HIV/AIDS-violence syndemic: Perceptions and experiences of health care and social service providers in the San Francisco Bay Area

Background: Associations between HIV/AIDS and specific forms of violence have been documented in several at-risk populations. However, the perspective of health care and social service providers, as well as actual practices and institutional policies potentially used to address this issue, are poorly understood. Methods: Purposive sampling was used to recruit health care and social service providers in the San Francisco Bay Area who served diverse client/patient populations defined by gender, race/ethnicity, sexual orientation, age, marginal housing, poverty, mental illness, sex work, substance use, and criminal history. In-depth, semi-structured, qualitative interviews were conducted with providers (N=30) whose services focused primarily on HIV/AIDS, violence, or both. Results: Providers described crossover risk between HIV/AIDS and several specific forms of violence in their clients and patients, including sexual abuse, bias-motivated violence, intimate partner violence, suicidality/self-harm, and community violence. Several factors were cited as contributing to the HIV/AIDS-violence connection across populations, the most common being substance use, low self-esteem, and depression. Despite these perceptions, crossover risk generally is not included in standard service protocols and is not assessed consistently by providers. Conclusions: Health care and social service providers offer a valuable perspective on the HIV/AIDS-violence syndemic, as they are uniquely able to discern patterns in client/patient populations they serve each day. Whereas providers in the Bay Area described an overall bidirectional relationship between HIV/AIDS and violence, clients and patients are not systematically assessed for crossover risk. Further research should examine this issue on a larger scale and determine the feasibility of an intervention targeting providers.