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Stark L, Mutumba M, Ssewamala F, Brathwaite R, Brown DS, Atwebembere R, Mwebembezi A. Protocol for a discrete choice experiment: understanding preferences for seeking health services for survivors of sexual violence in Uganda. BMJ Open 2024; 14:e081663. [PMID: 39107025 PMCID: PMC11308909 DOI: 10.1136/bmjopen-2023-081663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
INTRODUCTION Sexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan Africa, these services are significantly underused, with 9 out of 10 survivors not seeking care due to a range of psychological, cultural, economic and logistical factors. Thus, there is a strong need for research to improve health service utilisation for survivors of sexual violence. METHODS AND ANALYSIS The proposed study seeks to address the underutilization of health services for female survivors of sexual violence using a discrete choice experiment (DCE). The study will be conducted in the greater Masaka region of southwestern Uganda and target adult female survivors of sexual violence. We will first undertake qualitative interviews with 56 survivors of sexual violence to identify the key attributes and levels of the DCE. In order to ensure a sufficiently powered sample, 312 women who meet inclusion criteria will be interviewed. Our primary analysis will employ a mixed (random parameters) logit model. We will also model the role of individual-specific characteristics through latent class models. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the following ethics review boards in Uganda and the USA: the Uganda Virus Research Institute (UVRI), the Uganda National Council for Science and Technology (HS2364ES), Washington University in St Louis and the University of Michigan. Our methods conform to established guidelines for the protection of human subjects involved in research. Our dissemination plan targets a broad audience, ranging from policymakers and government agencies to healthcare providers, academic communities and survivors themselves.
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Affiliation(s)
- Lindsay Stark
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - M Mutumba
- University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Ssewamala
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - Rachel Brathwaite
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - Derek S Brown
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - Raymond Atwebembere
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
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Basimane Bisimwa P, Koyaweda GW, Bihehe Masemo D, Ayagirwe RBB, Birindwa AB, Bisimwa PN, Kikuni Besulani G, Kashosi TM, Mugisho Matabishi C, Mitima Misuka B, Mukonkole JPM, Bisimwa Nachega J, Mukwege Mukengere D, Komas NPJ. High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo. PLoS One 2024; 19:e0292473. [PMID: 38959256 PMCID: PMC11221749 DOI: 10.1371/journal.pone.0292473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/08/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population. METHODS A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status. RESULTS For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL). CONCLUSION This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.
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Affiliation(s)
- Parvine Basimane Bisimwa
- Viral Hepatitis Laboratory, Institut Pasteur de Bangui, Bangui, Central African Republic
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- International Center Advanced for Research and Training (ICART)/Panzi Fondation, Bukavu, Democratic Republic of Congo
| | | | - Dieudonné Bihehe Masemo
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
| | | | - Ahadi Bwihangane Birindwa
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | - Patrick Ntagereka Bisimwa
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | - Georges Kikuni Besulani
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
| | - Théophile Mitima Kashosi
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | | | - Bienfait Mitima Misuka
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | - Jean Paulin Mbo Mukonkole
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
| | - Jean Bisimwa Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, United States of America
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Denis Mukwege Mukengere
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
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Thomas D, Nakabugo L, Nambi F, Kibuuka J, Muwonge TR, Feutz E, Thomas KK, Simoni JM, Montgomery ET, Ware N, Wyatt MA, Katz IT, Kadama H, Mujugira A, Heffron R. Intimate Partner Violence and Adherence to PrEP and ART Among Ugandan HIV Serodifferent Couples. J Acquir Immune Defic Syndr 2024; 95:347-354. [PMID: 38133584 PMCID: PMC10896193 DOI: 10.1097/qai.0000000000003368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with increased risk of HIV acquisition and reduced engagement in HIV care. There is limited understanding of the ways in which IPV exposure and other maladaptive relationship dynamics may influence adherence to antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for individuals in committed, HIV serodifferent partnerships. METHODS We used binomial generalized linear mixed-effect regression models to evaluate the association between IPV exposure and ART/PrEP adherence among members of serodifferent couples in Uganda. Secondarily, we assessed the association between relationship powerlessness and ART/PrEP adherence. RESULTS We enrolled and followed both partners in 149 heterosexual serodifferent couples. The partner living with HIV was female in 64% of couples. IPV exposure was associated with low ART adherence (15% vs. 5% in quarters with no IPV, odds ratio: 4.78, 95% confidence interval: 1.48 to 15.42), but not low PrEP adherence (33% vs. 36%, P = 0.69). Among HIV-negative individuals, those reporting moderate relationship powerlessness were less likely to have poor PrEP adherence compared with those with low relationship powerlessness (20% vs. 30%, odds ratio: 0.57, 95% confidence interval: 0.36 to 0.90). We observed no association between relationship powerlessness and ART adherence. CONCLUSIONS We found that IPV exposure was associated with low adherence to ART and that relationship powerlessness was associated with good adherence to PrEP. These findings contribute to the evidence base outlining the influence of IPV and relationship power on ART/PrEP adherence for individuals in HIV serodifferent unions.
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Affiliation(s)
- Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Jane M. Simoni
- Department of Global Health, University of Washington, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA
| | - Elizabeth T. Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Norma Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Harvard Global, Cambridge, MA
| | | | | | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
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Roberts ST, Hartmann M, Minnis AM, Otticha SO, Browne EN, Montgomery ET, Agot K. Breaking down relationship barriers to increase PrEP uptake and adherence among adolescent girls and young women in Kenya: safety and preliminary effectiveness results from a pilot cluster-randomized trial. J Int AIDS Soc 2023; 26:e26198. [PMID: 38123866 PMCID: PMC10733161 DOI: 10.1002/jia2.26198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa, a priority population for epidemic control. However, intimate partner violence (IPV) and low relationship power can create significant challenges to PrEP use. The Tu'Washindi intervention aimed to increase PrEP use by addressing relationship- and violence-related barriers among AGYW enrolled in the DREAMS Initiative in Siaya County, Kenya. METHODS Our multi-level, community-based intervention was piloted in a cluster-randomized controlled trial conducted at six DREAMS sites from April to December 2019 (NCT03938818). Three intervention components were delivered over 6 months: an eight-session empowerment-based support club, community sensitization targeted towards male partners and a couples' PrEP education event. Participants were ages 17-24, HIV negative and either eligible for, or already taking, PrEP. Over 6 months of follow-up, we assessed IPV (months 3 and 6) and PrEP uptake and continuation (month 6) through interviewer-administered questionnaires; PrEP adherence was assessed with Wisepill electronic monitoring devices. These outcomes were compared using adjusted Poisson and negative binomial regression models. RESULTS We enrolled 103 AGYW with median age of 22 years (IQR 20-23); one-third were currently taking PrEP and 45% reported IPV in the past 3 months. Retention was 97% at month 6. Compared to the control arm, intervention arm participants were more likely to initiate PrEP, if not already using it at enrolment (52% vs. 24%, aRR 2.28, 95% CI 1.19-4.38, p = 0.01), and those taking PrEP had more days with device openings (25% of days vs. 13%, aRR 1.94, 95% CI 1.16-3.25, p = 0.01). Twenty percent of participants reported IPV during follow-up. There were trends towards fewer IPV events (aIRR 0.66, 95% CI 0.27-1.62, p = 0.37) and fewer events resulting in injury (aIRR 0.21, 95% CI 0.04-1.02, p = 0.05) in the intervention versus control arm. CONCLUSIONS Tu'Washindi shows promise in promoting PrEP uptake and adherence among AGYW without concomitant increases in IPV; however, adherence was still suboptimal. Further research is needed to determine whether these gains translate to increases in the proportion of AGYW with protective levels of PrEP adherence and to evaluate the potential for the intervention to reduce IPV risk.
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Affiliation(s)
- Sarah T. Roberts
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | - Miriam Hartmann
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | | | | | - Erica N. Browne
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | | | - Kawango Agot
- Impact Research and Development OrganizationKisumuKenya
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Spencer CN, Khalil M, Herbert M, Aravkin AY, Arrieta A, Baeza MJ, Bustreo F, Cagney J, Calderon-Anyosa RJC, Carr S, Chandan JK, Coll CVN, de Andrade FMD, de Andrade GN, Debure AN, Flor LS, Hammond B, Hay SI, Knaul FN, Lim RQH, McLaughlin SA, Minhas S, Mohr JK, Mullany EC, Murray CJL, O'Connell EM, Patwardhan V, Reinach S, Scott D, Sorenson RJD, Stein C, Stöckl H, Twalibu A, Vasconcelos N, Zheng P, Metheny N, Chandan JS, Gakidou E. Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study. Nat Med 2023; 29:3243-3258. [PMID: 38081957 PMCID: PMC10719101 DOI: 10.1038/s41591-023-02629-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/04/2023] [Indexed: 12/17/2023]
Abstract
The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.
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Affiliation(s)
- Cory N Spencer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mariam Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly Herbert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Alejandra Arrieta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - María Jose Baeza
- School of Medicine, The Pontifical Catholic University of Chile, Santiago, Chile
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Flavia Bustreo
- Fondation Botnar, Basel, Switzerland
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - Jack Cagney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jaidev Kaur Chandan
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carolina V N Coll
- Department of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Center, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Alexandra N Debure
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ben Hammond
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Felicia N Knaul
- Institute for the Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - Rachel Q H Lim
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sonica Minhas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jasleen K Mohr
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vedavati Patwardhan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Center on Gender Equity and Health, UC San Diego School of Medicine, San Diego, CA, USA
| | | | - Dalton Scott
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Reed J D Sorenson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caroline Stein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Heidi Stöckl
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Aisha Twalibu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Anguzu R, Walker RJ, Babikako HM, Beyer KMM, Dickson-Gomez J, Zhou Y, Cassidy LD. Intimate partner violence and antenatal care utilization predictors in Uganda: an analysis applying Andersen's behavioral model of healthcare utilization. BMC Public Health 2023; 23:2276. [PMID: 37978467 PMCID: PMC10656909 DOI: 10.1186/s12889-023-16827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Optimal utilization of antenatal care (ANC) services improves positive pregnancy experiences and birth outcomes. However, paucity of evidence exists on which factors should be targeted to increase ANC utilization among women experiencing intimate partner violence (IPV) in Uganda. OBJECTIVE To determine the independent association between IPV exposure and ANC utilization as well as the predictors of ANC utilization informed by Andersen's Behavioral Model of Healthcare Utilization. METHODS We analyzed 2016 Uganda Demographic and Health Survey data that included a sample of 1,768 women with children aged 12 to 18 months and responded to both ANC utilization and IPV items. Our outcome was ANC utilization, a count variable assessed as the number of ANC visits in the last 12 months preceding the survey. The key independent variable was exposure to any IPV form defined as self-report of having experienced physical, sexual and/or emotional IPV. Covariates were grouped into predisposing (age, formal education, religion, problem paying treatment costs), enabling (women's autonomy, mass media exposure), need (unintended pregnancy, parity, history of pregnancy termination), and healthcare system/environmental factors (rural/urban residence, spatial accessibility to health facility). Poisson regression models tested the independent association between IPV and ANC utilization, and the predictors of ANC utilization after controlling for potential confounders. RESULTS Mean number of ANC visits (ANC utilization) was 3.71 visits with standard deviation (SD) of ± 1.5 respectively. Overall, 60.8% of our sample reported experiencing any form of IPV. Any IPV exposure was associated with lower number of ANC visits (3.64, SD ± 1.41) when compared to women without IPV exposure (3.82, SD ± 1.64) at p = 0.013. In the adjusted models, any IPV exposure was negatively associated with ANC utilization when compared to women with no IPV exposure after controlling for enabling factors (Coef. -0.03; 95%CI -0.06,-0.01), and healthcare system/environmental factors (Coef. -0.06; 95%CI -0.11,-0.04). Predictors of ANC utilization were higher education (Coef. 0.27; 95%CI 0.15,0.39) compared with no education, high autonomy (Coef. 0.12; 95%CI 0.02,0.23) compared to low autonomy, and partial media exposure (Coef. 0.06; 95%CI 0.01,0.12) compared to low media exposure. CONCLUSION Addressing enabling and healthcare system/environmental factors may increase ANC utilization among Ugandan women experiencing IPV. Prevention and response interventions for IPV should include strategies to increase girls' higher education completion rates, improve women's financial autonomy, and mass media exposure to improve ANC utilization in similar populations in Uganda.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US.
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, US.
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, US
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, US
| | - Harriet M Babikako
- Department of Child Health and Development Center, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, Milwaukee, US
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, US
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Gunarathne L, Bhowmik J, Apputhurai P, Nedeljkovic M. Factors and consequences associated with intimate partner violence against women in low- and middle-income countries: A systematic review. PLoS One 2023; 18:e0293295. [PMID: 37939106 PMCID: PMC10631698 DOI: 10.1371/journal.pone.0293295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Intimate Partner Violence (IPV) is a global public health issue, with notably high prevalence rates observed within Low-and Middle-Income Countries (LMICs). This systematic review aimed to examine the risk factors and consequences associated with IPV against women in LMICs. Following PRISMA guidelines, we conducted a systematic review using three databases: Web of Science, ProQuest Central, and Scopus, covering the period from January 2010 to January 2022. The study included only peer-reviewed journal articles in English that investigated IPV against women in LMICs. Out of 167 articles screened, 30 met the inclusion criteria, comprising both quantitative and mixed-method studies. Risk factors of IPV were categorised as: demographic risk factors (23 studies), family risk factors (9 studies), community-level factors (1 studies), and behavioural risk factors (14 studies), while consequences of IPV were categorised as mental health impacts (13 studies), physical impacts (5 studies), and societal impacts (4 studies). In this study, several risk factors were identified including lower levels of education, marriage at a young age, poor wealth indices, rural residential areas, and acceptance of gender norms that contribute to the prevalence of IPV in LMICs. It is essential to address these factors through effective preventive policies and programs. Moreover, this review highlights the necessity of large-scale, high-quality policy-driven research to further examine risk factors and consequences, ultimately guiding the development of interventions aimed at preventing IPV against women in LMICs.
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Affiliation(s)
- Lakma Gunarathne
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Pragalathan Apputhurai
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Wang L, Hong C, He N, Xavier Hall CD, Simoni JM, Wong FY. Depression as a mediator between intimate partner violence (IPV) and CD4 cell count among men who have sex with men (MSM) living with HIV in China. AIDS Care 2023; 35:1667-1676. [PMID: 37018752 DOI: 10.1080/09540121.2023.2195608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Intimate partner violence (IPV) is associated with adverse mental and physical outcomes among men who have sex with men (MSM) living with HIV. Few studies focus on psychological IPV, such as verbal threats. This study examined the associations between different forms of IPV and depression and CD4+ cell count, with depression as a mediator for the association between IPV and CD4+ cell count. Data for these analyses were derived from a larger cross-sectional study on HIV-HCV co-infection among MSM in Shanghai, China (N = 1623). We estimated the average causal mediation effects (ACME) and average direct effects (ADE) through three steps. About 16% of participants experienced IPV, with forced sex (7%), verbal threats (5%), and thrown objects (4%) being most common. Verbal threats showed the strongest link with depression and low CD4+ cell count. Depression fully mediated the relationship between verbal abuse and low CD4+ cell count, suggesting it as a potential pathway between psychological IPV and poorer HIV-related health outcomes. More research on psychological IPV is warranted to examine its health impacts. Mental health could be a potential focus of intervention to enhance HIV-related health outcomes among MSM with IPV experience.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Chenglin Hong
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Na He
- School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, WA, USA
| | - Frank Y Wong
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, FL, USA
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
- John D. Bower School of Population Health, Department of Population Health Science, University Mississippi Medical Center, Jackson, MS, USA
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9
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Kuchukhidze S, Panagiotoglou D, Boily MC, Diabaté S, Imai-Eaton JW, Stöckl H, Mbofana F, Wanyenze RK, Maheu-Giroux M. Characteristics of male perpetrators of intimate partner violence and implications for women's HIV status: A pooled analysis of cohabiting couples from 27 countries in Africa (2000-2020). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002146. [PMID: 37672520 PMCID: PMC10482294 DOI: 10.1371/journal.pgph.0002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
Intimate partner violence (IPV) may increase women's HIV acquisition risk. Still, knowledge on pathways through which IPV exacerbates HIV burden is emerging. We examined the individual and partnership-level characteristics of male perpetrators of physical and/or sexual IPV and considered their implications for women's HIV status. We pooled individual-level data from nationally representative, cross-sectional surveys in 27 countries in Africa (2000-2020) with information on past-year physical and/or sexual IPV and HIV serology among cohabiting couples (≥15 years). Current partners of women experiencing past-year IPV were assumed to be IPV perpetrators. We used Poisson regression, based on Generalized Estimating Equations, to estimate prevalence ratios (PR) for male partner and partnership-level factors associated with perpetration of IPV, and men's HIV status. We used marginal standardization to estimate the adjusted risk differences (aRD) quantifying the incremental effect of IPV on women's risk of living with HIV, beyond the risk from their partners' HIV status. Models were adjusted for survey fixed effects and potential confounders. In the 48 surveys available from 27 countries (N = 111,659 couples), one-fifth of women reported that their partner had perpetrated IPV in the past year. Men who perpetrated IPV were more likely to be living with HIV (aPR = 1.09; 95%CI: 1.01-1.16). The aRD for living with HIV among women aged 15-24 whose partners were HIV seropositive and perpetrated past-year IPV was 30% (95%CI: 26%-35%), compared to women whose partners were HIV seronegative and did not perpetrate IPV. Compared to the same group, aRD among women whose partner was HIV seropositive without perpetrating IPV was 27% (95%CI: 23%-30%). Men who perpetrated IPV are more likely to be living with HIV. IPV is associated with a slight increase in young women's risk of living with HIV beyond the risk of having an HIV seropositive partner, which suggests the mutually reinforcing effects of HIV/IPV.
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Affiliation(s)
- Salome Kuchukhidze
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Souleymane Diabaté
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de Médecine et Spécialités Médicales, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Infectious Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany
| | | | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
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10
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Mugumba E, Kagwa M, Muhumuza D, Namukwaya R, Amunyongire R, Maling S. Prevalence and correlates of intimate partner violence following partner notification among index HIV clients attending primary healthcare facilities in Uganda. AIDS Care 2023; 35:859-866. [PMID: 36120933 PMCID: PMC10020122 DOI: 10.1080/09540121.2022.2122390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Assisted partner notification (APN) program was adopted by Uganda to increase individuals testing for HIV through their partners who test HIV positive. Thus, early enrollment in treatment and ensuring prevention services for the affected couple. However, APN is associated with high levels of Intimate partner violence (IPV). We aimed at determining the prevalence of IPV following APN in a cross-sectional study of newly diagnosed HIV clients in southwestern Uganda. We used the modified version of the Conflict Tactics Scale to assess IPV. We also collected information on sociodemographics of the index clients and their sexual partners, and outcome of linkage to care of partner. Logistic regression was used to determine the factors associated with IPV. We enrolled 327 index clients, mean age was 39.1, 63.6% were female and 35.5 experienced IPV following APN. The likelihood of experiencing IPV was more than twice if a health worker/provider disclosed the status to the partner. However, if the partners turned out to be HIV positive, it was protective against experiencing IPV, adjusted odds ratio 0.39, 95% confidence interval 0.23-0.69, p = 0.001. We conclude that IPV is common following partner notification in rural Uganda and should be screened and addressed.
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Affiliation(s)
- Eria Mugumba
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Kagwa
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickson Muhumuza
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Racheal Namukwaya
- Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara Uganda
| | - Ronaldo Amunyongire
- Department of Nursing, Mbarara University of Science and Technology, Mbarara Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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11
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Mittal M, Paden McCormick A, Palit M, Trabold N, Spencer C. A Meta-Analysis and Systematic Review of Community-Based Intimate Partner Violence Interventions in India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5277. [PMID: 37047893 PMCID: PMC10093839 DOI: 10.3390/ijerph20075277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
Intimate partner violence (IPV) in India remains an entrenched and prevalent public health issue. Despite ample evidence of the widespread problem of IPV in India and associated mental and physical morbidities, far less is known about intervention models to reduce IPV in India. The aims of this meta-analysis and systematic review are to assess the effectiveness of community-based interventions to reduce IPV in India and to provide a narrative synthesis of these intervention approaches. A total of 9 databases were searched to identify peer-reviewed, English-language articles published between January 2000 and September 2022. The search identified 10 studies that met study inclusion criteria, including 3 randomized control trials, 4 quasi-experimental, 2 pre/post, and 1 time-series evaluation. Eight studies were included in the meta-analysis. There was notable variation in the interventions and approaches employed to reduce IPV and varying measurement of IPV outcomes. The results of the meta-analysis show that participating in community-based IPV interventions produced a significant reduction in IPV among women. When considering different types of IPV, study participants were less likely to report physical and psychological IPV victimization. In addition, participants were also less likely to report approving of IPV after participating in community-based IPV interventions. Community-based interventions and research addressing IPV are still evolving in India. Missing descriptions of theoretical frameworks, sampling, intervention design, and inadequately reported effectiveness of intervention (both quantitative and qualitative reporting) need to be addressed. Moreover, long-term evaluations of the pilot interventions are needed to provide a clear picture of the long-term effectiveness, sustainability, and replicability of the community-based IPV interventions. The findings have implications for researchers, practitioners (community health workers, clinicians, and social workers), and policymakers keen on IPV reduction in India and globally.
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Affiliation(s)
- Mona Mittal
- Department of Family Science, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Anna Paden McCormick
- Department of Family Science, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Manjushree Palit
- Jindal School of Psychology and Counseling, Jindal Global University, Sonipat 131001, India
| | - Nicole Trabold
- College of Health Science and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Chelsea Spencer
- Department of Applied Human Sciences, Kansas State University, Manhattan, KS 66506, USA;
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12
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Kuchukhidze S, Panagiotoglou D, Boily MC, Diabaté S, Eaton JW, Mbofana F, Sardinha L, Schrubbe L, Stöckl H, Wanyenze RK, Maheu-Giroux M. The effects of intimate partner violence on women's risk of HIV acquisition and engagement in the HIV treatment and care cascade: a pooled analysis of nationally representative surveys in sub-Saharan Africa. Lancet HIV 2023; 10:e107-e117. [PMID: 36463914 DOI: 10.1016/s2352-3018(22)00305-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Achieving the 95-95-95 targets for HIV diagnosis, treatment, and viral load suppression to end the HIV epidemic hinges on eliminating structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa has among the highest prevalence of IPV and HIV worldwide. We aimed to examine the effects of IPV on recent HIV infection and women's engagement in the HIV care cascade in sub-Saharan Africa. METHODS We did a retrospective pooled analysis of data from nationally representative, cross-sectional surveys with information on physical or sexual IPV (or both) and HIV testing, from Jan 1, 2000, to Dec 31, 2020. Relevant surveys were identified from data catalogues and previous large-scale reviews, and included the Demographic and Health Survey, the AIDS Indicator Survey, the Population-based HIV Impact Assessment, and the South Africa National HIV Prevalence, Incidence, Behavior and Communication Survey. Individual-level data on all female respondents who were ever-partnered (currently or formerly married or cohabiting) and aged 15 years or older were included. We used Poisson regression to estimate crude and adjusted prevalence ratios (PRs) for the association between past-year experience of physical or sexual IPV (or both), as the primary exposure, and recent HIV infection (measured with recency assays), as the primary outcome. We also assessed associations of past-year IPV with self-reported HIV testing (also in the past year), and antiretroviral therapy (ART) uptake and viral load suppression at the time of surveying. Models were adjusted for participant age, age at sexual debut (HIV recency analysis), urban or rural residency, partnership status, education, and survey-level fixed effects. FINDINGS 57 surveys with data on self-reported HIV testing and past-year physical or sexual IPV were available from 30 countries, encompassing 280 259 ever-partnered women aged 15-64 years. 59 456 (21·2%) women had experienced physical or sexual IPV in the past year. Six surveys had information on recent HIV infection and seven had data on ART uptake and viral load suppression. The crude PR for recent HIV infection among women who had experienced past-year physical or sexual IPV, versus those who had not, was 3·51 (95% CI 1·64-7·51; n=19 179). The adjusted PR was 3·22 (1·51-6·85). Past-year physical or sexual IPV had minimal effect on self-reported HIV testing in the past year in crude analysis (PR 0·97 [0·96-0·98]; n=274 506) and adjusted analysis (adjusted PR 0·99 [0·98-1·01]). Results were inconclusive for the association of ART uptake with past-year IPV among women living with HIV (crude PR 0·90 [0·85-0·96], adjusted PR 0·96 [0·90-1·02]; n=5629). Women living with HIV who had experienced physical or sexual IPV in the past year were less likely to achieve viral load suppression than those who had not experienced past-year IPV (crude PR 0·85 [0·79-0·91], adjusted PR 0·91 [0·84-0·98], n=5627). INTERPRETATION Past-year physical or sexual IPV was associated with recent HIV acquisition and less frequent viral load suppression. Preventing IPV is inherently imperative but eliminating IPV could contribute to ending the HIV epidemic. FUNDING Canadian Institutes of Health Research, the Canada Research Chairs Program, and Fonds de recherche du Québec-Santé. TRANSLATIONS For the French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Salome Kuchukhidze
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Souleymane Diabaté
- Département de Médecine Sociale et Préventive, Université Laval, Québec City, QC, Canada; Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada; Département de Médecine et Spécialités, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | | | - Leah Schrubbe
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada.
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13
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Tsega NT, Belay DG, Aragaw FM, Asratie MH, Gashaw M, Endalew M. Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: multilevel analysis based on 2016 Ethiopian Demographic and Health Survey. BMC Womens Health 2022; 22:549. [PMID: 36572908 PMCID: PMC9793678 DOI: 10.1186/s12905-022-02143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The period of youth is important for the foundation of healthy and stable relationships, women's health and well-being. Youth women face a higher risk of experiencing violence than older women. Intimate partner violence (IPV) against youth women is a significant public health concern. Despite paramount negative health consequences of IPV for the survivor, as per our knowledge, research study on IPV and associated factors among youth women in Ethiopia is scarce. Therefore, this study aimed to assess the magnitude and associated factors of IPV among youth women in Ethiopia. METHODS The data was accessed from 2016 Ethiopia demographic and health survey (EDHS) which was a cross sectional population based household survey. It was also conducted using a multi-stage stratified random cluster sampling approach. The data were cleaned, weighted, and analyzed using STATA Version 14 software. The total weighted sample of 1077 youth women were used in this study. Multilevel logistic regression modeling was used to determine factors associated with IPV among youth women. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to declare the significant variables. RESULTS Among the total participants, 30.27% (95% CI 27.59, 33.09) of youth women experienced IPV. Individual level variables such as: Being widowed/divorced/separated (AOR = 2.28; 95% CI 1.33, 3.91), having a partner who drinks alcohol (AOR = 5.76; 95% CI 3.42, 9.69), witnessing inter-parental violence during childhood (AOR = 3.45; 95% CI 2.21, 5.37), being afraid of partners (AOR = 7.09; 95% CI 4.30, 11.68), and from community level variables, youth women residing in communities with a low proportion of educated youth women (AOR = 0.31; 95% CI 0.13, 0.78) were significantly associated with having experience of IPV. CONCLUSION The magnitude of intimate partner violence among youth women in Ethiopia was relatively high as compared to the global estimate of IPV. Individual and community level variables such as currently widowed/divorced/separated women, having a partner who drinks alcohol, witnessing inter-parental violence, being afraid of partner, and women from a low proportion of community level youth women's education were significantly associated with intimate partner violence. To decrease this public health problem, it is better to strengthen legislation on the purchase and sale of alcohol, provide legal protection for separated/divorced women, establish effective legal response services for IPV, promote gender equality, and provide psychological support for those who witnessed inter-parental violence during childhood to reduce IPV.
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Affiliation(s)
- Nuhamin Tesfa Tsega
- grid.59547.3a0000 0000 8539 4635Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- grid.59547.3a0000 0000 8539 4635Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- grid.59547.3a0000 0000 8539 4635Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Agathis NT, Annor FB, Mercy J, Chiang L, de Barros RB, Massetti GM. How the Global Violence Against Children and Youth Surveys Help Improve Pediatric Global Health. Pediatrics 2022; 150:e2022057124. [PMID: 36263716 PMCID: PMC10683777 DOI: 10.1542/peds.2022-057124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, National Center for Injury Prevention and Control
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Francis B. Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - James Mercy
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Laura Chiang
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Regina Benevides de Barros
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control
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15
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Mutumba M, Bhattacharya S, Ssewamala FM. Assessing the social patterning and magnitude of inequalities in sexual violence among young women in Uganda: Findings from 2016 demographic and health survey. Glob Public Health 2022; 17:2826-2840. [PMID: 35167776 DOI: 10.1080/17441692.2022.2037149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual violence (SV) is a significant global public health problem. To develop effectively targeted interventions to prevent SV and allocate resources equitably requires identifying the most vulnerable groups and the magnitude of these social inequities. However, these data are currently lacking. Using the Uganda Demographic and Health Survey, we examined SV among all young women and ever-married young women. We conducted univariate and bivariate analyses to characterise the prevalence and social patterning of SV, and then utilised the World Health Organization Health Equity Assessment Toolkit (HEAT) to assess the magnitude of social inequities in SV. At the national level, 5.5% among all young women and 20.5% of ever-married young women had experienced SV. For all young women, the largest inequities in SV were based on sub-national region of residence. Among the ever-married young women, we found profound education, wealth and place-based inequities in SV, which favoured young women with higher education, in wealthier households, and within central regions of Uganda. Our findings suggest a need for regionally targeted multi-sectoral interventions that take into consideration that multiple intersecting social dimensions such as education, poverty and the safe built environment, to address young women's risk for SV.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Fred M Ssewamala
- Brown School of Social Work, University of Washington at St. Louis, St. Louis, MO, USA
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16
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Oseso L, Krakowiak D, Nduati R, Farquhar C, Kinuthia J, Osoti AO, Guthrie B. Past intimate partner violence (IPV) predicts incident IPV during pregnancy and postpartum in pregnant women in Kisumu, Kenya. Int J Gynaecol Obstet 2022; 159:290-296. [PMID: 35064967 PMCID: PMC9304447 DOI: 10.1002/ijgo.14107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/08/2021] [Accepted: 01/20/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate how identifying factors associated with peripartum and postpartum intimate partner violence (IPV) may facilitate prioritizing women for psychosocial support. METHODS Pregnant women in Kenya were asked about IPV by their current partner at baseline (screening), during pregnancy and at 6 weeks and 6 months postpartum. IPV was defined as being physically hurt or forced to participate in sexual activities or being threatened or frightened by a partner. RESULTS A total of 502 women (11.8% HIV-positive) enrolled during pregnancy and were successfully followed for 6 months postpartum, 430 (85.7%) reported never experiencing IPV, 32 (6.4%) reported IPV at least once in their lifetime but not in the past 6 months, and 31 (6.2%) reported IPV in the past 6 months but not in the past month. During pregnancy and postpartum, 61 (12.2%) reported incident IPV. Women who at baseline reported IPV in the past 6 months were at 2.7-fold higher odds of experiencing IPV peripartum and postpartum (odds ratio 2.77; 95% confidence interval 1.17-6.53; P = 0.020) compared with women who had never experienced IPV. This association remained significant in multivariable analysis. CONCLUSION Screening for recent IPV during antenatal care visits may be an effective means to identify women at highest risk of IPV and offer targeted prevention interventions.
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Affiliation(s)
- Linda Oseso
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- HIV Vaccine Trials Network, Vaccine and Infectious Disease Division, Fred Hutch, Seattle, WA, USA
| | - Daisy Krakowiak
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Alfred O Osoti
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Brandon Guthrie
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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17
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Stubbs A, Szoeke C. The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. TRAUMA, VIOLENCE & ABUSE 2022; 23:1157-1172. [PMID: 33541243 DOI: 10.1177/1524838020985541] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019. METHODS SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening. RESULTS IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes. CONCLUSION The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.
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Affiliation(s)
- Anita Stubbs
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne and Austin Health, Australia
| | - Cassandra Szoeke
- Centre for Medical Research (Royal Melbourne Hospital), Department of Medicine, 2281University of Melbourne, Australia
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Akobirshoev I, Valentine A, Zandam H, Nandakumar A, Jewkes R, Blecher M, Mitra M. Disparities in intimate partner violence among women at the intersection of disability and HIV status in South Africa: a cross-sectional study. BMJ Open 2022; 12:e054782. [PMID: 36113942 PMCID: PMC9486199 DOI: 10.1136/bmjopen-2021-054782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Previous research suggests a significant relationship between intimate partner violence (IPV) and HIV infection in women and that the risk of IPV is heightened in women with disabilities. Women with disabilities, particularly those residing in low-income and middle-income countries, may experience additional burdens that increase their vulnerability to IPV. We aimed to examine the association between having disability and HIV infection and the risk of IPV among women in South Africa. DESIGN Using the 2016 South Africa Demographic and Health Survey, we calculated the prevalence of IPV and conducted modified Poisson regressions to estimate the unadjusted and adjusted risk ratios of experiencing IPV by disability and HIV status. PARTICIPANTS Our final analytical sample included 1269 ever-partnered women aged 18-49 years, who responded to the IPV module and received HIV testing. RESULTS The prevalence of IPV was twice as high in women with disabilities with HIV infection compared with women without disabilities without HIV infection (21.2% vs 50.1%). Our unadjusted regression analysis showed that compared with women without disabilities without HIV infection, women with disabilities with HIV infection had almost four times higher odds (OR 3.72, 95% CI 1.27 to 10.9, p<0.05) of experiencing IPV. It appeared that women with disabilities with HIV infection experience compounded disparity. The association was compounded, with the OR for the combination of disability status and HIV status equal to or more than the sum of each of the individual ORs. CONCLUSIONS Women with disabilities and HIV infection are at exceptionally high risk of IPV in South Africa. Given that HIV infection and disability magnify each other's risks for IPV, targeted interventions to prevent IPV and to address the complex and varied needs of doubly marginalised populations of women with disabilities with HIV infection are critical.
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Affiliation(s)
- Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Hussaini Zandam
- Lurie Institute for Disability Policy, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Allyala Nandakumar
- Institute for Global Health and Development, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Rachel Jewkes
- Gender and Health Division, South African Medical Research Council, Pretoria, South Africa
| | - Mark Blecher
- Health and Social Development, National Treasury of South Africa, Cape Town, South Africa
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
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Paul P, Mondal D. Association Between Intimate Partner Violence and Contraceptive Use in India: Exploring the Moderating Role of Husband's Controlling Behaviors. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP15405-NP15433. [PMID: 34000903 DOI: 10.1177/08862605211015212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Existing studies show a mixed relationship between intimate partner violence (IPV) and contraceptive use. This study assesses the association between women's exposure to IPV and contraceptive use in India. Furthermore, we aim to determine whether husband's controlling behaviors play a moderating role in the IPV-contraception link. We used nationally representative data from the recent round of the National Family Health Survey (NFHS-4), conducted in 2015-2016. In this study, the use of contraceptives is the outcome variable, categorized into three groups: no/traditional methods, modern methods, and female sterilization. Women's exposure to IPV in the past year is the key exposure of interest. Socio-economic and demographic variables were used as covariates. Multinomial logistic regression models were performed to examine the association between women's exposure to IPV and contraceptive use. Of the total participants (N = 58,891), approximately one in every four women (24.1%) experienced any form of IPV in the past year. Slightly over half (50.8%) reported using either traditional methods of contraception or no contraceptive at all. About 14% of the respondents were using modern methods of contraception and 34.9% had undergone sterilization. After controlling for confounding factors, women who experienced IPV were 8% (95% CI [.87, .99]) less likely to report using modern contraceptives than those who did not face any IPV. Conversely, women who faced IPV were 14% (95% CI [1.09, 1.20]) more likely to undergo sterilization. Furthermore, women who experienced any form of IPV and whose husbands endorse controlling attitudes were 12% (95% CI [.81, .95]) less likely to report using modern contraceptives and 11% (95% CI [1.04, 1.17]) more likely to undergo sterilization. Interventions should be made to prevent violence against women that would increase their ability to choose appropriate contraception methods to avoid unintended pregnancies.
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Affiliation(s)
- Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Dinabandhu Mondal
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
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Sexual and Gender-Based Violence and Vulnerability to HIV Infection in Uganda: Evidence from Multilevel Modelling of Population-Level HIV/AIDS Data. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11070301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Sexual and gender-based violence (SGBV) is highly prevalent in Uganda and its link with HIV infection and compromising access to HIV/AIDS services is known. However, current evidence is controversial. Most of the studies indicate a positive relationship but a few indicate otherwise. Moreover, there is no research examining the effects of community-level SGBV on HIV infection. Objectives: This research explores the association between SGBV and vulnerability to HIV infection. Methods: Multilevel binary logistic regression is applied to secondary data of Uganda AIDS Indicators Survey conducted in 2011. The survey data comprises 12,153 women and 9588 men. Results: SGBV significantly increases the likelihood of HIV infection, with victims having 34%, 1.34 [1.06–1.70] higher odds than non-victims. At the community level, wealth, and pre-sex alcohol abuse are important determinants. Conclusions: Vulnerability to the risk of HIV infection in Uganda is associated with individual-level and community factors. Effective HIV prevention policies need to pay attention to victims of SGBV using individual- and community-level strategies.
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Stanton AM, Bwana M, Owembabazi M, Atukunda E, Musinguzi E, Ezegbe H, Smith P, Psaros C, Matthews LT, Kaida A. Sexual and Relationship Benefits of a Safer Conception Intervention Among Men with HIV Who Seek to Have Children with Serodifferent Partners in Uganda. AIDS Behav 2022; 26:1841-1852. [PMID: 34796420 PMCID: PMC9050835 DOI: 10.1007/s10461-021-03533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
Many men with HIV (MWH) in Uganda desire children, yet seldom receive reproductive counseling related to HIV care. Because men are under engaged in safer conception programming, they miss opportunities to reap the benefits of these programs. The objective of this sub-analysis was to explore the relationship and intimacy benefits of integrating safer conception counseling and strategies into HIV care, an emergent theme from exit interviews with men who participated in a pilot safer conception program and their partners. Twenty interviews were conducted with MWH who desired a child in the next year with an HIV-uninfected/status unknown female partner, and separate interviews were conducted with female partners (n = 20); of the 40 interviews, 28 were completed by both members of a couple. Interviews explored experiences participating in The Healthy Families program, which offered MWH safer conception counseling and access to specific strategies. Data were analyzed using thematic analysis. Three major subthemes or "pathways" to the relationship and intimacy benefits associated with participation in the program emerged: (1) improved dyadic communication; (2) joint decision-making and power equity in the context of reproduction; and (3) increased sexual and relational intimacy, driven by reduced fear of HIV transmission and relationship dissolution. These data suggest that the intervention not only helped couples realize their reproductive goals; it also improved relationship dynamics and facilitated intimacy, strengthening partnerships and reducing fears of separation. Directly addressing these benefits with MWH and their partners may increase engagement with HIV prevention strategies for conception.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mwebesa Bwana
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moran Owembabazi
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Esther Atukunda
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Elijah Musinguzi
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Henrietta Ezegbe
- Simon Fraser University (SFU), Faculty of Health Sciences, BLU 10522, 8888 University Drive, Burnaby, B.C., V5A 1S6, Canada
| | - Patricia Smith
- Simon Fraser University (SFU), Faculty of Health Sciences, BLU 10522, 8888 University Drive, Burnaby, B.C., V5A 1S6, Canada
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Angela Kaida
- Simon Fraser University (SFU), Faculty of Health Sciences, BLU 10522, 8888 University Drive, Burnaby, B.C., V5A 1S6, Canada.
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Leddy AM, Selin A, Lippman SA, Kimaru LJ, Twine R, Gómez-Olivé X, Kahn K, Pettifor A. Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort. AIDS Behav 2022; 26:1863-1870. [PMID: 34800183 PMCID: PMC9046300 DOI: 10.1007/s10461-021-03535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/05/2022]
Abstract
Limited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco, 550 16th St., 3rd floor, San Francisco, CA, 94158, USA.
| | - Amanda Selin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sheri A Lippman
- Department of Medicine, University of California, San Francisco, 550 16th St., 3rd floor, San Francisco, CA, 94158, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda J Kimaru
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Arishaba A, Kiduuma W, Night G, Arinaitwe I, Niyonzima V, Mubangizi V. Predictors and Factors Associated with Counseling Seeking Behavior Against Intimate Partner Violence Among HIV-Positive Women in Southwestern Uganda. HIV AIDS (Auckl) 2022; 14:275-283. [PMID: 35711852 PMCID: PMC9196276 DOI: 10.2147/hiv.s362398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Adella Arishaba
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Wilson Kiduuma
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Grace Night
- Department of Physiotherapy, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Innocent Arinaitwe
- Department of Internal Medicine, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
- Correspondence: Vallence Niyonzima, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara city, Uganda, Tel +256777842830, Email
| | - Vincent Mubangizi
- Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda
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Intimate partner violence and oral HIV pre-exposure prophylaxis adherence among young African women. AIDS 2022; 36:1151-1159. [PMID: 35579012 PMCID: PMC9486991 DOI: 10.1097/qad.0000000000003216] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the effect of intimate partner violence (IPV) on oral PrEP adherence among adolescent girls and young women (AGYW). DESIGN We conducted a secondary analysis of data from HIV Prevention Trials Network 082 (HPTN 082), a multisite prospective study designed to assess oral PrEP adherence among AGYW in southern Africa. METHODS We estimated the relative prevalence of high PrEP adherence 3 and 6 months after initiation among AGYW 16-25 years who reported a history of any IPV in the past year at enrollment versus AGYW who did not, both overall and by age. High adherence was defined as an intracellular tenofovir-diphosphate concentration at least 700 fmol/punch in dried blood spots. RESULTS Among 409 PrEP-initiating AGYW, half (49%) reported experiencing any IPV by a current/recent partner in the year prior to enrollment. Overall, a similar proportion of AGYW who reported IPV had high PrEP adherence at months 3 and 6 as AGYW who did not report IPV. There was, however, evidence of effect modification by age at month 3: among AGYW less than 21 years, those who reported IPV were less than half as likely to have high adherence [adjusted PR (aPR) = 0.43, 95% confidence interval (CI) 0.22-0.86]; among AGYW aged 21 years, those who reported IPV were more than twice as likely to have high adherence (aPR = 2.21, 95% CI 1.34-3.66). At month 6, effect estimates within each age stratum were consistent in direction to those at month 3. CONCLUSION IPV events may either impede or motivate PrEP adherence among African AGYW, with age appearing to be an important consideration for IPV-related adherence interventions.
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The CHARISMA randomized controlled trial: a relationship-focused counseling intervention integrated within oral PrEP delivery for HIV prevention among women in Johannesburg, South Africa. J Acquir Immune Defic Syndr 2022; 90:425-433. [PMID: 35416797 DOI: 10.1097/qai.0000000000002991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Consistent use of oral pre-exposure prophylaxis (PrEP) has been a challenge among women, particularly when in relationships with lack of partner support or intimate partner violence (IPV). Methods. We conducted a randomized controlled trial (RCT) of an empowerment counseling intervention called "CHARISMA" delivered to women within a PrEP demonstration project in Johannesburg, South Africa. The trial tested the effectiveness of CHARISMA to increase PrEP adherence; decrease social harms (SHs) and IPV; and improve partnership dynamics (e.g. communication, disclosure and support) as compared to those who received the standard of care (SOC) counselling support and referrals. 407 HIV-seronegative, non-pregnant women aged 18-45 years were enrolled for 6 months of PrEP use, with 203 randomized (1:1) to the intervention. All participants reporting IPV received counseling and referrals that followed the WHO five-step Listen, Inquire, Validate, Enhance Safety, and Support approach. Results. This RCT did not identify statistically significant differences between study arms for PrEP adherence or relationship dynamics, with the exception of an increase in PrEP disclosure among intervention arm women. In our study, we cannot determine whether the lack of detectable findings may have been due to lack of intervention effect, strength of SOC services, low risk in the study population or other factors. Conclusions: Addressing IPV and relationship dynamics remain important factors influencing HIV risk, and addressing these within the context of PrEP delivery is an important synergistic opportunity. CHARISMA was highly acceptable to participants, and further adaptation and testing of the intervention to other populations and settings will augment the evidence base.
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Das T, Roy TB, Roy R. Reintegration with family and intimate partner violence (IPV) against women among the returnee migrant worker's family during COVID-19 induced lockdown: A Block-level analysis using multinomial logistic regression model. CHILDREN AND YOUTH SERVICES REVIEW 2021; 130:106226. [PMID: 34511676 PMCID: PMC8416023 DOI: 10.1016/j.childyouth.2021.106226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 05/06/2023]
Abstract
Worldwide the incidents of intimate partner violence (IPV) have increased due to lockdowns related to the COVID-19 pandemic. This paper aims to identify the association between IPV and different socio-economic factors of women & their most recent partner during the COVID-19 pandemic in returnee migrant worker families in Balurghat Block (area 363.9 sq. km), Dakshin Dinajpur district, West Bengal, India. A total of 159 ever-married women were included in this present study, whose husbands were engaged as workers elsewhere at least two years before the lockdown. The result of the multinomial logistic regression model revealed that, after controlling for other variables, the women who had the poorest wealth background were 37% more likely (RRR: 1.37; 95% CI [1.18, 1.47]) to experience IPV almost every day in a week than those who had a middle wealth background. Conversely, the women who had the poorest wealth background were 37% (95% CI [0.57, 0.82]) less likely to experience IPV for three to four days in a week. Furthermore, the women whose partners were currently unemployed were 21% more likely (RRR: 1.21; 95% CI [1.16, 1.36]) to experience IPV almost every day in a week than those whose husbands were currently employed. The women whose husband's had a loan were 26% more likely (RRR: 1.26; 95% CI [1.25, 1.33]) to experience IPV for three to four days in a week than those whose husbands did not have any loans. The likelihood to experience IPV almost every day in a week is higher among those women whose husbands attain weekly (31%) loan instalment pattern and consume alcohol daily (31%). Interventions are needed at the grassroots level and some economic planning is required at an urgent basis.
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Affiliation(s)
- Tanu Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, India
| | - Tamal Basu Roy
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, India
| | - Ranjan Roy
- Department of Geography and Applied Geography, University of North Bengal, West Bengal, India
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HIV/STI Prevention Interventions for Women Who Have Experienced Intimate Partner Violence: A Systematic Review and Look at Whether the Interventions Were Designed for Disseminations. AIDS Behav 2021; 25:3605-3616. [PMID: 34050404 PMCID: PMC8163592 DOI: 10.1007/s10461-021-03318-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/31/2022]
Abstract
This systematic review of HIV/STI prevention interventions for women who have experienced intimate partner violence (IPV) describes the interventions characteristics, impact on HIV-related outcomes, and whether the studies were designed for dissemination. Six intervention studies met the inclusion criteria. Two studies were randomized controlled trials. The interventions consisted of between one and eight individual and/or group sessions. The interventions durations ranged from 10 minutes to 18 hours. The interventions impacts were assessed across 12 HIV-related outcomes. Two randomized control trials showed significantly fewer unprotected sexual episodes or consistent safer sex among abused women in the treatment conditions compared to the control groups. Two studies chose a delivery site for scalability purposes and three interventions were manualized. Three studies examined intervention acceptability, feasibility or fidelity. HIV/STI prevention interventions for women who have experienced IPV may be improved with randomized control designs and greater efforts to design the interventions for dissemination.
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Hooft A, Pfeil S, Mussengue J, Jetha E, He F, Jain S, Manuel S, Langa PV, Sundararajan R. Explaining utilization of HIV prevention and testing services among university students in Mozambique: results from a mixed methods study. BMC Public Health 2021; 21:1891. [PMID: 34666721 PMCID: PMC8525004 DOI: 10.1186/s12889-021-11788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In Mozambique, HIV infection disproportionately affects young adults, particularly women. Despite awareness and knowledge of HIV transmission, many university students have not received HIV testing and continue to engage in high-risk sexual behaviors, including inconsistent condom use. Further understanding of patterns of engagement with HIV prevention and testing is key to reducing HIV transmission in this at-risk population. METHODS This study used a sequential mixed methods approach to examine patterns of engagement and perceptions of HIV prevention and testing services among higher education students in Mozambique. Survey data were collected from a representative sample of 501 students from Universidade Eduardo Mondlane (UEM) in Maputo, Mozambique to assess the primary outcomes of 1) HIV testing within the last 12 months; and 2) condom use during last sexual encounter. We employed univariate and multivariate regression models. The survey was followed by qualitative interviews with 70 survey participants which were analyzed using an inductive, content-focused analysis to further explain and contextualize survey findings. RESULTS Over 85% of students reported to be sexually active, among these 74% reported condom use during their last sexual encounter, and 64.2% reported an HIV test within the past 12 months. Females were more likely to have had HIV testing in the past 12 months in comparison to their male peers (aOR 1.82, 95% CI 1.11, 2.99), but were half as likely to have used a condom with their last sexual encounter (aOR 0.52, 95% CI 0.33, 0.83), when controlling for other factors. Qualitative data suggests that these discrepancies may be explained by differential perceptions in risk and trust/mistrust, with women being more concerned about infidelity by their male partner(s) and assuming more responsibility for knowing their own serostatus. Women were also subject to negative stereotypes for possessing condoms in comparison to men, which could explain lower propensity for use. CONCLUSION Given gendered differences in uptake of condom use and HIV testing, and perceived HIV risk, interventions tailored specifically to male and female students may impact engagement with HIV prevention and testing and empower informed choices about sexual behaviors.
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Affiliation(s)
- Anneka Hooft
- Department of Emergency Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA.
- Department of Emergency Medicine, Pediatric Emergency Medicine, 550 16th St, 5th Floor, San Francisco, CA, 94143, USA.
| | - Sarah Pfeil
- University of California, Davis, 4860 Y Street #2500, Sacramento, CA, 95817, USA
| | - Josina Mussengue
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyere, Maputo, Mozambique
| | - Eunice Jetha
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyere, Maputo, Mozambique
| | - Feng He
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093, CA, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093, CA, USA
| | - Sandra Manuel
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyere, Maputo, Mozambique
| | - Patrício V Langa
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyere, Maputo, Mozambique
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA.
- Department of Emergency Medicine, Weill Cornell Medicine, 585 East 68th Street, New York, NY, 10065, USA.
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Bukuluki P, Kisaakye P, Wandiembe SP, Musuya T, Letiyo E, Bazira D. An examination of physical violence against women and its justification in development settings in Uganda. PLoS One 2021; 16:e0255281. [PMID: 34587182 PMCID: PMC8480831 DOI: 10.1371/journal.pone.0255281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022] Open
Abstract
This paper uses data from a community cross-sectional survey to examine the factors that are associated with justification of physical violence against women. Results indicate that respondents who were married at the time of the survey were less likely (OR = 0.29; CI = 0.17–0.52) to agree that it is justified for a man to physically assault his partner that their counterparts who were single. The likelihood to justify physical violence was less likely to happen among respondents with primary education (OR = 0.49; CI = 0.39–0.62), secondary education (OR = 0.40; CI = 0.31–0.53) and vocation or tertiary education (OR = 0.28; CI = 0.19–0.41) than among respondents with no education. Protestants were less likely (OR = 0.77; CI = 0.64–0.94) to justify physical violence than the Catholics. Respondents who were not formally employed were more likely (OR = 1.66; CI = 1.32–2.08) to justify physical violence than their counterparts who were in formal employment in the last three months preceding the survey. Respondents who agreed that it is okay for a man to control his partner’s movements (OR = 1.27; CI = 1.04–1.55), it is okay for a man to have sex with his wife anytime (OR = 2.28; CI = 1.87–2.78), alcohol is the main reason for violence against women (OR = 1.67; CI = 1.33–2.10), men need sex more than women (OR = 1.57; CI = 1.23–1.99) and women know where to obtain support in case of violence (OR = 1.42; CI = 1.00–2.02) were more likely to justify physical violence than respondents who disagreed. The likelihood to justify physical violence was less among respondents who agreed that: violence is not the only way to deal with disagreements (OR = 0.54; CI = 0.33–0.86), it is possible for men to stop violence (OR = 0.62; CI = 0.47–0.82) and it is acceptable for a woman to ask her partner to use a condom (OR = 0.61; CI = 0.51–0.73) than their counterparts who disagreed. There is need to increase investment in social norms change programmes in order to strengthen contestation of tolerance of physical violence among men and women in Uganda.
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Affiliation(s)
- Paul Bukuluki
- School of Social Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Peter Kisaakye
- School of Statistics and Planning, Makerere University, Kampala, Uganda
| | | | - Tina Musuya
- Centre for Domestic Violence Prevention, Mulago, Uganda
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Malama K, Sagaon Teyssier L, Parker R, Tichacek A, Sharkey T, Kilembe W, Inambao M, Price MA, Spire B, Allen S. Client-Initiated Violence Against Zambian Female Sex Workers: Prevalence and Associations With Behavior, Environment, and Sexual History. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9483-NP9500. [PMID: 31268388 PMCID: PMC8366593 DOI: 10.1177/0886260519860083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Violence against women is a known risk factor for HIV and affects female sex workers (FSW) in sub-Saharan Africa. Little is known about the magnitude and determinants of violence against FSW in Zambia, where HIV and gender-based violence prevalence are high. We conducted a cross-sectional study, using multivariable logistic regression, to determine the prevalence and correlates of client-initiated physical violence among 419 FSW in Lusaka and Ndola. The prevalence of client-initiated physical violence was 39%. The odds of violence were higher for FSW who: lived in Lusaka, recruited clients from the street, serviced clients in the clients' homes, had a physically forced sexual debut, and had a higher client volume. Our results call for safer working spaces for FSW and violence prevention interventions for their male clients.
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Affiliation(s)
- Kalonde Malama
- Aix-Marseille Université, APHM, INSERM, IRD, Sciences Économiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France
| | - Luis Sagaon Teyssier
- Aix-Marseille Université, APHM, INSERM, IRD, Sciences Économiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United States
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United States
| | - Tyronza Sharkey
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - William Kilembe
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - Mubiana Inambao
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Ndola, Zambia
| | - Matt A Price
- International AIDS Vaccine Initiative (IAVI) New York, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Bruno Spire
- Aix-Marseille Université, APHM, INSERM, IRD, Sciences Économiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United States
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Gormley R, Nicholson V, Parry R, Lee M, Webster K, Sanchez M, Cardinal C, Li J, Wang L, Balleny R, de Pokomandy A, Loutfy M, Kaida A. Help-Seeking to Cope With Experiences of Violence Among Women Living With HIV in Canada. Violence Against Women 2021; 28:823-850. [PMID: 34269116 PMCID: PMC8785290 DOI: 10.1177/10778012211019047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Using baseline data from a community-collaborative cohort of women living with HIV in Canada, we assessed the prevalence and correlates of help-seeking among 1,057 women who reported experiencing violence in adulthood (≥16 years). After violence, 447 (42%) sought help, while 610 (58%) did not. Frequently accessed supports included health care providers (n = 313, 70%), family/friends (n = 244, 55%), and non-HIV community organizations (n = 235, 53%). All accessed supports were perceived as helpful. Independent correlates of help-seeking included reporting a previous mental health diagnosis, a history of injection drug use, experiencing childhood violence, and experiencing sexism. We discuss considerations for better supporting women who experience violence.
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Affiliation(s)
- Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Rebeccah Parry
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Claudette Cardinal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Rosa Balleny
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,Division of AIDS, University of British Columbia, Vancouver, British Columbia, Canada
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Meinhart M, Seff I, Troy K, McNelly S, Vahedi L, Poulton C, Stark L. Identifying the Impact of Intimate Partner Violence in Humanitarian Settings: Using an Ecological Framework to Review 15 Years of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6963. [PMID: 34209746 PMCID: PMC8297014 DOI: 10.3390/ijerph18136963] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational impact of IPV in humanitarian settings. However, findings highlighted a glaring gap in evidence examining the non-health impact of IPV for survivors in humanitarian settings and across levels of the ecological framework. Without enhanced research of women and girls and the violence they experience, humanitarian responses will continue to underachieve, and the needs of women and girls will continue to be relegated as secondary interests. Investment should prioritize addressing the range of both health and non-health impacts of IPV among individuals, families, and communities, as well as consider how the humanitarian environment influences these linkages.
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Affiliation(s)
- Melissa Meinhart
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Ilana Seff
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Katrina Troy
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Samantha McNelly
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Luissa Vahedi
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | | | - Lindsay Stark
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
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Hartmann M, Otticha S, Agot K, Minnis AM, Montgomery ET, Roberts ST. Tu'Washindi na PrEP: Working With Young Women and Service Providers to Design an Intervention for PrEP Uptake and Adherence in the Context of Gender-Based Violence. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:103-119. [PMID: 33821679 PMCID: PMC8384060 DOI: 10.1521/aeap.2021.33.2.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition among adolescent girls and young women (AGYW). Existing evidence suggests that uptake and adherence are low among AGYW and that relationship factors such as gender-based violence (GBV) are important barriers. Through a community-based participatory research (CBPR) process, a youth advisory board (YAB), service providers (SP), and a study team developed the Tu'Washindi na PrEP intervention to support AGYW PrEP use in the context of GBV. The YAB also guided the formative research and interpretation of results. The authors pretested the intervention with SP, AGYW and their partners, and community change agents, and then developed guides for AGYW support clubs, community-based male sensitization sessions, and couples-based events that included formulation of story lines for dramatized PrEP negotiation and information dissemination skills. Stakeholder engagement led to an intervention responsive to AGYW's needs for PrEP support in the context of their relationships, which was evaluated through a 6-month pilot community randomized controlled trial.
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Affiliation(s)
- Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, California
| | | | - Kawango Agot
- Impact Research Development Organization, Kisumu, Kenya
| | - Alexandra M Minnis
- Women's Global Health Imperative, RTI International, Berkeley, California
| | | | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, California
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34
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Awungafac G, Mugamba S, Nalugoda F, Sjöland CF, Kigozi G, Rautiainen S, Malyabe RB, Ziegel L, Nakigozi G, Nalwoga GK, Kyasanku E, Nkale J, Watya S, Ekström AM, Kågesten A. Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda. BMJ Open 2021; 11:e045427. [PMID: 33789856 PMCID: PMC8016075 DOI: 10.1136/bmjopen-2020-045427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns. DESIGN Population-based, cross-sectional household survey. SETTING Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda. PARTICIPANTS A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314). MEASURES Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours. RESULTS The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion. CONCLUSION This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.
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Affiliation(s)
- George Awungafac
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Stephen Mugamba
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | | | - Godfrey Kigozi
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Susanne Rautiainen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Leo Ziegel
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Gertrude Nakigozi
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | | | - Emmanuel Kyasanku
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - James Nkale
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Stephen Watya
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Anna Kågesten
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Colombini M, Scorgie F, Stangl A, Harvey S, Ramskin L, Khoza N, Mashauri E, Baron D, Lees S, Kapiga S, Watts C, Delany-Moretlwe S. Exploring the feasibility and acceptability of integrating screening for gender-based violence into HIV counselling and testing for adolescent girls and young women in Tanzania and South Africa. BMC Public Health 2021; 21:433. [PMID: 33658000 PMCID: PMC7927237 DOI: 10.1186/s12889-021-10454-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) undermines HIV prevention and treatment cascades, particularly among women who report partner violence. Screening for violence during HIV testing, and prior to offering pre-exposure prophylaxis (PrEP) to HIV uninfected women, provides an opportunity to identify those at heightened HIV risk and greater potential for non-adherence or early discontinuation of PrEP. The paper describes our experience with offering integrated GBV screening and referral as part of HIV counselling and testing. This component was implemented within EMPOWER, a demonstration project offering combination HIV prevention, including daily oral PrEP, to young women in South Africa and Tanzania. METHODS Between February 2017 and March 2018, a process evaluation was conducted to explore views, experiences and practices of stakeholders (study participants and study clinical staff) during implementation of the GBV screening component. This article assesses the feasibility and acceptability of the approach from multiple stakeholder perspectives, drawing on counselling session observations (n = 10), in-depth interviews with participants aged 16-24 (n = 39) and clinical staff (n = 13), and notes from debriefings with counsellors. Study process data were also collected (e.g. number of women screened and referred). Following a thematic inductive approach, qualitative data were analysed using qualitative software (NVivo 11). RESULTS Findings show that 31% of young women screened positive for GBV and only 10% requested referrals. Overall, study participants accessing PrEP were amenable to being asked about violence during HIV risk assessment, as this offered the opportunity to find emotional relief and seek help, although a few found this traumatic. In both sites, the sensitive and empathetic approach of the staff helped mitigate distress of GBV disclosure. In general, the delivery of GBV screening in HCT proved to be feasible, provided that the basic principles of confidentiality, staff empathy, and absence of judgment were observed. However, uptake of linkage to further care remained low in both sites. CONCLUSION Most stakeholders found GBV screening acceptable and feasible. Key principles that should be in place for young women to be asked safely about GBV during HIV counselling and testing included respect for confidentiality, a youth-friendly and non-judgmental environment, and a functioning referral network.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Fiona Scorgie
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Anne Stangl
- International Center for Research on Women, Washington, DC USA
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Lethabo Ramskin
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Nomhle Khoza
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | | | - Deborah Baron
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - on behalf of the EMPOWER study team
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
- International Center for Research on Women, Washington, DC USA
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Grose RG, Chen JS, Roof KA, Rachel S, Yount KM. Sexual and Reproductive Health Outcomes of Violence Against Women and Girls in Lower-Income Countries: A Review of Reviews. JOURNAL OF SEX RESEARCH 2021; 58:1-20. [PMID: 31902238 DOI: 10.1080/00224499.2019.1707466] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.
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Affiliation(s)
- Rose Grace Grose
- Department of Community Health Education, Colorado School of Public Health, University of Northern Colorado
| | - Julia S Chen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Katherine A Roof
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Sharon Rachel
- Kennedy-Satcher Center for Mental Health Equity, Satcher Health Leadership Institute, Morehouse School of Medicine
| | - Kathryn M Yount
- Asa Griggs Candler Chair of Global Health | Professor of Global Health and Sociology, Hubert Department of Global Health and Department of Sociology, Emory University
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Blain M, Richardson BA, Kinuthia J, Poole DN, Jaoko W, Wilson KS, Kaggiah A, Simoni JM, Farquhar C, McClelland RS. Psychosocial Factors, Condomless Sex, and Detectable Viral Load in HIV-Positive Women in Serodiscordant Couples in Nairobi, Kenya. AIDS Behav 2020; 24:3346-3358. [PMID: 32394232 PMCID: PMC7655612 DOI: 10.1007/s10461-020-02907-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This prospective study of HIV-positive Kenyan women in serodiscordant couples examined relationships between psychosocial factors, viral suppression, and condomless sex. Participants were screened for alcohol use disorders and intimate partner violence (IPV) annually and depressive symptoms every 6 months. Prostate specific antigen (PSA) detection was used as a marker for condomless sex. A total of 151 participants contributed 349 person-years of follow-up. Hazardous/harmful alcohol use was associated with increased risk of detecting PSA in vaginal secretions (aRR 1.99, 95%CI 1.08-3.66, χ2 = 4.85 (1)), while IPV and depression were not. Events representing HIV transmission potential, where there was biological evidence of condomless sex at a visit with a detectable plasma viral load, were observed at 2% of visits. The high prevalence of IPV and association between alcohol use and sexual risk suggest the need for monitoring and support for these conditions as part of comprehensive HIV care for women.
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Affiliation(s)
- Michela Blain
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA.
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, USA
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Danielle N Poole
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Kate S Wilson
- Department of Global Health, University of Washington, Seattle, USA
| | | | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - R Scott McClelland
- Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box 356423, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, USA
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38
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Klabbers RE, Muwonge TR, Ayikobua E, Izizinga D, Bassett IV, Kambugu A, Tsai AC, Ravicz M, Klabbers G, O'Laughlin KN. Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda. J Glob Health 2020; 10:020440. [PMID: 33312504 PMCID: PMC7719270 DOI: 10.7189/jogh.10.020440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assisted partner notification (APN) for HIV was introduced in refugee settlements in West Nile Uganda in 2018 to facilitate testing of sexual partners. While APN is an effective strategy recommended by the World Health Organization, its safety has not been evaluated in a refugee settlement context in which participants have high prior exposure to interpersonal violence. The extent to which interpersonal violence influences APN utilization and the frequency with which post-APN interpersonal violence occurs remains unknown. METHODS To explore the relationship between APN and interpersonal violence, a cross-sectional mixed-methods study was conducted at 11 health centers in refugee settlements in West Nile Uganda. Routinely collected index client and sexual partner data were extracted from APN registers and semi-structured interviews were conducted with health workers. RESULTS Through APN, 1126 partners of 882 distinct index clients were identified. For 8% (75/958) of partners, index clients reported a history of intimate partner violence (IPV). For 20% (226/1126) of partners, index clients were screened for post-APN IPV; 8 cases were reported of which 88% (7/8) concerned partners with whom index clients reported prior history of IPV. In qualitative interviews (N = 32), health workers reported HIV disclosure-related physical, sexual and psychological violence and deprivation or neglect. Incidents of disclosure-related violence against health workers and dependents of index clients were also reported. Fear of disclosure-related violence was identified as a major barrier to APN that prevents index clients from listing sexual partners. CONCLUSIONS Incidents of interpersonal violence have been reported following HIV-disclosure and fear of interpersonal violence strongly influences APN participation. Addressing HIV perception and stigma may contribute to APN uptake and program safety. Prospective research on interpersonal violence involving index clients and sexual partners in refugee settlements is needed to facilitate safe engagement in APN for this vulnerable population.
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Affiliation(s)
- Robin E Klabbers
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Timothy R Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ayikobua
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diego Izizinga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ingrid V Bassett
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miranda Ravicz
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gonnie Klabbers
- Department of Health, Ethics and Society, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA
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Ali B, Mittal M, Schroder A, Ishman N, Quinton S, Boekeloo B. Psychological Violence and Sexual Risk Behavior Among Predominantly African American Women. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:5574-5588. [PMID: 29294855 DOI: 10.1177/0886260517720734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Physical and sexual violence are commonly researched as risk factors for human immunodeficiency virus (HIV). However, psychological violence and its relationship with HIV risk behaviors have received limited attention among African American/Black (Black) women. This study examined (a) the frequency of recent (past 3 months) psychological violence, physical violence, and sexual violence and (b) the association of HIV risk behaviors, including unprotected sex, sex under the influence of alcohol/drugs, and sex exchange for money/drugs/shelter, with psychological violence. Participants included 191 women (89.2% Black), who were recruited through information sessions held at community centers, Parent Teacher Association meetings, substance use and HIV counseling centers, radio public service announcements, and word of mouth. Interested women participated in a multisession HIV and substance use prevention program and completed a self-reported assessment at program baseline. The current study utilized baseline data collected for a longitudinal study. Results from descriptive analysis indicated that the rate of psychological violence was higher than physical violence or sexual violence, and it was strongly associated with physical and sexual violence. Furthermore, hierarchical logistic regression analysis showed that unprotected sex was significantly associated with recent psychological violence after controlling for covariates. Findings suggest that recent psychological violence is more common than physical or sexual violence and it relates to sexual risk behaviors among Black women. Recent psychological violence may indicate psychosocial and sexual vulnerability for HIV and warrants particular attention among Black women.
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Affiliation(s)
- Bina Ali
- University of Maryland, College Park, USA
| | | | | | - Najah Ishman
- Strategic Community Services, Inc., Annapolis, MD, USA
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Schumann H, Rubagumya K, Rubaihayo J, Harms G, Wanyenze RK, Theuring S. The incidence of HIV and associated risk factors among pregnant women in Kabarole District, Uganda. PLoS One 2020; 15:e0234174. [PMID: 32502227 PMCID: PMC7274402 DOI: 10.1371/journal.pone.0234174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/20/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The study attempted to determine the incidence of HIV among pregnant women in Kabarole District, Uganda, and to identify socio-demographic and behavioral risk factors for seroconversion during pregnancy. METHODS We carried out a retrospective cohort study among women for whom a documented HIV-negative test result from the first pregnancy trimester could be confirmed using available records, and who were HIV-retested in the third trimester or during delivery. In total, 1610 pregnant women from three different healthcare settings took part in the study. We captured the results of repeated HIV tests and conducted semi-structured interviews to explore participants' socio-demographic characteristics and sexual risk behavior. For HIV incidence rates, we calculated the number of seroconversions per 100 person-years. We used Fisher's exact test to test for potential associations. Penalized maximum likelihood logistic regression and Poisson regression were applied to adjust for potential confounders. RESULTS The overall HIV incidence rate among participants was 2.9/100 women-years. Among socio-demographic characteristics, the multivariable analysis showed a significant association of marital status with HIV incidence in pregnancy (IRR 8.78, 95%CI [1.13-68.33]). Risky sexual behaviors including higher number of sexual partners in pregnancy (IRR 2.78 [1.30-5.94]), unprotected sex with unknown persons (IRR 14.25 [4.52-44.93]), alcohol abuse (IRR 12.08 [4.18-34.90]) and sex under the influence of drugs or alcohol (IRR 6.33 [1.36-29.49]) were significantly associated with seroconversion in pregnancy (similar results in logistic regression). CONCLUSIONS HIV incidence was three times higher among our pregnant study population compared to the general female population in Uganda. This underlines the importance of HIV prevention and repeat testing during pregnancy. Identified risk groups should be considered for pre-exposure prophylaxis.
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Affiliation(s)
- Hannah Schumann
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kenyonyozi Rubagumya
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - John Rubaihayo
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Correlates of intimate partner violence among urban women in sub-Saharan Africa. PLoS One 2020; 15:e0230508. [PMID: 32210457 PMCID: PMC7094863 DOI: 10.1371/journal.pone.0230508] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction The dynamics of intimate partner violence (IPV)—one of the world’s leading public health problems—in urban Africa remain poorly understood. Yet, urban areas are key to the future of women’s health in Africa. Study objectives We explored survivor-, partner-, and household-level correlates of prevalence rates for types of IPV in urban SSA women. Method The study uses DHS data from 42,143 urban women aged 15–49 in 27 SSA countries. Associations at the bivariate level were examined using the Pearson Chi-square test. The modified Poisson regression test estimated the relative prevalence of IPV subtypes in the study population at the multivariate level. Results Approximately 36% of women in urban SSA experienced at least one form of IPV; 12.8% experienced two types; and 4.6% experienced all three types. SSA urban women who had only primary-level education, had 3 or more living children, were informally employed, were in polygynous unions, or who approved of wife-beating similarly displayed higher adjusted prevalence rates for all three forms of IPV compared respectively to their counterparts without formal education, without a living child, were unemployed, in monogamous unions, or who do not approve of wife-beating. On the other hand, the region’s urban women who began cohabiting between ages 25 and 35 years or who lived in higher wealth households showed consistently lower adjusted prevalence rates for all three forms of IPV relative to their counterparts who began cohabiting before 18 years or who lived in lower wealth households. Compared to their counterparts without formal education, without a living child, or whose partners did not have formal education, women with secondary and higher education, with 1–2 living children, or whose partners had only primary level schooling displayed higher adjusted prevalence rates for both IPEV and IPPV, but not for IPSV. However, relative to their counterparts whose partners were aged 25 years or below, living with a partner aged 40 years and above was associated with statistically significant reduced prevalence rates for IPPV and IPSV, but not for IPEV. Only for IPPV did women with partners educated at secondary and above levels display statistically significant higher adjusted prevalence rates relative to their counterparts with uneducated partners. Also, solely for IPPV did women who began cohabiting between ages 18 and 24 years or whose partners were employed (whether formally or informally) show decreased adjusted prevalence rates relative to their counterparts who started cohabiting before 18 years or whose partners were unemployed. In addition, only for IPSV did women aged 40 years and above or living in middle wealth households show statistically significant reduced adjusted prevalence rates relative to their counterparts aged less than 25 years or living in lower wealth households. Discussion and conclusion By 2030, the majority of SSA women will be urban dwellers. Complexities surround IPV in urban SSA, highlighting the unique dynamics of the problem in this setting. While affirming the link between IPV and marital power inequities and dynamics, findings suggest that the specific correlates of prevalence rates for different IPV sub-types in urban SSA women can, at once, be both similar and unique. The contextual drivers of the differences and similarities in the correlates of the prevalence rates of IPV sub-types among the region’s urban women need further interrogation.
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Gebrekristos LT, Groves AK, McNaughton Reyes L, Maman S, Moodley D. IPV victimization in pregnancy increases postpartum STI incidence among adolescent mothers in Durban, South Africa. AIDS Care 2020; 32:193-197. [PMID: 32193964 DOI: 10.1080/09540121.2020.1742871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Women, and specifically, adolescents, are at high risk of HIV and STIs during the postpartum period. Biological and behavioral factors contribute to adolescents' susceptibility. However, the influence of behavioral factors, like intimate partner violence (IPV), on postpartum STI acquisition has been understudied. The study's purpose is to determine whether IPV victimization during pregnancy predicts incident STIs in the first 6 months postpartum. Adolescent mothers (14-19 years) were recruited at a township hospital's maternity ward near Durban. Adolescent mothers who were HIV-negative and had no laboratory-diagnosed STIs at baseline (6 weeks postpartum) were included in the analysis (n = 61). We used a modified Poisson regression with robust standard errors to assess differences in postpartum STI risk by IPV victimization during pregnancy controlling for covariates. At baseline, 25 (41%) adolescent mothers reported IPV victimization during pregnancy. Adolescent mothers who reported IPV during pregnancy were at higher risk of receiving an STI diagnoses at 6 months postpartum (aRR: 4.43; 95% CI: 1.31-14.97). Our findings heighten understanding of HIV risk among a vulnerable subset of adolescent girls: adolescent mothers. Non-combined interventions that help young mothers and their partners navigate partnership dynamics to reduce IPV and STIs are needed to reduce HIV risk.
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Affiliation(s)
- Luwam T Gebrekristos
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Luz McNaughton Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal Nelson R. Mandela School of Medicine, Durban, South Africa
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Abramsky T, Kapinga I, Mshana G, Lees S, Hansen CH, Hashim R, Stöckl H, Kapiga S, Harvey S. Couples data from north-western Tanzania: Insights from a survey of male partners of women enrolled in the MAISHA cluster randomized trial of an intimate partner violence prevention intervention. PLoS One 2020; 15:e0240112. [PMID: 33006997 PMCID: PMC7531846 DOI: 10.1371/journal.pone.0240112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Globally, around 30% of ever-partnered women have experienced physical and/or sexual intimate partner violence (IPV) during their lifetime. To date, most research into causes and prevention of IPV involves surveys of women, with little research into risk-factors for male perpetration. This paper describes a survey of male partners of women participating in the MAISHA cluster randomised trial (CRT) of an IPV prevention intervention, in Mwanza City, Tanzania. Using linked couples' data, we explore man-, woman-, and relationship-/household-level factors associated with physical and sexual IPV. METHODS Women were interviewed at baseline and 29-months follow-up. At follow-up, women were asked for consent to invite their partner to participate in the male survey. We describe response rates for the women's follow-up and male partners' surveys, and identify factors associated with women's consent to approach partners. Multivariate logistic regression was used to explore factors associated with women's past-year experiences of physical and sexual IPV. RESULTS 512 (65%) partnered women consented for the partner to be approached, higher among intervention than control women. 425 (83%) male partners were interviewed. Women consenting were disproportionately likely to be in longer-term relationships. Past-year IPV was associated with lower consent among control women, but greater consent in the intervention arm. Factors associated with increased odds of physical IPV were women's childhood experiences of abuse, young age, women's lower income and women's attitudes justifying IPV. Sexual IPV was associated with women's childhood experiences of abuse, young age, educational disparity within couple, men's alcohol use and women's poor mental health. CONCLUSIONS We successfully conducted a survey of male partners with the full consent of women trial participants. The breadth of factors associated with IPV demonstrates the need for IPV prevention interventions to work with women and men, and specifically couples. Interventions should address risk-factors for both physical and sexual IPV.
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Affiliation(s)
- Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Imma Kapinga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Heidi Stöckl
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
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A Dyadic Investigation of Relationship Dynamics and Depressive Symptoms in HIV-Affected Couples in Malawi. AIDS Behav 2019; 23:3435-3443. [PMID: 31273489 DOI: 10.1007/s10461-019-02583-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Depression is the leading cause of disability worldwide with health implications for people living with HIV. Primary partnerships like marriage could be protective against depression but may worsen depression depending on the relationship quality. We examined depression and its association with relationship dynamics in a cross-sectional sample of 211 HIV-affected married couples in Malawi. We fit multivariable multilevel linear regression models for depressive symptoms. Men and women reported similar levels of depressive symptoms; 28% had a score indicative of probable depression. Almost half of couples had at least one partner with probable depression. In the adjusted models, equality (B = - 0.22; p < 0.01) and unity (B = - 0.94; p < 0.05) were associated with fewer depressive symptoms while individuals with more experiences of physical (B = 0.81; p < 0.01), sexual (B = 0.87; p < 0.01), and emotional violence (B = 1.52; p < 0.001) had higher levels of depressive symptoms. Couples-based interventions aiming to improve relationships may address depression, especially in settings with inadequate mental health services.
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Interventions to reduce gender-based violence among young people living with or affected by HIV/AIDS in low-income and middle-income countries. AIDS 2019; 33:2219-2236. [PMID: 31373916 DOI: 10.1097/qad.0000000000002337] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE(S) This study explored the effectiveness of gender-based violence (GBV) interventions on young people living with or affected by HIV in low- and middle-income countries (LMICs). DESIGN Systematic review and meta-analysis. METHODS We pre-registered a protocol, then searched 13 databases and grey literature. We screened randomized and quasi-experimental studies (n = 2199) of young people (aged 10-24) living with or affected by HIV in LMICs. Outcomes were GBV and/or GBV-related attitudes. We appraised the data for risk of bias and quality of evidence. Narrative syntheses and multilevel random effects meta-analyses were conducted. RESULTS We included 18 studies evaluating 21 interventions. Intervention arms were categorized as: sexual health and social empowerment (SHSE; n = 7); SHSE combined with economic strengthening (n = 4); self-defence (n = 3); safer schools (n = 2); economic strengthening only (n = 2); GBV sensitization (n = 2) and safer schools and parenting (n = 1). Risk of bias was moderate/high and quality of evidence low. Narrative syntheses indicated promising effects on GBV exposure, but no or mixed effects on GBV perpetration and attitudes for self-defence and GBV sensitization interventions. Safer school interventions showed no effects. For SHSE interventions and SHSE combined with economic strengthening, meta-analyses showed a small reduction in GBV exposure but not perpetration. Economic-only interventions had no overall effect. CONCLUSION SHSE, SHSE plus and self-defence and gender sensitization interventions may be effective for GBV exposure and GBV-related attitudes but not for GBV perpetration. However, the quality of evidence is poor. Future intervention research must include both boys and girls, adolescents living with HIV and key populations.
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Beres LK, Merrill KG, McGready J, Denison JA, Schwartz S, Sikazwe I, Decker MR. Intimate partner violence polyvictimisation and HIV among coupled women in Zambia: Analysis of a population-based survey. Glob Public Health 2019; 15:558-570. [PMID: 31710273 DOI: 10.1080/17441692.2019.1686532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women in sub-Saharan Africa are disproportionately at risk for the dual epidemics of intimate partner violence (IPV) and HIV. Little is known about how specific violence profiles affect women's HIV risk, limiting effective intervention. We analysed couples' data from the Zambia Demographic and Health Survey 2013-2014 to evaluate relationships among IPV, male partner HIV status and women's HIV status. We considered the individual and combined effects of physical, sexual, emotional, and high controlling behaviour violence and accumulated violence exposure, respectively. Among partnered women, 48.9% (n = 2,812) experienced IPV victimisation, of whom 52.1% (n = 1,465) reported polyvictimisation (experiencing two or more violence types). Female HIV prevalence was 13.2%. Adjusted for demographics, HIV was significantly higher for women who experienced three (17.3%, aPR 1.33, 95%CI: 1.04-1.69, p = 0.02) or four (22.1%, aPR 1.66, 95%CI: 1.23-2.26, p ≤ 0.01) types versus no IPV. Violence including emotional and/or high controlling victimisation was associated with female HIV infection (aPR: 1.31, 95%CI: 1.09-1.57, p = 0.01). Physical and/or sexual violence victimisation in the absence of other victimisation was not associated with HIV (aPR: 0.92, 95%CI:0.73-1.15, p = 0.46). IPV and HIV interventions are incomplete without addressing emotional and controlling IPV and the role of coercive relationship dynamics in transmission risk.
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Affiliation(s)
- Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Saxena A, Deschamps MM, Dorvil N, Christophe I, Rosenberg R, Jean-Gilles M, Koenig S, Pape JW, Dévieux JG. Association between intimate partner violence and HIV status among Haitian Women. Glob Public Health 2019; 14:1557-1568. [PMID: 30999807 DOI: 10.1080/17441692.2019.1602156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The prevalence of intimate partner violence (IPV) among women living in Haiti increased from 25% in 2006-29% in 2012, with escalating reports of crisis in the last several years. We examined the association between IPV and HIV status among these women in Haiti. Participants were drawn from a larger sample of women (n = 513) with a history of IPV. Women living with HIV (n = 55) were matched to uninfected women (n = 110) to form a control group. Attitudes towards gender roles, mental and physical well-being, and partner violence were assessed and compared. Logistic regressions were utilised to calculate multivariable-adjusted odds ratios. Women living with HIV were more likely to report more severe forms of psychological violence (p < 0.01), and severe physical violence (p < 0.0001). Women who experienced severe forms of IPV were 3.5 times more likely to have an HIV positive status compared to those who did not experience severe IPV (p < 0.0001). There were significant associations between severe forms of IPV, and HIV status among Haitian women. IPV severity should be integrated into eligibility screening for biomedical strategies of prevention such as pre-exposure prophylaxis (PrEP) among Haitian women.
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Affiliation(s)
- Anshul Saxena
- Florida International University, AIDS Prevention Program , Miami , FL , USA.,Baptist Health South Florida , Miami , FL , USA
| | | | | | | | - Rhonda Rosenberg
- Florida International University, AIDS Prevention Program , Miami , FL , USA
| | - Michèle Jean-Gilles
- Florida International University, AIDS Prevention Program , Miami , FL , USA
| | - Serena Koenig
- Division of Global Health Equity, Brigham and Women's Hospital , Boston , MA , USA
| | - Jean W Pape
- GHESKIO , Port-au-Prince , Haiti.,Department of Medicine, Cornell University, Center for Global Health , New York , NY , USA
| | - Jessy G Dévieux
- Florida International University, AIDS Prevention Program , Miami , FL , USA
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Abstract
There has been limited study of the syndemic link between HIV and intimate partner violence (IPV) among rural populations in the United States. We utilized the Revised Conflict Tactics Scale-2 to examine the past year prevalence, type (psychological aggression, physical assault, and sexual assault), and the impact of IPV on HIV clinical outcomes among men living with HIV in rural Appalachia. Approximately 39% of participants experienced some type of IPV in the preceding year, with 67% of those individuals experiencing more than 1 type of IPV. Approximately 77% of participants endorsing IPV exposure experienced psychological aggression. Most participants exposed to psychological aggression (70%) and/or physical assault (57%) were both victims and perpetrators, and those experiencing sexual assault reported being exclusively victims (65%). There were no significant differences in clinical outcomes including viral load and CD4 count, which may be secondary to small sample size derived from a clinic population with a high rate of virologic suppression (94%). This study demonstrates the need to assess IPV exposure in men living with HIV and further highlights the intricacies of relationship violence in these individuals.
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Brief Report: Age-Disparate Relationships and HIV Prevalence Among Never Married Women in Rakai, Uganda. J Acquir Immune Defic Syndr 2019; 79:430-434. [PMID: 30365449 DOI: 10.1097/qai.0000000000001832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Age-disparate relationships are associated with increased HIV prevalence. We determined whether the frequency of age-disparate relationships in never married women changed over time and whether they are associated with HIV prevalence in Rakai, Uganda. METHODS A total of 10,061 never married women, aged 15-49 years, in the Rakai Community Cohort Study provided information on the age of their male sexual partners from 1997 to 2013. Logistic regression was used to assess trends in age-disparate relationships (≥5 years) between never married women and their male partners. Log-binomial regression was used to estimate adjusted prevalence ratios (adjPR) of HIV prevalence associated with age-disparate relationships. RESULTS Two thousand nine hundred ninety-nine women (30%) had a male partner ≥5 years older, which remained stable over time. The prevalence of HIV among women in age-disparate relationships was 14%, 10% for women in relationships with men 0-4 years older (adjPR 1.36, 95% confidence interval: 1.22 to 1.53) not controlling women's age; however, after age adjustment, the impact of age-disparate relationships on HIV prevalence was attenuated. Age-disparate relationships were associated with increased HIV prevalence among women aged 15-17 years (adjPR 1.83, 95% confidence interval: 1.10 to 3.17), but not in other age groups. CONCLUSIONS The frequency of age-disparate relationships among never married women was unchanged over a 15-year period in Rakai, Uganda. Age-disparate relationships were associated with increased HIV prevalence among adolescents aged 15-17 years, but not older women.
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Greene H, Jolly PE, Johnson T, Galarza R, Jaoko W, Padilla LA. Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women. ACTA ACUST UNITED AC 2019; 5. [PMID: 32766452 PMCID: PMC7405985 DOI: 10.16966/2380-5536.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Kenya has the fourth-largest HIV epidemic across the globe. Disclosure of HIV-positive status plays a critical role in the prevention of HIV transmission. Disclosure, specifically to sexual partners, has been shown to foster safer sexual behaviors in addition to emotional, social, or monetary support from partners. Objective: This study was conducted to identify factors associated with HIV-positive status disclosure to sexual partners compared to disclosure to other than sexual partners. Methods: A cross-sectional study was conducted from May to August 2012 among 497 HIV-positive women 19–49 years of age who had sex in the past six months. Participants were recruited from the Kenyatta National Hospital and Mbagathi Direct Hospital in Nairobi, Kenya. A questionnaire was administered to obtain data on HIV disclosure. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with disclosure of HIV-positive status to sexual partners. Results: Of the 497 women, 349 reported to whom they had disclosed their HIV status. Approximately 34% had disclosed their HIV-positive status to a sexual partner. Women who disclosed to their sexual partners were 11 times more likely to be married or in a common-law relationship and 4 times more likely for their sexual partner or spouse to be the heads of the households. Frequency of condom use, belief that HIV disclosure is important for HIV prevention and control, knowledge of partner’s HIV status, and number of sex partners were also significantly associated with disclosing to a sexual partner. Conclusion: This study found a low rate of disclosure of HIV-positive status by women to sexual partners and identified a number of factors associated with disclosure to sexual partners. These findings can be used in designing interventions that focus on individuals who have not disclosed their HIV-positive status to their sexual partners by demonstrating the importance of disclosure and safe sex practices.
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Affiliation(s)
- Haley Greene
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Pauline E Jolly
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Tierra Johnson
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Ruby Galarza
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Luz A Padilla
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
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