Sexually Transmitted Diseases

Sexually Transmitted Infections and Interpersonal Violence

Prevention efforts are complicated when violence is present in an intimate relationship and when sexual violence has been coerced or forced during childhood, adolescence, or the adult years. The relationship between STI transmission and interpersonal violence is an issue at all ages, for all sexual relationship types (heterosexual, homosexual, and bisexual), and among diverse racial, ethnic, and cultural communities. This relationship is a unique problem that can be explained in various ways. Most frequently, it is discussed after a sexual assault or sexual coercion (by an intimate partner, acquaintance, family member, or stranger). There is also a relationship between STIs and intimate partner violence, not only with sexual violence, but also when emotional and/or physical violence are present. STI transmission has also been related to a history of childhood sexual abuse. Issues of power and power imbalances are frequently discussed in relation to interpersonal violence. Literature suggests that those who are victims of violence-emotional, physical or sexual-despite their age are in a position that leaves them compromised to assert or negotiate for themselves, putting them at risk of various forms of violation and harm. This compromised state of power puts victims at risk of violence, which has implications for many health and mental health consequences, such as increased rates of STIs.

Sexual Assault

The CDC recommends defining sexual assault as any sexual act or contact that is forced or threatened by physical force, threats, or intimidation. Sexual assault can occur in the context of an intimate relationship and may be perpetrated by an acquaintance, a family member, or a stranger. These possibilities present an increased risk for STI transmission at the time of the assault because of the potential unknown sexual history of the assailant coupled with the probable lack of barrier protection. Sexual assault has further implications for the future psychological functioning of the victim, influencing future sexual decisions with subsequent sexual encounters that may put the victim at risk for exposure and infection of STIs.

Intimate Partner Violence

Intimate partner violence (IPV), as defined by the CDC, is physical, emotional, and sexual violence or threats of such violence and has been associated with increased STI rates and sexual practices that increase the risk of STI transmission. This association can be identified through the increased rate of violence with the negotiation of condom usage or safe sex practices. Victims of IPV express fear of engaging in the discussion of condom use or safe sex practices because of the potential for physical, sexual, or emotional violence ensuing. These factors are also magnified when alcohol and drug use are present. Alcohol and drug use has long been established as a risk factor for IPV, and the use of alcohol or drugs has important implications in the transmission of STIs. Temporal order of IPV and alcohol and/or drug use has not been well established; however, the use of either by a victim or a perpetrator can be a risk factor for violence or can be a mechanism to cope with a violent episode within a relationship. Alcohol and/or drug use can put a victim at risk by impairing the victim's ability to consent or make good decisions regarding safe sex practices, and alcohol and/or drug use may lead to coerced or forced sexual activities. IPV has many implications for the health and welfare of those in an abusive relationship and leads to an increased risk and transmission of STIs.

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