Breaking the Silence: Lesbian, Gay, and Bisexual Experiences of Intimate Partner Violence and Health-Related Effects

Breaking the Silence: Lesbian, Gay, and Bisexual Experiences of Intimate Partner Violence and Health-Related Effects Between 1989-1996, multiple agenc...
Author: Adelia Tate
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Breaking the Silence: Lesbian, Gay, and Bisexual Experiences of Intimate Partner Violence and Health-Related Effects Between 1989-1996, multiple agencies both domestic (American Medical Association) and international (World Health Organization) began a campaign to end violence against women, because it was a “public health problem” and health care’s “silent epidemic” (document WHO/EHA/SPI.POA.2; Schornstein 1997). What resulted is an ever-increasing body of literature on the negative health outcomes of (mostly) physical and sexual IPV on women abused (mostly) by men. This body of literature exposes a grim reality: victims of physical and sexual intimate partner violence suffer higher levels of both acute and chronic physical health problems than those who are not abused (Campbell and Wasco 2005; Coker et al. 2002a; Fischbach and Herbert 1997; Plichta 2004; Porcerelli et al. 2003; Wolkenstein and Sterman 1998). For men who are victims of IPV and for women abused by women, the health-related outcomes of violence have not been well documented. For example, even though the California Health Interview Survey (2007 and 2009; see Zahnd et al. 2010 and Golberg and Meyer, 2013) and the Centers for Disease Control and Prevention’s (CDC) National Intimate Partner and Sexual Violence Survey (NISVS 2013; see Walters, Chen and Breiding 2013) released detailed reports on same-sex victimization, this data has yet to be used to examine health disparities related to violence in relationships—and has yet to be publicly released for such examination by scholars and activists. Although “the short and long-term effects of domestic violence are health care issues that nearly every practicing physician encounters in the course of routine clinical practice” (Alpert 1995), no study using a representative, probability sample has assessed whether or not there are disparities in negative health outcomes and/or disparities in health care/medical service utilization between lesbian, gay, and bisexual (LGB) men and women and heterosexual/straight men and women. This paper underscores the importance of expanding understandings of intimate partner violence by examining these very issues: first by comparing rates of intimate partner violence (sexual, physical,

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psychological, control, and stalking), then by comparing rates of negative health outcomes (physical and psychological) of said violence, and finally by examining the medical and psychological health care seeking and utilization behaviors, controlling for injuries suffered. For contrast, this paper also looks at care-seeking at community and criminal justice service providers.

Methods and Data This study employs both descriptive and inferential statistical techniques using Stata/SE 13 quantitative data analysis software for large datasets. Namely, this study uses a two-sample test of proportions, to compare lesbian, gay, and bisexual individuals to heterosexual/straight individuals and determine if there are significant differences in the proportion of violence experienced, injuries suffered from violence, and health care seeking while controlling for injuries suffered. For example, in this study there are two samples (LGB people and heterosexual/straight people) and the proportion of those experiencing intimate partner violence is recorded within each sample and compared for equivalency. If the proportions are equal, then LGB people and heterosexual/straight people experience statistically similar rates of violence; if the proportions are not equal, than we can say that one sample experiences statistically significantly more violence than the other sample. Sample. Data come from the Centers for Disease Control’s “National Intimate Partner and Sexual Violence Survey.” Before implementation of the National Intimate Partner and Sexual Violence Survey (NISVS) in 2010, the most recent detailed national data on the public health burden intimate partner violence were obtained from the National Violence against Women Survey conducted during 1995–1996. According to the 2014 report summary: “NISVS is an ongoing nationally representative random-digit–dial telephone survey of the noninstitutionalized English- and Spanish-speaking U.S. population aged ≥18 years. NISVS uses a dual-frame sampling strategy that includes both landline and cellular telephones and is conducted in 50 states and the District of Columbia. In 2011, a total of 14,155 interviews were conducted (7,758 women and 6,397 men). A total of 12,727 interviews were completed, and 1,428 interviews were partially completed. A total of 6,879 women and 5,848 men completed the survey. 2

Approximately 40.0% of completed interviews were conducted by landline telephone, and 60.0% of completed interviews were conducted by using a respondent's cellular telephone.” Given the specific follow-up questions measured and included in the variables below, in this analysis there were 2,612 heterosexual/straight men, 2,869 heterosexual/straight women, 127 gay men and 81 lesbian women, and 299 bisexual men and 579 bisexual women. Sexual orientation in this study is a combination of self-identification (the respondent marked heterosexual/straight, lesbian/gay, or bisexual) and behavioral-based (comparing the sex of the individual to the sex of their identified intimate partners). Thus, some individuals who marked heterosexual/straight may have been moved to the “bisexual” category if they had experienced abuse by a same-sex partner; likewise, some individuals who marked lesbian/gay may have been moved to the “bisexual” category if they indicated they had experienced abuse by an opposite-sex partner.i Variables. This analysis examines physical, sexual, psychological and control, and stalking intimate partner violence.ii As this analysis seeks to better understand the health-related effects of intimate partner violence on individuals and their health care seeking behaviors, unique variables were also constructed following from these instances of violence. Physical Health Outcomes. To measure negative physical health-related outcomes, a binary variable was constructed that took into account the specific injuries received from the reported sexual, physical and/or stalking violence. Specifically, an individual was included as having experienced a physical injury following if they responded “yes” to any of the following questions about sexual violence: “Were you ever physically injured when {initials} did this/any of these things? For example, did you have bruises, {if female, vaginal or} anal tears, or other internal or external injuries?” “Did you ever get an STD or other infection when {initials} did this/any of these things? For example, did you get chlamydia, gonorrhea, HIV, or some other STD?” Or, for women, “Did you ever get pregnant when {initials} did this/any of these things?” Individuals who responded “yes” to any of the following questions about physical, sexual, or stalking violence were also included: “Were 3

you ever injured when this/any of these things happened with any of these people?” Specific injuries later marked included minor or major bruises/cuts, broken bones/teeth, being knocked out or choked, or other physical injuries sustained during the violent incident. Psychological Health Outcomes. Psychological health outcomes were measured by constructing a binary (yes/no) variable. Respondents answered “yes” to negative psychological health outcomes if, following any instance of sexual, physical, psychological, control, or stalking intimate partner violence victimization, they reported that the injury they sustained was: being “concerned for your safety” or “fearful,” experiencing “nightmares,” trying “hard not to think it or go out of your way to avoid being reminded about it,” feeling “like you were constantly on guard, watchful, or easily startled,” or feeling “numb or detached from others, your activities, or your surroundings.” Health Care Seeking Behaviors. To measure health care seeking behaviors, variables were constructed to indicate if a person either needed and/or sought out medical care, emergency services, or surgery or psychological counseling/treatment (via licensed practitioner or conversations with a crisis hotline, victim’s advocate, and/or support group) for their IPV injuries. Additionally, for comparison among certain service sectors, variables were constructed to indicate whether the victim/survivor had discussed the nature of their injuries (i.e. told someone they were abused by an intimate partner) with previously indicated physical and mental health care providers and/or people within community services, criminal justice services, or religious services.

Results To start, it’s important to highlight that almost uniformly, bisexual men and women experience significantly higher rates of all forms of intimate partner violence (IPV), significantly higher rates of physical/psychological injury and trauma following IPV victimization, and significantly underutilize medical, community, and religious services for these injuries. 4

Sexual Intimate Partner Violence More specifically, for sexual abuse (see Table 1 below), 30-80% of individuals experienced victimization by an intimate partner, with heterosexual/straight men experiencing the lowest rates and bisexual women experiencing the highest rates. The two-sample test of proportions produced negative and significant z values, indicating that gay men are more likely than straight men to be victims of sexual abuse (z = -2.7637, p

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