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Callands TA, Taylor EN, Sileo KM, Gilliam SM, Hansen NB. Understanding the Effects of Trauma Exposure, Life Stress, Intimate Partner Violence, and Depression on Sexually Transmitted Infection Risk in Post-Conflict Liberia. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1519-1530. [PMID: 38167991 DOI: 10.1007/s10508-023-02765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
In sub-Saharan Africa, sexually transmitted infections (STIs) are a public health concern. The impact of STIs are exacerbated in post-conflict low- and middle-income countries, such as Liberia, where exposure to traumatic events is prevalent and access to mental health services are limited. Following a syndemics framework, this study used regression analyses to explore the independent, additive, and multiplicative effects of four psychosocial conditions (exposure to war-related traumatic events, intimate partner violence [IPV], stressful life events, and depressive symptoms) on self-reported STIs. Data were collected from 379 youth aged 18-30 years (n = 170 women; n = 179 men) in Montserrado County, Liberia. Results revealed that psychosocial variables correlated with each other and STI risk. In multivariable analysis, stressful life events, depressive symptoms, and IPV were statistically significant predictors of STI risk. We found support for an additive effect between the number of psychosocial conditions reported and STI risk, as well as a multiplicative effect (interaction) between IPV and depressive symptoms on STI risk. Our results suggest a synergy between experiencing psychosocial conditions and STI risk and point to the potential benefit of multi-level sexual health approaches that simultaneously address mental health and IPV among youth in Liberia.
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Affiliation(s)
- Tamora A Callands
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, 30602, USA.
| | - Erica N Taylor
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | - Katelyn M Sileo
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, 30602, USA
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2
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Tesfai Y, Lucea MB, Chan E, Asuquo T, Zhu H, Gaines TL, Campbell JC, Stockman JK, Tsuyuki K. Cumulative Lifetime Violence and Bacterial Vaginosis Infection in Sexually Transmitted Infections: Findings From a Retrospective Cohort Study Among Black Women at Risk for HIV. AJPM FOCUS 2024; 3:100180. [PMID: 38445027 PMCID: PMC10912451 DOI: 10.1016/j.focus.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Introduction Bacterial vaginosis is the most common vaginal condition among women of reproductive age and has been associated with sexually transmitted infections. This study examines the association between cumulative lifetime violence exposure, bacterial vaginosis, and sexually transmitted infections among Black women at risk for HIV. Methods HIV-negative Black women in a retrospective cohort study (N=230) completed survey questions on cumulative violence (exposure to sexual or physical abuse before age 18 years and exposure to intimate partner violence or sexual violence [partner or other] after age 18 years and past year), bacterial vaginosis (lifetime and past year), and sexually transmitted infection diagnosis (lifetime and past year). Logistic regression models estimated the associations between cumulative violence, bacterial vaginosis, and sexually transmitted infections. Bacterial vaginosis was examined as a moderator in the association between cumulative violence and sexually transmitted infections. Results Many women reported cumulative violence exposure (40%), lifetime bacterial vaginosis diagnosis (53%), and lifetime sexually transmitted infection diagnosis (73%). Cumulative violence experience was significantly associated with increased adjusted odds of lifetime bacterial vaginosis diagnosis (AOR=1.98; 95% CI=1.10, 3.54). Lifetime bacterial vaginosis diagnosis (AOR=2.76; 95% CI=1.45, 5.22) and past-year bacterial vaginosis diagnosis (AOR=2.16; 95% CI=1.14, 4.10) were significantly associated with increased odds of lifetime sexually transmitted infection diagnosis. Lifetime bacterial vaginosis diagnosis (AOR=2.10; 95% CI=1.19, 3.70) and past-year bacterial vaginosis diagnosis (AOR=3.00; 95% CI=1.70, 5.31) were significantly associated with past-year sexually transmitted infection diagnosis. Lifetime bacterial vaginosis infection significantly increased the odds of lifetime sexually transmitted infection diagnosis with increasing cumulative violence exposure. Conclusions Our findings support educating and screening Black women who experience cumulative violence for bacterial vaginosis to reduce the risk of untreated bacterial vaginosis and sexually transmitted infections.
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Affiliation(s)
- Yordanos Tesfai
- Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Marguerite B. Lucea
- Department of Nursing, College of Health Professions, Towson University, Towson, Maryland
| | - Erica Chan
- Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Theresa Asuquo
- Program in Medical Education - Health Equity (PRIME-HEQ), Department of Medicine, University of California, San Diego, La Jolla, California
| | - Helen Zhu
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Tommi L. Gaines
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | | | - Jamila K. Stockman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Kiyomi Tsuyuki
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
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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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Caswell RJ, Ross JDC, Maidment I, Bradbury-Jones C. Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2661-2679. [PMID: 35762535 DOI: 10.1177/15248380221111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
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Obetta KC, Ogbonna IO, Oyigbo DN, Ugwu OO, Ugwu KO, Onah BN, Ugwunnadi CM, Acha JO, Chuke NU, Nkemjika O, Okoye OE. Prevalence of trichomoniasis infection among adults in Nigerian community settings. Medicine (Baltimore) 2023; 102:e34585. [PMID: 37713889 PMCID: PMC10508445 DOI: 10.1097/md.0000000000034585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/13/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Trichomonas vaginalis (TV) is a sexually transmitted pathogen. The study was conducted to determine its prevalence among 300 adult patients in 4 public health facilities in the Nsukka District of Enugu State, Nigeria. METHOD The researchers collected high vagina swabs and urine samples were collected from 150 men and 150 women, respectively. The specimens were scrutinized for color, odor of discharge and urine, and motile trichomoniasis. RESULTS The prevalence of the TV was 45.0% (135/300) with women showing the highest prevalence (63.7%). Among the patients attending the University of Nigeria, Nsukka Medical Center, the prevalence was the highest at 31.9%. TV infection was more common among older adults aged 38 to 47 years (39.3%), married adults (76.3%), and those with secondary education (68.9%). Urogenital analysis reported that males with pains during urination were 51.0% and males with penile tingling were 12.2%. The highest vaginal Hydrogen ion concentration level of 6.8 was observed in women aged 38 to 47 years. Additionally, the results reported that Vaginal candidiasis, Bacterial vaginosis, and Herpes simplex virus type 2 antibodies were not independently associated with TV infection. In the unadjusted analysis, the odds of TV infection were higher in men (8.1), while Chlamydia trachomatis infection was higher in women (8.8). Among the adults diagnosed with herpes simplex virus type 2 antibodies, the odds of TV infection were 3.9 for both men and women. Men with penile human papillomavirus infection had lower odds of TV infection (1.9), while women with vaginal human papillomavirus infection had higher odds of TV infection (2.2). CONCLUSION The prevalence of TV infection is high among sexually active adults in the Nigerian community. It is therefore crucial to implement the increased public health actions such as regular and early diagnosis to reduce its prevalence.
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Affiliation(s)
- K. Chukwuemeka Obetta
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Dorida Nneka Oyigbo
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Oliver Onyemaechi Ugwu
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Beatrice N. Onah
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chinasa Maryrose Ugwunnadi
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Joseph O. Acha
- Community Development Unit of the Department of Continuing Education and Development Studies, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ngozi Uzoamaka Chuke
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Ogechi Nkemjika
- Administration Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Onyinyechi Elizabeth Okoye
- Community Development Unit of the Department of Adult Education and Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
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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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Baudin T, Sarkar K, Guerrouche K. Éducation et infécondité en Inde. POPULATION 2021. [DOI: 10.3917/popu.2103.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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8
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Bermudez ANC, Cochon KL, Operario D. Intimate Partner Violence and HIV Testing in Filipino Women: Analysis of the 2017 Philippine National Demographic and Health Survey. Violence Against Women 2021; 28:2857-2876. [PMID: 34817307 DOI: 10.1177/10778012211045709] [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: 11/15/2022]
Abstract
We sought to determine the association between intimate partner violence (IPV) and HIV testing among a representative household sample of Filipino women, using data collected from the 2017 National Demographic and Health Survey. In our sample, we found that 23.63% experienced IPV, and only 1.99% were tested for HIV in the past 12 months. We found that IPV was associated with an increased odds of HIV testing in the past 12 months (aOR = 1.42; 95% CI = 1.02, 1.99). Our study highlights the need to consider formal encounters with IPV survivors as opportunities to engage them in the HIV prevention and care continua.
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Affiliation(s)
- Amiel Nazer C Bermudez
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Philippine Initiative for Research, Service, and Training, School of Public Health, Brown University, Providence, RI, USA; Department of Epidemiology and Biostatistics, College of Public Health, 54725University of the Philippines Manila, Manila, Philippines
| | - Kim L Cochon
- JC School of Public Health and Primary Care, Faculty of Medicine, 71024The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Don Operario
- Department of Social and Behavioral Health Sciences, School of Public Health, Brown University, Providence, RI, USA; Philippine Initiative for Research, Service, and Training, School of Public Health, 174610Brown University, Providence, RI, USA
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9
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Deosthali PB, Rege S, Arora S. Women's experiences of marital rape and sexual violence within marriage in India: evidence from service records. Sex Reprod Health Matters 2021; 29:2048455. [PMID: 35348043 PMCID: PMC8967187 DOI: 10.1080/26410397.2022.2048455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sexual violence within marriage is common and manifests in various forms, including marital rape. It has serious physical and mental health consequences and is a violation of women’s sexual and reproductive health rights. Marital rape, reproductive coercion, inserting objects in the vagina or anus, and withholding sexual pleasure are forms of violence routinely experienced by women. Based on service records of survivors coming to public hospitals in an Indian city, this paper presents their pathways to disclosure and institutional responses such as hospitals and police. The findings highlight that a large proportion of survivors of domestic violence confide having experienced forced sexual intercourse by the husband while sharing their experience of physical, economic, and emotional violence with crisis intervention counsellors. However, a small number of women do report marital rape to formal systems like hospitals and police. These systems respond inadequately to women reporting marital rape, as the rape law exempts rape by husband. Sexual violence within marriage can have serious health consequences, and a sensitive healthcare provider can create an enabling environment for disclosing abuse and providing relevant care and support. The paper argues that a necessary precondition to enable women to access health care and justice is to nullify “Exception 2 to Section 375 of the Indian Penal Code” This exception exempts rape by the husband from the purview of the rape law.
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Affiliation(s)
| | - Sangeeta Rege
- Coordinator, Centre for Enquiry Into Health and Allied Themes, Mumbai, India
| | - Sanjida Arora
- Research Officer, Centre for Enquiry Into Health and Allied Themes, Mumbai, India. Correspondence:
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10
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Defilipo ÉC, Chagas PSDC, Ribeiro LC. Violence against pregnant women and associated factors in the city of Governador Valadares. Rev Saude Publica 2020; 54:135. [PMID: 33331419 PMCID: PMC7702383 DOI: 10.11606/s1518-8787.2020054002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To characterize violence against women during pregnancy and to verify its association with socioeconomic, demographic, obstetric, behavioral factors, health care and diseases during pregnancy. METHODS Cross-sectional study carried out with puerperal women whose birth took place at the Municipal Hospital of Governador Valadares, in Minas Gerais, from May 2017 to July 2018. Data collection was performed through interviews, and complementary information was obtained by analyzing the prenatal file and medical records. For data analysis, logistic regression was used. RESULTS The total of 771 puerperal women participated in the study. Of these, 62 (8.0%) reported having suffered physical, psychological or sexual violence during pregnancy. The pregnant women most likely to have suffered violence were alcohol dependent (OR = 4.97; 95%CI 2.30–10.75; p < 0.001), those who did not perform prenatal care (OR = 3.88; 95%CI 1.00–15.09; p = 0.050), those who used health services in an emergency during pregnancy (OR = 2.47; 95%CI 1.42–4.30; p = 0.001) and who had gestational diabetes (OR = 2.59; 95%CI 1.06–6.32; p = 0.037) and sexually transmitted diseases (OR = 3.85; 95%CI 1.41–10.50; p = 0.009). CONCLUSION Violence against pregnant women is associated with behavioral factors and related to health care and diseases during pregnancy. It is essential to recognize factors associated by health professionals through actions to track situations of violence against women since the beginning of prenatal care, in order to enable early intervention.
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Affiliation(s)
- Érica Cesário Defilipo
- Universidade Federal de Juiz de Fora campus Governador Valadares. Instituto de Ciências da Vida. Departamento de Fisioterapia. Governador Valadares, MG, Brasil
| | - Paula Silva de Carvalho Chagas
- Universidade Federal de Juiz de Fora. Faculdade de Fisioterapia. Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-funcional. Juiz de Fora, MG, Brasil
| | - Luiz Cláudio Ribeiro
- Universidade Federal de Juiz de Fora. Departamento de Estatística. Programa de Pós-Graduação em Saúde Coletiva. Juiz de Fora, MG, Brasil
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11
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Geller RJ, Decker MR, Adedimeji AA, Weber KM, Kassaye S, Taylor TN, Cohen J, Adimora AA, Haddad LB, Fischl M, Cunningham S, Golub ET. A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018. J Womens Health (Larchmt) 2020; 29:1256-1267. [PMID: 32996812 DOI: 10.1089/jwh.2019.7972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.
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Affiliation(s)
- Ruth J Geller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Tonya N Taylor
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sarah Cunningham
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Caswell RJ, Maidment I, Ross JDC, Bradbury-Jones C. How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review. BMJ Open 2020; 10:e037599. [PMID: 32554729 PMCID: PMC7304828 DOI: 10.1136/bmjopen-2020-037599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services. METHODS AND ANALYSIS To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories. DATA ANALYSIS A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field. ETHICS AND DISSEMINATION This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies. PROSPERO REGISTRATION DETAILS CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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13
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Hogben M, Leichliter J, Aral SO. An Overview of Social and Behavioral Determinants of STI. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Roberts ST, Flaherty BP, Deya R, Masese L, Ngina J, McClelland RS, Simoni J, Graham SM. Patterns of Gender-Based Violence and Associations with Mental Health and HIV Risk Behavior Among Female Sex Workers in Mombasa, Kenya: A Latent Class Analysis. AIDS Behav 2018; 22:3273-3286. [PMID: 29603110 PMCID: PMC6146064 DOI: 10.1007/s10461-018-2107-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gender-based violence (GBV) is common among female sex workers (FSWs) and is associated with multiple HIV risk factors, including poor mental health, high-risk sexual behavior, and sexually transmitted infections (STIs). Prior studies have focused on GBV of one type (e.g. physical or sexual) or from one kind of perpetrator (e.g., clients or regular partners), but many FSWs experience overlapping types of violence from multiple perpetrators, with varying frequency and severity. We examined the association between lifetime patterns of GBV and HIV risk factors in 283 FSWs in Mombasa, Kenya. Patterns of GBV were identified with latent class analysis based on physical, sexual, or emotional violence from multiple perpetrators. Cross-sectional outcomes included depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, disordered alcohol and other drug use, number of sex partners, self-reported unprotected sex, prostate-specific antigen (PSA) in vaginal secretions, and a combined unprotected sex indicator based on self-report or PSA detection. We also measured HIV/STI incidence over 12 months following GBV assessment. Associations between GBV patterns and each outcome were modeled separately using linear regression for mental health outcomes and Poisson regression for sexual risk outcomes. Lifetime prevalence of GBV was 87%. We identified 4 GBV patterns, labeled Low (21% prevalence), Sexual (23%), Physical/Moderate Emotional (18%), and Severe (39%). Compared to women with Low GBV, those with Severe GBV had higher scores for depressive symptoms, PTSD symptoms, and disordered alcohol use, and had more sex partners. Women with Sexual GBV had higher scores for disordered alcohol use than women with Low GBV, but similar sexual risk behavior. Women with Physical/Moderate Emotional GBV had more sex partners and a higher prevalence of unprotected sex than women with Low GBV, but no differences in mental health. HIV/STI incidence did not differ significantly by GBV pattern. The prevalence of GBV was extremely high in this sample of Kenyan FSWs, and different GBV patterns were associated with distinct mental health and sexual risk outcomes. Increased understanding of how health consequences vary by GBV type and severity could lead to more effective programs to reduce HIV risk in this vulnerable population.
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Affiliation(s)
- Sarah T Roberts
- Women's Global Health Imperative, RTI International, 351 California St, Ste 500, San Francisco, CA, 94104, USA.
| | - Brian P Flaherty
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Ruth Deya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Linnet Masese
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jacqueline Ngina
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - R Scott McClelland
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan M Graham
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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15
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Montgomery BEE, Frew PM, Hughes JP, Wang J, Adimora AA, Haley DF, Kuo I, Jennings L, El-Bassel N, Hodder SL. HIV Risk Characteristics Associated with Violence Against Women: A Longitudinal Study Among Women in the United States. J Womens Health (Larchmt) 2018; 27:1317-1326. [PMID: 29905502 DOI: 10.1089/jwh.2017.6505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Using data from HIV Prevention Trials Network 064, a multisite, observational cohort study conducted to estimate HIV incidence rates among women living in areas of high poverty and HIV prevalence in the United States, we examined the use of HIV risk characteristics to predict emotional abuse, physical violence, and forced sex. METHODS Participants included 2099 women, 18-44 years of age, who reported unprotected vaginal or anal sex with a male partner and an additional personal or perceived male partner HIV risk characteristic in the past 6 months. Adjusting for time-varying covariates, generalized estimating equations were used to assess the ability of HIV risk characteristics to predict violence 6 months later. RESULTS Reported analyses were limited to the 1980 study participants who reported having a male sex partner at that assessment. Exchanging sex, perceived partner concurrency, and perceived partner incarceration were significantly predictive of emotional abuse 6 months later (adjusted odds ratio [AOR]: 1.60; 1.59; 1.34, respectively). Prior sexually transmitted infection diagnosis, exchanging sex, and binge drinking were significantly predictive of physical violence 6 months later (AOR: 1.62; 1.71; 1.47, respectively). None of the variables measured was significantly predictive of forced sex. CONCLUSIONS Strategies that address reducing violence against women should be studied further in the context of HIV prevention programs.
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Affiliation(s)
- Brooke E E Montgomery
- 1 Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Paula M Frew
- 2 Department of Medicine, Emory University School of Medicine , Atlanta, Georgia .,3 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia .,4 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - James P Hughes
- 5 Department of Biostatistics, University of Washington , Seattle, Washington
| | - Jing Wang
- 6 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Adaora A Adimora
- 7 UNC School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Danielle F Haley
- 8 Institute for Global Health and Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Irene Kuo
- 9 Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University , Washington, District of Columbia
| | - Larissa Jennings
- 10 Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Nabila El-Bassel
- 11 Columbia University School of Social Work , New York, New York
| | - Sally L Hodder
- 12 West Virginia Clinical and Translational Science Institute , Morgantown, West Virginia
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16
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Ward JE. Environmental determinants of high population rates of sexually transmitted diseases. Aust N Z J Public Health 2018. [PMID: 29528546 DOI: 10.1111/1753-6405.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jeanette E Ward
- Kimberley Population Health Unit, Western Australia Country Health Service.,Nulungu Research Institute, University of Notre Dame, Broome, Western Australia
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17
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Vyas S. Marital violence and sexually transmitted infections among women in post-revolution Egypt. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:68-74. [PMID: 28844360 DOI: 10.1016/j.srhc.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/15/2017] [Accepted: 06/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the relationship between past year physical or sexual partner violence against women and women's self-report of sexually transmitted infection (STI) symptoms in post-revolution Egypt; and to examine the effects of men's and women's risky sexual behavioural characteristics and structural dimensions of poverty and gender inequality on this relationship. STUDY DESIGN This study uses the nationally representative cross-sectional demographic and health survey data conducted in 2014. Multivariate logistic regression was used to assess the relationship between past year partner violence and self-report of STI symptoms among currently married women. MAIN OUTCOME MEASURES women's self-report of STI was based on their responses to three questions; whether in the past year they had: got a disease through sexual contact?, a genital sore or ulcer?, or a bad smelling abnormal genital discharge? Women who gave an affirmative response to one or more of these questions were assumed to self-report STI. RESULTS Almost one-third of women self-reported symptoms of STI. Fourteen percent of women reported they had experienced physical or sexual violence by a male partner in the past 12months. Abused women had a 2.76 times higher odds of self-reported STI symptoms (95% CI 2.25-3.38). The significant relationship between self-reported STI and past year partner violence against women did not alter when adjusting for men's and women's behavioural characteristics and factors related to poverty and gender inequality. CONCLUSIONS Public health interventions that address women's sexual and reproductive health need to consider violence response and prevention strategies.
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Affiliation(s)
- Seema Vyas
- London School of Hygiene and Tropical Medicine, Department of Population Health, Keppel Street, London WC1E 7HT, United Kingdom.
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18
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Shabnam S. Sexually Transmitted Infections and Spousal Violence: The Experience of Married Women in India. INDIAN JOURNAL OF GENDER STUDIES 2017. [DOI: 10.1177/0971521516678530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A growing body of research has documented that spousal violence has several adverse effects on the reproductive health of women. Using the dataset of the third National Family Health Survey (NFHS-3) conducted in India in 2005–2006, the present study tries to find out the relationship between spousal violence and the prevalence of sexually transmitted infections (STIs) among women. How prevailing gender norms act as underlying factors of women’s risk of STI has been discussed in this paper. Overall, 9.6 per cent women in India reported an STI/STI symptom in the year preceding the survey. After covariate adjustment it was found that, compared to the women who did not experience violence in 12 months before the survey, the chances of having an STI/STI symptom was twice higher for those who experienced only physical violence and three times higher for those who experienced both physical and sexual violence during that period. The findings of this study suggest that prevention of marital violence should be incorporated in the programmes that aim to reduce STIs among women.
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Affiliation(s)
- Shewli Shabnam
- Department of Geography, Bidhannagar College, Kolkata, India
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19
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Newberry JA, Mahadevan S, Gohil N, Jamshed R, Prajapati J, Rao GR, Strehlow M. Using an emergency response infrastructure to help women who experience gender-based violence in Gujarat, India. Bull World Health Organ 2016; 94:388-92. [PMID: 27147769 PMCID: PMC4850532 DOI: 10.2471/blt.15.163741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/27/2022] Open
Abstract
Problem Many women who experience gender-based violence may never seek any formal help because they do not feel safe or confident that they will receive help if they try. Approach A public–private-academic partnership in Gujarat, India, established a toll-free telephone helpline – called 181 Abhayam – for women experiencing gender-based violence. The partnership used existing emergency response service infrastructure to link women to phone counselling, nongovernmental organizations (NGOs) and government programmes. Local setting In India, the lifetime prevalence of gender-based violence is 37.2%, but less than 1% of women will ever seek help beyond their family or friends. Before implementation of the helpline, there were no toll-free helplines or centralized coordinating systems for government programmes, NGOs and emergency response services. Relevant changes In February 2014, the helpline was launched across Gujarat. In the first 10 months, the helpline assisted 9767 individuals, of which 8654 identified themselves as women. Of all calls, 79% (7694) required an intervention by phone or in person on the day they called and 43% (4190) of calls were by or for women experiencing violence. Lessons learnt Despite previous data that showed women experiencing gender-based violence rarely sought help from formal sources, women in Gujarat did use the helpline for concerns across the spectrum of gender-based violence. However, for evaluating the impact of the helpline, the operational definitions of concern categories need to be further clarified. The initial triage system for incoming calls was advantageous for handling high call volumes, but may have contributed to dropped calls.
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Affiliation(s)
- Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M121, Stanford, CA 94305, United States of America (USA)
| | - Swaminatha Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M121, Stanford, CA 94305, United States of America (USA)
| | | | - Roma Jamshed
- GVK Emergency Management Research Institute, Hyderabad, India
| | | | - Gv Ramana Rao
- GVK Emergency Management Research Institute, Hyderabad, India
| | - Matthew Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M121, Stanford, CA 94305, United States of America (USA)
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Prakash R, Manthri S, Tayyaba S, Joy A, Raj SS, Singh D, Agarwal A. Effect of Physical Violence on Sexually Transmitted Infections and Treatment Seeking Behaviour among Female Sex Workers in Thane District, Maharashtra, India. PLoS One 2016; 11:e0150347. [PMID: 26933884 PMCID: PMC4774990 DOI: 10.1371/journal.pone.0150347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Violence against sex workers can heighten their vulnerability to HIV and other sexually transmitted infections (STIs). Evidence suggests the risk of acquiring STI/HIV infections among female sex workers (FSWs) who have experienced violence to be almost three-times higher than FSWs, who have not experienced violence. Moreover, an experience of physical and sexual violence makes it difficult for them to negotiate safer sex with their partners and often act as a barrier to utilization of prevention services. METHODS This study utilizes data from 2785 FSWs aged 18 years and above who participated in a cross-sectional behavioural study conducted during 2013-14 in Thane district, Maharashtra. A probability-based two-stage cluster sampling method was used for data collection. This study assesses the effect of physical violence on self-reported STI symptoms (any STI and multiple STIs) and treatment seeking for the last STI symptom using propensity score matching method. RESULTS About 18% of sampled FSWs reported physical violence at the time of the survey. The likelihood of experiencing such violence was significantly higher among FSWs who solicited clients at public places, engaged in other economic activities apart from sex work, had savings, and reported high client volume per week. FSWs experiencing violence were also inconsistent condom users while engaging in sex with regular partners and clients. The average adjusted effect of violence clearly depicted an increase in the risk of any STI (11%, p<0.05) and multiple STIs (8%, p<0.10) and reduction in treatment seeking (10%, p<0.05). CONCLUSIONS This study demonstrates a significant effect of physical violence on reporting of any STI symptom and treatment seeking. Findings call for the immediate inclusion of strategies aimed to address violence related challenges in HIV prevention program currently being provided at Thane district. Such strategies would further help in enhancing the access to tailored STI prevention and care services among FSWs in the district.
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Affiliation(s)
- Ravi Prakash
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
- * E-mail: ;
| | - Suneedh Manthri
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Shaikh Tayyaba
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Anna Joy
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Sunil Saksena Raj
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Devender Singh
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Ashok Agarwal
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
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Kalokhe A, Del Rio C, Dunkle K, Stephenson R, Metheny N, Paranjape A, Sahay S. Domestic violence against women in India: A systematic review of a decade of quantitative studies. Glob Public Health 2016; 12:498-513. [PMID: 26886155 DOI: 10.1080/17441692.2015.1119293] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.
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Affiliation(s)
- Ameeta Kalokhe
- a Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA.,b Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Carlos Del Rio
- a Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA.,b Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Kristin Dunkle
- c Department of Behavioral Sciences and Health Education , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Rob Stephenson
- b Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA.,d Center for Sexuality and Health Disparities , University of Michigan School of Public Health and School of Nursing , Ann Arbor , MI , USA
| | - Nicholas Metheny
- d Center for Sexuality and Health Disparities , University of Michigan School of Public Health and School of Nursing , Ann Arbor , MI , USA
| | - Anuradha Paranjape
- e General Internal Medicine , Temple University School of Medicine , Philadelphia , PA , USA
| | - Seema Sahay
- f Department of Social and Behavioral Sciences , National AIDS Research Institute , Pune , India
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Kalokhe AS, Stephenson R, Kelley ME, Dunkle KL, Paranjape A, Solas V, Karve L, del Rio C, Sahay S. The Development and Validation of the Indian Family Violence and Control Scale. PLoS One 2016; 11:e0148120. [PMID: 26824611 PMCID: PMC4732749 DOI: 10.1371/journal.pone.0148120] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
The high prevalence of domestic violence (DV) among married women in India and associated negative health repercussions highlight the need for effective prevention strategies and tools to measure the efficacy of such interventions. Literature supporting differing manifestations of DV by culture underscores the need for a culturally-tailored scale to more effectively measure DV in the Indian context. We therefore aimed to develop and validate such a tool, the Indian Family Violence and Control Scale (IFVCS), through a mixed-methods study. The psychometric development of IFVCS is herein discussed. After field pre-testing and expert review, a 63-item questionnaire was administered to a random sample of 630 married women from May-July 2013 in Pune, India. The item response theory approach for binary data to explore the IFVCS structure suggested that IFVCS is reliable, with the majority of items having high (>0.5) and significant factor loadings. Concurrent validity, assessed by comparing responses to IFVCS with the validated, abridged Conflict Tactics Scale-2, was high (r = 0.899, p<0.001) as was the construct validity, demonstrated by its significant association with several established DV correlates. Therefore, initial assessment of the IFVCS psychometric properties suggests that it is an effective tool for measuring DV among married women in India and speaks to its capacity for enhancing understanding of DV epidemiology and for evaluating the effectiveness of future DV interventions.
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Affiliation(s)
- Ameeta S. Kalokhe
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
- * E-mail: (ASK); (SS)
| | - Rob Stephenson
- University of Michigan School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, MI, United States of America
| | - Mary E. Kelley
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, Georgia, United States of America
| | - Kristin L. Dunkle
- South African Medical Research Council, Gender and Health Research Unit, Pretoria, South Africa
| | - Anuradha Paranjape
- Temple University School of Medicine, Department of Medicine, Section of General Internal Medicine, Philadelphia, Pennsylvania, United States of America
| | - Vikram Solas
- Department of Social & Behavioral Research, National AIDS Research Institute, Pune, Maharashtra, India
| | - Latika Karve
- Department of Social & Behavioral Research, National AIDS Research Institute, Pune, Maharashtra, India
| | - Carlos del Rio
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Seema Sahay
- Department of Social & Behavioral Research, National AIDS Research Institute, Pune, Maharashtra, India
- * E-mail: (ASK); (SS)
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Kalokhe AS, Potdar RR, Stephenson R, Dunkle KL, Paranjape A, del Rio C, Sahay S. How well does the World Health Organization definition of domestic violence work for India? PLoS One 2015; 10:e0120909. [PMID: 25811374 PMCID: PMC4374684 DOI: 10.1371/journal.pone.0120909] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 02/09/2015] [Indexed: 12/01/2022] Open
Abstract
Domestic violence (DV) is reported by 40% of married women in India and associated with substantial morbidity. An operational research definition is therefore needed to enhance understanding of DV epidemiology in India and inform DV interventions and measures. To arrive at a culturally-tailored definition, we aimed to better understand how definitions provided by the World Health Organization and the 2005 India Protection of Women from Domestic Violence Act match the perceptions of behaviors constituting DV among the Indian community. Between September 2012 and January 2013, 16 key informant interviews with experts in DV and family counseling and 2 gender-concordant focus groups of lay community members were conducted in Pune, India to understand community perceptions of the definition of DV, perpetrators of DV, and examples of DV encountered by married women in Pune, India. Several key themes emerged regarding behaviors and acts constituting DV including 1) the exertion of control over a woman's reproductive decision-making, mobility, socializing with family and friends, finances, and access to food and nutrition, 2) the widespread acceptance of sexual abuse and the influences of affluence on sexual DV manifestations, 3) the shaping of physical abuse experiences by readily-available tools and the presence of witnesses, 4) psychological abuse for infertility, dowry, and girl-children, and 5) the perpetration of DV by the husband and other members of his family. Findings support the need for a culturally-tailored operational definition that expands on the WHO surveillance definition to inform the development of more effective DV intervention strategies and measures.
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Affiliation(s)
- Ameeta S. Kalokhe
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | | | - Rob Stephenson
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Kristin L. Dunkle
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, Georgia, United States of America
| | - Anuradha Paranjape
- Temple University School of Medicine, Department of Medicine, Section of General Internal Medicine, Philadelphia, Pennsylvania, United States of America
| | - Carlos del Rio
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, United States of America
| | - Seema Sahay
- National AIDS Research Institute, Pune, Maharashtra, India
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Kamimura A, Ganta V, Myers K, Thomas T. Intimate partner violence and physical and mental health among women utilizing community health services in Gujarat, India. BMC WOMENS HEALTH 2014; 14:127. [PMID: 25319589 PMCID: PMC4286938 DOI: 10.1186/1472-6874-14-127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
Abstract
Background Intimate partner violence (IPV) is a significant public health threat which causes injury and acute and chronic physical and mental health problems. In India, a high percentage of women experience IPV. The purposes of this study include 1) to describe the lifetime prevalence of IPV, and 2) to examine the association between IPV and physical and mental health well-being, among women utilizing community health services for the economically disadvantaged in India. Methods Women utilizing community health services (N = 219) aged between 18 and 62 years completed a self-administered survey in Gujarat, India. Standardized instruments were used to measure perceived physical and mental health well-being. In addition, participants were asked about their lifetime experience with IPV, and socio-demographic questions. Analysis was restricted to the ever-married participants who completed the questions on IPV (N = 167). Results Participants with a lifetime history of IPV were more likely to have reported poorer physical and mental health compared to those without a lifetime history of IPV. More than half of the participants with an IPV history experienced multiple types of IPV (physical, sexual and/or emotional IPV). While being in the highest caste was a significant positive factor associated with better health, caste and other socio-demographic factors were not associated with IPV. Conclusions Women in India face risk of IPV. Yet those experiencing IPV do not seek help or rely on informal help sources. Community health organizations may take a role in IPV prevention and intervention. Diversity of intervention options would be important to encourage more women with IPV experience to seek help.
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Affiliation(s)
- Akiko Kamimura
- Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, Utah 84112, USA.
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Fichorova RN, Beatty N, Sassi RRS, Yamamoto HS, Allred EN, Leviton A. Systemic inflammation in the extremely low gestational age newborn following maternal genitourinary infections. Am J Reprod Immunol 2014; 73:162-74. [PMID: 25164433 DOI: 10.1111/aji.12313] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022] Open
Abstract
PROBLEM Gestational genitourinary infections are associated with lifelong disabilities, but it is unknown if neonatal inflammation is involved. METHOD Mothers of 914 infants born before 28th gestation week reported cervical/vaginal infection (CVI), and/or urine/bladder/kidney infection (UTI), or neither. Inflammation proteins measured in baby's blood on postnatal days 1, 7, and 14 were considered elevated if in the top quartile for gestational age. Logistic regression models adjusting for potential confounders assessed odds ratios. RESULTS Compared to mothers with neither UTI/CVI, those with CVI were more likely to have infants with elevated CRP, SAA, MPO, IL-1β, IL-6, IL-6R, TNF-α, RANTES, ICAM-3, E-selectin, and VEGF-R2 on day 1; those with UTI were more likely to have infants with elevated MPO, IL-6R, TNF-R1, TNF-R2, and RANTES on day 7. Placental anaerobes and genital mycoplasma were more common in pregnancies with CVI. CONCLUSION Gestational UTI/CVI should be targeted for preventing systemic inflammation in the very preterm newborn.
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Affiliation(s)
- Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Jejeebhoy SJ, Santhya KG, Acharya R. Violence against women in South Asia: the need for the active engagement of the health sector. Glob Public Health 2014; 9:678-90. [PMID: 24842297 DOI: 10.1080/17441692.2014.916736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intimate partner violence is pervasive in South Asia, yet married women's experiences regarding seeking help when faced with intimate partner violence and the health sector response remain largely unexplored. This commentary reviews the available published and unpublished literature and summarises what is known about the prevalence of marital violence against women and violence-related care-seeking experienced by women in this region. The commentary highlights that between one-fifth and one-half of married women are affected by violence perpetrated by their husband in South Asia, violence starts early in a marriage and the health consequences are wide ranging and long lasting. Yet, very few women seek support from the health sector, and the health system is not proactive in identifying and supporting women at risk. A greater commitment to making the health system responsive to women in distress is essential and should be undertaken with the same level of commitment given to prevention programmes.
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Decker MR, Miller E, McCauley HL, Tancredi DJ, Anderson H, Levenson RR, Silverman JG. Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics. Sex Transm Infect 2014; 90:145-9. [PMID: 24234072 PMCID: PMC4305329 DOI: 10.1136/sextrans-2013-051288] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES Adolescent and young adult women are at high risk for sexually transmitted infections (STIs)/HIV and intimate partner violence (IPV). We evaluate the prevalence of IPV in the past 3 months and its associations with STI/HIV risk, STI and related care-seeking over the same time period. METHODS Female family planning clinic patients ages 16-29 years (n=3504) participated in a cross-sectional survey in 2011-2012 as a baseline assessment for an intervention study. We examined associations of recent IPV with sexual and drug-related STI/HIV risk behaviour, self-reported STI and STI-related clinical care seeking via logistic regression. RESULTS Recent physical or sexual IPV (prevalence 11%) was associated with recent sexual and drug-related STI/HIV risk, specifically unprotected vaginal sex (adjusted OR (AOR) 1.93, 95% CI 1.52 to 2.44), unprotected anal sex (AOR 2.22, 95% CI 1.51 to 3.27) and injection drug use, their own (AOR 3.39, 95% CI 1.47 to 7.79) and their partner's (AOR 3.85, 1.91 to 7.75). IPV was also linked with coercive sexual risk: involuntary condom non-use (AOR 1.87 to 95% CI 1.51 to 2.33), and fears of requesting condoms (AOR 4.15, 95% CI 2.73 to 6.30) and refusing sex (AOR 11.84, 95% CI 7.59 to 18.45). STI-related care-seeking was also more common among those abused (AOR 2.49, 95% CI 1.87 to 3.31). CONCLUSIONS Recent IPV is concurrent with sexual and drug-related STI/HIV risk, including coercive sexual risk, thus compromising women's agency in STI/HIV risk reduction. Clinical risk assessments should broaden to include unprotected heterosexual anal sex, coercive sexual risk and IPV, and should promote safety and harm reduction.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, Maryland, USA
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Jejeebhoy SJ, Santhya KG, Acharya R. Physical and sexual violence and symptoms of gynaecological morbidity among married young women in India. Glob Public Health 2013; 8:1151-67. [PMID: 24295049 DOI: 10.1080/17441692.2013.860466] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Evidence from India about young women's experience of physical and sexual violence within marriage and its sexual and reproductive health consequences is limited. Data, drawn from 12,220 married women ages 15-24 years old from six Indian states, were used to identify associations between the experience of violence and recent symptoms of gynaecological morbidity, using logistic regression analysis. Young women who had experienced physical, sexual, or both forms of violence in the 12 months preceding the interview were more likely than others to report symptoms of gynaecological morbidity (odds ratios, 1.8-2.1); associations were evident in all six states. However, associations were weak between those who had experienced violence earlier in marriage but not in the 12 months preceding the interview and those who had never experienced violence. Findings highlight the need for the health system to play a proactive role in recognising and responding to the needs of young women experiencing marital violence.
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Decker MR, Pearson E, Illangasekare SL, Clark E, Sherman SG. Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator. BMC Public Health 2013; 13:876. [PMID: 24060235 PMCID: PMC3852292 DOI: 10.1186/1471-2458-13-876] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/11/2013] [Indexed: 11/14/2022] Open
Abstract
Background Physical and sexual violence heighten STI/HIV risk for women in sex work. Against this backdrop, we describe the nature of abuse against women in sex work, and its STI/HIV implications, across perpetrators. Methods Adult women involved in sex work (n = 35) in Baltimore, MD participated in an in-depth interview and brief survey. Results Physical and sexual violence were prevalent, with 43% reporting past-month abuse. Clients were the primary perpetrators; their violence was severe, compromised women’s condom and sexual negotiation, and included forced and coerced anal intercourse. Sex work was a factor in intimate partner violence. Police abuse was largely an exploitation of power imbalances for coerced sex. Conclusions Findings affirm the need to address physical and sexual violence, particularly that perpetrated by clients, as a social determinant of health for women in sex work, as well as a threat to safety and wellbeing, and a contextual barrier to HIV risk reduction.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe St,, E4142, Baltimore, MD 21205, USA.
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Abstract
This study investigated whether a Chlamydia diagnosis was associated with relationship breakup or physical violence from partners when compared to other attenders at a sexually transmitted infections (STIs) clinic. Patients diagnosed with Chlamydia and who had a regular partner at the time of diagnosis, were contacted 3-12 months later and completed a questionnaire on relationship history. A comparison group of gender-matched non-STI patients were also interviewed. About half of Chlamydia cases (exposed) and non-cases (unexposed) had broken up with their partner since diagnosis (52% vs. 47%; p=0.42), but cases were more likely to have split up within one week of diagnosis (48% vs. 24%; p=0.003), and somewhat more likely to resume the relationship (24% vs. 15%; p=0.24). The prevalence of reported physical violence in the past year was slightly higher in cases than the unexposed group (9% vs. 4%; p=0.09). Cases that saw a health adviser were less likely to report experiencing physical violence than those who had not seen a health adviser (7% vs. 12%: p=0.31). Patients with Chlamydia are more likely to suffer relationship breakup soon after diagnosis than STI clinic attenders without an STI. Health advice should include reassurance about sexual relationships as well as safer sex.
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Decker MR, Wirtz AL, Pretorius C, Sherman SG, Sweat MD, Baral SD, Beyrer C, Kerrigan DL. Estimating the impact of reducing violence against female sex workers on HIV epidemics in Kenya and Ukraine: a policy modeling exercise. Am J Reprod Immunol 2013; 69 Suppl 1:122-32. [PMID: 23387931 DOI: 10.1111/aji.12063] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Female sex workers (FSWs) worldwide suffer disproportionate burdens of HIV and gender-based violence. Despite evidence linking these threats, little is known about the potential HIV epidemic impact of reducing abuse. METHOD OF STUDY The Goals model approximated the impact of reducing violence against FSWs on HIV epidemics in Ukraine and Kenya, measured by reductions in new infections among FSWs and adults. Cumulative infections averted over a 5-year period, in which violence declined was calculated, relative to a status quo with no reduction. Projections held HIV interventions constant at baseline levels; subsequently, scenarios adjusted for planned expansion of antiretroviral therapy (ART) coverage. RESULTS An approximate 25% reduction in incident HIV infections among FSWs was observed when physical or sexual violence was reduced; cumulative infections averted were 21,200 and 4700 in Kenya and Ukraine, respectively. Similar percent reductions were observed assuming ART coverage expansion, with approximately 18,200 and 4400 infections averted among FSWs in Kenya and Ukraine. New infections were also averted in the general population. CONCLUSION Reducing violence against FSWs appears to impart significant reductions in new infections among FSWs and in the general adult population in both generalized and concentrated epidemics. Limitations provide direction to improve the precision of future estimates.
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Affiliation(s)
- Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Naved RT. Sexual violence towards married women in Bangladesh. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:595-602. [PMID: 23254953 DOI: 10.1007/s10508-012-0045-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 04/14/2012] [Accepted: 08/18/2012] [Indexed: 06/01/2023]
Abstract
This article explored the magnitude and nature of within marriage sexual violence against women and factors associated with physically forced sex by husbands in urban and rural Bangladesh using population-based survey data from 2001 (n = 2,702). Results showed high prevalence of lifetime sexual violence: 37 % in urban and 50 % in rural areas. An overwhelming majority of the women reported being sexually abused by husbands more than once. Logistic regression analyses revealed that six out of ten independent variables included in the models were significant. The factors positively associated with physically forced sex by husbands during the last 12 months were: history of physical abuse of husband's mother by his father; level of controlling behavior by husband; and forced or coerced first sex. Women's age (20-24 compared to 15-19) and dowry demand at marriage increased the likelihood of this violence in the rural area. Urban women in the second and third income quartiles were more likely to be exposed to this violence compared to women in the first quartile. Results highlight the need for prevention programs targeting men, which would help at the same time to break the cycle of intergenerational exposure and thereby transmission of violence. Notions of gender equality; women's sexual rights; and women's right to consent and choice need to be widely promoted particularly among men.
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Klot JF, Auerbach JD, Berry MR. Sexual violence and HIV transmission: summary proceedings of a scientific research planning meeting. Am J Reprod Immunol 2013; 69 Suppl 1:5-19. [PMID: 23157400 PMCID: PMC3619416 DOI: 10.1111/aji.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This summarizes proceedings of a Scientific Research Planning Meeting on Sexual Violence and HIV transmission, convened by the Social Science Research Council on 19–20 March 2012 at the Greentree Foundation in New York. The Meeting brought together an interdisciplinary group of basic, clinical, epidemiological and social science researchers and policy makers with the aim of: (1) examining what is known about the physiology of sexual violence and its role in HIV transmission, acquisition and pathogenesis; (2) specifying factors that distinguish risks throughout the maturation of the female genital tract, the reproductive cycle and among post-menopausal women; and (3) developing a research agenda to explore unanswered questions. The Meeting resulted in a consensus Research Agenda and White Paper that identify priorities for HIV research, policy and practice as it pertains to the role of sexual violence and genital injury in HIV transmission, acquisition and pathogenesis, particularly among women and girls.
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Kishor S. Married women's risk of STIs in developing countries: the role of intimate partner violence and partner's infection status. Violence Against Women 2012; 18:829-53. [PMID: 22946108 DOI: 10.1177/1077801212455358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data for nationally representative samples of cohabiting couples in six developing countries show that intimate partner violence (IPV) increases the risk of self-reported sexually transmitted infections (STIs) for currently married women (ORs = 1.4-2.2) in all six countries, and that the strength of this relationship is not diminished by controls for proximate determinants such as husband's self-reported STI status and men's and women's higher-risk behaviors. The robustness of the IPV-STI relationship suggests the need to acknowledge IPV as an STI risk factor for women on par with other recognized risk factors such as multiple sexual partners and unprotected sexual intercourse.
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Dunkle KL, Decker MR. Gender-based violence and HIV: reviewing the evidence for links and causal pathways in the general population and high-risk groups. Am J Reprod Immunol 2012; 69 Suppl 1:20-6. [PMID: 23216606 DOI: 10.1111/aji.12039] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022] Open
Abstract
A growing body of international research documents strong associations between gender-based violence and HIV, both in the general population and among high-risk subpopulations such as female sex workers. The causal pathways responsible are multiple and complex, thus conceptual clarity is needed to best inform population-based, clinical, and individually oriented interventions. Our brief overview is intended to provide an introduction to the research on the various mechanisms that link GBV to HIV risk. We review the evidence, describe the causal pathways, provide a conceptual framework, and outline prevention and intervention priorities at both the individual and population levels.
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Affiliation(s)
- Kristin L Dunkle
- Department of Behavioral Sciences and Health Education and Center for AIDS Research, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Kavitha N. Is Young Maternal Age a Risk Factor for Sexually Transmitted Diseases and Anaemia in India? An Examination in Urban and Rural Areas. JOURNAL OF HEALTH MANAGEMENT 2011. [DOI: 10.1177/097206341101300303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present research work aims to study the effect of young maternal age on the prevalence of sexually transmitted diseases (STDs) and anaemia using National Family Health Survey-3 (NFHS-3) data for India. Analysis has been done for currently married women in the reproductive age group and who had their first birth in the age group 29 or below. Data have been analysed for urban and rural areas separately. The bivariate analysis showed that per cent of women who had their first birth during adolescence is higher in rural areas than urban areas. Further, women who had their first birth during adolescence reported a higher prevalence of STDs and anaemia than women who had their first birth at later ages in both settings. Logistic regression analysis has been used to examine the net influence of maternal age on the prevalence of anaemia and STDs. The multivariate findings revealed that the likelihood of prevalence of STDs and anaemia (urban areas) was higher among adolescent women than among adult women.
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Affiliation(s)
- N. Kavitha
- Population Research Centre, Institute for Social and Economic Change, Nagarbhavi, Bangalore, India
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Couture MC, Soto JC, Akom E, Joseph G, Zunzunegui MV. Violence against intimate partners and associations with inconsistent condom use among clients of female sex workers in Haiti. Public Health Rep 2010; 125:896-902. [PMID: 21121235 DOI: 10.1177/003335491012500617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marie-Claude Couture
- Department of Social and Preventive Medicine, University of Montreal, Quebec, Canada.
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Beattie TSH, Bhattacharjee P, Ramesh BM, Gurnani V, Anthony J, Isac S, Mohan HL, Ramakrishnan A, Wheeler T, Bradley J, Blanchard JF, Moses S. Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program. BMC Public Health 2010; 10:476. [PMID: 20701791 PMCID: PMC2931467 DOI: 10.1186/1471-2458-10-476] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 08/11/2010] [Indexed: 11/10/2022] Open
Abstract
Background Violence against female sex workers (FSWs) can impede HIV prevention efforts and contravenes their human rights. We developed a multi-layered violence intervention targeting policy makers, secondary stakeholders (police, lawyers, media), and primary stakeholders (FSWs), as part of wider HIV prevention programming involving >60,000 FSWs in Karnataka state. This study examined if violence against FSWs is associated with reduced condom use and increased STI/HIV risk, and if addressing violence against FSWs within a large-scale HIV prevention program can reduce levels of violence against them. Methods FSWs were randomly selected to participate in polling booth surveys (PBS 2006-2008; short behavioural questionnaires administered anonymously) and integrated behavioural-biological assessments (IBBAs 2005-2009; administered face-to-face). Results 3,852 FSWs participated in the IBBAs and 7,638 FSWs participated in the PBS. Overall, 11.0% of FSWs in the IBBAs and 26.4% of FSWs in the PBS reported being beaten or raped in the past year. FSWs who reported violence in the past year were significantly less likely to report condom use with clients (zero unprotected sex acts in previous month, 55.4% vs. 75.5%, adjusted odds ratio (AOR) 0.4, 95% confidence interval (CI) 0.3 to 0.5, p < 0.001); to have accessed the HIV intervention program (ever contacted by peer educator, 84.9% vs. 89.6%, AOR 0.7, 95% CI 0.4 to 1.0, p = 0.04); or to have ever visited the project sexual health clinic (59.0% vs. 68.1%, AOR 0.7, 95% CI 0.6 to 1.0, p = 0.02); and were significantly more likely to be infected with gonorrhea (5.0% vs. 2.6%, AOR 1.9, 95% CI 1.1 to 3.3, p = 0.02). By the follow-up surveys, significant reductions were seen in the proportions of FSWs reporting violence compared with baseline (IBBA 13.0% vs. 9.0%, AOR 0.7, 95% CI 0.5 to 0.9 p = 0.01; PBS 27.3% vs. 18.9%, crude OR 0.5, 95% CI 0.4 to 0.5, p < 0.001). Conclusions This program demonstrates that a structural approach to addressing violence can be effectively delivered at scale. Addressing violence against FSWs is important for the success of HIV prevention programs, and for protecting their basic human rights.
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Affiliation(s)
- Tara S H Beattie
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Madhivanan P, Bartman MT, Pasutti L, Krupp K, Arun A, Reingold AL, Klausner JD. Prevalence of Trichomonas vaginalis infection among young reproductive age women in India: implications for treatment and prevention. Sex Health 2010; 6:339-44. [PMID: 19917204 DOI: 10.1071/sh09038] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 07/31/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Trichomonas vaginalis infection is the most common curable sexually transmissible infection (STI) worldwide. The present study describes the burden and correlates of T. vaginalis infection among young reproductive age women in Mysore, India. METHODS Between November 2005 and March 2006, sexually active women aged 15-30 years were recruited from low-income peri-urban and rural neighbourhoods of Mysore, India. Participants were interviewed and offered a physical examination and testing for T. vaginalis, bacterial vaginosis, vaginal candidiasis, Neisseria gonorrheoea and herpes simplex virus type-2 antibodies. RESULTS Of the 898 participating women, 76 had a T. vaginalis infection (8.5%, 95% confidence interval [95% CI]: 6.7-10.5%). Nearly all (98%) participants were married and most reported their spouse as their main sex partner. The mean age at marriage was 16.9 years (s.d. 2.9 years) and two-thirds of the sample reported having first sexual intercourse before the age of 19 years. Risk factors independently associated with T. vaginalis infection included early age at first intercourse (adjusted odds ratio [OR] 2.09; 95% CI: 1.09-4.00), concurrent bacterial vaginosis (OR 8.21; 95% CI: 4.30-15.66), vaginal candidiasis (OR 2.40; 95% CI: 1.48-3.89) and herpes simplex virus type-2 infection (OR 3.44; 95% CI: 1.97-6.02). CONCLUSION The burden of T. vaginalis infection at 8.5% is relatively high among a community sample of young reproductive aged women. Because this infection increases the risk of HIV transmission and is associated with adverse pregnancy outcomes, there is a need for increased screening and treatment of this easily curable sexually transmissible infection in India.
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Affiliation(s)
- Purnima Madhivanan
- Public Health Research Institute, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, Karnataka, India.
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Symptoms of Reproductive Tract Infections and Mental Distress among Women in Low-Income Urban Neighborhoods of Beirut, Lebanon. J Womens Health (Larchmt) 2009; 18:1701-8. [DOI: 10.1089/jwh.2008.0962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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