently do not ask questions about pets in the family. At the same time, the past 20 years have seen an increase in state and federal legislation and policies that have been enacted, in part, because of the growing body of evidence on the link. Knowledge of the link also has influenced a number of court cases deciding parental rights. Moreover, awareness of the link is illustrated by the passage of pet protection orders for victims of domestic violence as well as the inclusion of pet abuse as a form of domestic violence. Human service and animal service professionals should articulate more ways in which they can communicate with one another, thus adding more information and resources to any intervention or treatment of family violence.

Women identified with HIV at labor and delivery: testing, disclosing and linking to care challenges.

OBJECTIVE: To determine if women with undocumented HIV status in late pregnancy or at labor and delivery who are rapidly tested and identified as HIV infected have high-risk behaviors and psychosocial obstacles hindering postpartum follow-up. METHODS: Consenting participants (women with undocumented HIV status and > or =24 weeks gestational age (GA) and imminent delivery or > or =34 weeks GA) in 6 cities were rapidly tested and interviewed. HIV-positive women were offered follow-up. RESULTS: From 2001-2005, 54 HIV-infected women were identified: median age 26 years; 91% African American; 11 (20%) lost custody of their infants; 30 (56%) knew they or their partner were HIV-infected, but had no antenatal HIV care; 25 met criteria for starting antiretroviral therapy. Comparison between 48 HIV-infected and 130 HIV-negative women, tested and interviewed at the same hospitals, showed HIV-infected women more likely to be African American (P < .01) and report no prenatal care (P < .001), use street drugs (P < .01), have unstable residency (P < .05), not live with the father of their infant (P < .001), and have children in foster care (P < .01). Sixteen women (30%) and 17 (31%) infants did not remain in follow-up study due to relocation, child protective custody, and psychosocial issues including frequent substance use. CONCLUSION: Over half of HIV-infected women knew they or their partner were infected with HIV, but did not initially disclose their status. Increased support services and substance abuse treatment are critical to facilitate better continuity of care for these socially marginalized women.

Correlates of prenatal HIV testing in women with undocumented status at delivery.

OBJECTIVE: To determine factors associated with prenatal HIV testing in women who accepted rapid testing at delivery. METHODS: The mother-infant rapid intervention at delivery (MIRIAD) protocol offered counseling and voluntary HIV testing in six US cities including New York City (NYC). These hospitals are required to document the HIV status of pregnant women or their infants. From January 2002 to January 2005, 653 HIV-negative women were interviewed post-partum. RESULTS: 63% of women reported prior HIV testing during the index pregnancy, although their results were not available at delivery. Multivariate logistic modeling identified receipt of prenatal care and delivery in NYC as being associated with having been offered prenatal HIV testing. In a model restricted to women receiving medical care, emergency department (ED) use and delivery outside of NYC were associated with not having been offered testing. In a model restricted to women who were offered prenatal testing, acceptance was associated with delivery outside of NYC. CONCLUSIONS: Improved documentation of prenatal test results, expanded prenatal testing in non-traditional settings like EDs, and routine voluntary "opt-out" testing during pregnancy may further reduce perinatal HIV transmission.

Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.

This study addressed two aims: (1) to assess the level of depressive symptoms among pregnant, HIV-infected racial and ethnic minority women and (2) to identify potentially modifiable factors associated with prenatal depression in order to foster proactive clinical screening and intervention for these women. Baseline interview data collected from HIV-infected women participating in the Perinatal Guidelines Evaluation Project were analyzed. Participants were from prenatal clinics in four areas representative of the U. S. HIV/AIDS epidemic among women. Of the final sample (n = 307), 280 were minorities (218 blacks [African American and Caribbean], 62 Hispanic). Standardized interviews assessed potential psychosocial factors associated with pregnancy-related depression and psychological distress (life stressors, inadequate social support, and ineffective coping skills) in a population for whom little work has been done. Depressive symptomatology was considerable, despite excluding somatic items in order to avoid confounding from prenatal or HIV-related physical symptoms. The psychosocial factors significantly predicted the level of prenatal depressive symptoms beyond the effects of demographic and health-related factors. Perceived stress, social isolation, and disengagement coping were associated with greater depression, positive partner support with lower depression. These findings demonstrate that psychosocial and behavioral factors amenable to clinical intervention are associated with prenatal depression among women of color with HIV. Routine screening to identify those currently depressed or at risk for depression should be integrated into prenatal HIV-care settings to target issues most needing intervention.

Integrating mental health services into primary HIV care for women: the Whole Life project.

The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project-a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine-successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, implementation strategies, effects of the service integration, and lessons learned. Funded by the Health Resources and Services Administration (HRSA) as a Special Program of National Significance (SPNS), Whole Life efforts have been sustained beyond the demonstration funding period as a result of the changes brought about in organizational structures, service delivery, and the providers' conceptualization of health for HIV-infected women.