Perpetration of intimate partner violence and mental health outcomes: sex- and gender-disaggregated associations among adolescents and young adults in Nigeria

Preexposure Prophylaxis and Intimate Partner Violence Among Gay, Bisexual, and Other Men Who Have Sex With Men: A Global Scoping Review of the Literature

ABSTRACT

Men who have sex with men (MSM) experience intimate partner violence (IPV) and are at an elevated risk of HIV acquisition. Preexposure prophylaxis (PrEP) is an effective preventative measure against HIV. However, its adoption and consistent use among MSM, especially those experiencing IPV, is low. This scoping review summarizes literature relevant to HIV PrEP, focusing on MSM who experience IPV. Of the 110 studies identified, eight eligible studies met the inclusion and exclusion criteria. Most of these were conducted in the United States, focusing exclusively on adult MSM. Most studies evaluated daily oral PrEP. The studies assessed the impact of IPV on respondent's knowledge, willingness, preference, and PrEP use and revealed varying levels of association between IPV and PrEP. Future research is essential to develop practice guidelines and policy to enhance PrEP uptake in this vulnerable population.

Does domestic violence legislation reduce permissive attitudes about intimate partner violence? Longitudinal evidence from men and women from 61 countries

ABSTRACT

Introduction

Intimate partner violence (IPV) is highly prevalent and has substantial implication for women's health. Changing IPV attitudes is one pathway to reduce IPV. While evidence suggests that interventions targeting individuals may change IPV attitudes, the effect of wider-scale interventions, such as legislation, remains unknown.

Methods

We used individual-level IPV attitudes information collected between 1997 and 2020 by the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys, which we linked with national-level domestic violence (DV) legislation information. We evaluated the effect of adoption of DV legislation on changes in IPV attitudes using a difference-in-differences study design that controlled for time-varying country-level confounding and accounted for staggered timing of legislation adoption.

Results

Our sample included harmonised information across 61 countries, composed of 2 184 047 women from 60 countries and 390 877 men from 40 countries. After controlling for country-level time-varying confounders, adoption of DV legislation reduced IPV acceptability among women (average treatment effect among treated=-0.07, 95% CI: -0.16, 0.06) and men (average treatment effect among treated=-0.11, 95% CI: -0.22, 0.03) although estimates were imprecise and included the null.

Conclusions

DV legislation may reduce permissive IPV attitudes, especially among men, although conclusions should be interpreted cautiously due to imprecise estimates.

Correlates of Intimate Partner Violence Victimization and Perpetration in Adolescents and Young Adults in Sub-Saharan Africa: A Systematic Review

Intimate partner violence (IPV) is a global public health crisis with long-term adverse consequences for both victims and perpetrators. Patterns of violence often begin during adolescence, yet most interventions target adult relationships. A systematic review was conducted to identify correlates of IPV victimization and perpetration among adolescents and young adults in sub-Saharan Africa (SSA). Eligible studies included participants 10 to 24 years old, took place in SSA, and tested a statistical association between a correlate and an IPV outcome. Correlates were defined as any condition or characteristic associated with statistically significant increased or decreased risk of IPV victimization or perpetration. PsycInfo, PubMed, Embase, and African Index Medicus were searched and included studies published between January 1, 2000 and February 4, 2022. The search resulted in 3,384 original studies, of which 55 met inclusion criteria and were analyzed. Correlates were first qualitatively synthesized by developmental period (e.g., early adolescence, older adolescence, and young adulthood) and then organized in a conceptual framework by correlate type (e.g., socio-demographic; health, behavior, and attitudes; relational; or contextual). Over two decades of literature reveals variability in evidence by developmental period but also substantial overlap in the correlates of victimization and perpetration. This review identifies multiple points for intervention and results suggest the urgent need for earlier, developmentally appropriate prevention efforts among younger adolescents as well as combined approaches that target both victimization and perpetration of IPV.

The social, cultural, and health context of controlling behavior and emotional intimate partner violence among adolescent girls and young women living with human immunodeficiency virus in Uganda: A qualitative study

BACKGROUND

Many adolescent girls and young women (AGYW) living with human immunodeficiency virus (HIV) report intimate partner violence (IPV), including emotional IPV and controlling behavior. Yet, few studies have examined the association between these forms of IPV and health outcomes among AGYW living with HIV.

OBJECTIVES

We conducted an exploratory qualitative study to understand the contexts in which controlling behavior and emotional IPV might impact the health of AGYW living with HIV in Uganda.

DESIGN

We used a participatory action research design involving community stakeholders (health workers, program managers of non-governmental organizations serving IPV survivors, and AGYW living with HIV).

METHODS

Data were collected through in-depth interviews and focus groups. We analyzed data using an inductive thematic analysis approach.

RESULTS

The following four themes related to different dimensions of controlling behavior and emotional IPV among AGYW living with HIV emerged from the data: (1) age-related controlling behavior and emotional IPV; (2) HIV-related controlling behavior and emotional IPV; (3) isolation-type controlling behavior and poor HIV health; (4) financial control and poor HIV health. Embedded throughout the four themes were issues related to male partners' misuse of power.

CONCLUSION

AGYW living with HIV experience unique forms of emotional IPV and controlling behavior that impede their ability to remain healthy. Inequitable gender norms may further increase the risk of emotional IPV and controlling behavior among AGYW living with HIV. Couples-based interventions that build healthy relationship skills and offer social support may help to reduce these forms of IPV.

Association between gender social norms and cardiovascular disease mortality and life expectancy: an ecological study

OBJECTIVE

Examine the association between country-level gender social norms and (1) cardiovascular disease mortality rates; (2) female to male cardiovascular disease mortality ratios; and (3) life expectancy.

DESIGN

Ecological study with the country as the unit of analysis.

SETTING

Global, country-level data.

PARTICIPANTS

Global population of countries with data available on gender social norms as measured by the Gender Social Norms Index (developed by the United Nations Development Programme).

MAIN OUTCOME MEASURES

Country-level female and male age-standardised cardiovascular disease mortality rates, population age-standardised cardiovascular disease mortality rates, female to male cardiovascular disease mortality ratios, female and male life expectancy at birth. Outcome measure data were retrieved from the WHO and the Institute for Health Metrics and Evaluation. Multivariable linear regression models were fitted to explore the relationship between gender social norms and the outcome variables.

RESULTS

Higher levels of biased gender social norms, as measured by the Gender Social Norms Index, were associated with higher female, male and population cardiovascular disease mortality rates in the multivariable models (β 4.86, 95% CIs 3.18 to 6.54; β 5.28, 95% CIs 3.42 to 7.15; β 4.89, 95% CIs 3.18 to 6.60), and lower female and male life expectancy (β -0.07, 95% CIs -0.11 to -0.03; β -0.05, 95% CIs -0.10 to -0.01). These results included adjustment within the models for potentially confounding country-level factors including gross domestic product per capita, population mean years of schooling, physicians per 1000 population, year of Gender Social Norms Index data collection and maternal mortality ratio.

CONCLUSIONS

Our analysis suggests that higher levels of biased gender social norms are associated with higher rates of population cardiovascular disease mortality and lower life expectancy for both sexes. Future research should explore this relationship further, to define its causal role and promote public health action.

Intimate Partner Violence and Mental Health: Deepening Our Understanding of Associations, Pathways, and Prevention in Low- and Middle-Income Countries

Mental health disorders and related symptoms are among the top leading causes of disability adjusted life years (DALYs) among youth (10-24 years) and adults (25-49 years) [...].

HIV Disclosure Among Sexually Infected People Living with HIV and AIDS in China: Prevalence, Influencing Factors, and Negative Outcomes

HIV disclosure is crucial for HIV prevention and control, but may also lead to discrimination, insult, and even violence against people living with HIV and AIDS (PLWHAs). In this study, we examined HIV disclosure, its influencing factors, and its association with intimate partner violence (IPV) among 1153 PLWHAs through the sexual route in Jinan, Shandong Province, China. Our results showed that 76.4% (881/1153) PLWHAs had disclosed someone about their HIV infection, the HIV disclosure rates among family members, friends, spouses, and current fixed partners of PLWHAs were 43.5% (501/1153), 47.9% (552/1153), 56.8% (129/227), and 43.2% (336/777), respectively. HIV disclosure was affected by socio-demographics, disease characteristics, and psycho-social factors and varied among family members, close friends, spouses, and current fixed sexual partners. Age ≤ 33 years (aOR 1.79, 95% CI 1.27-2.53), heterosexual infection route (aOR 1.52, 95% CI 1.06-2.17), HIV diagnosis time > 36 months (aOR 1.84, 95% CI 1.30-2.59), with other chronic diseases (aOR 1.87, 95% CI 1.34-2.61), lower self-stigma (aOR 4.03-4.36, 95% CI 1.98-8.74), higher social support (aOR 1.71-1.73, 95% CI 1.03-2.83), no depression (aOR 1.54, 95% CI 1.12-2.11), and no suicidal ideation (aOR 1.79, 95% CI 1.28-2.50) were all independently associated with increased likelihood of HIV disclosure. HIV disclosure was associated with an increased risk of IPV among current fixed sexual partners (aOR 1.87, 95% CI 1.38-2.54) and spouses (aOR 2.54, 95% CI 1.41-4.56). Our findings suggest that the HIV disclosure rate of PLWHAs is still low and is affected by multiple factors. There is an urgent need to design targeted and comprehensive interventions to improve HIV disclosure. IPV prevention should also be incorporated into the intervention system of HIV disclosure to ensure adequate and continuous support for PLWHAs.

The Role of Pornography Use in Intimate Partner Violence in Different-Sex Couples: A Prospective Longitudinal Study

Pornography use and intimate partner violence (IPV) are both prevalent in romantic relationships. However, information is lacking about whether pornography use predicts IPV. This study examined the relation between frequency of pornography use (FPU) and IPV across a span of 4 months in a sample of 132 different-sex couple dyads. At least one partner in each couple was attending a Canadian university. Participants (N = 264) completed online measures of pornography use, IPV, and social desirability at baseline and at a 4-month follow-up. Two longitudinal actor-partner interdependence models using a structural equation framework to conduct path analyses demonstrated that (a) higher FPU among men at baseline predicted increases in IPV perpetration and victimization from baseline to 4-month follow-up for both men and women and (b) women's baseline FPU did not predict change in IPV over time for themselves or their partners. These findings suggest that frequent pornography use among male partners in different-sex romantic relationships may represent an under-recognized risk factor for IPV, and further research is needed to identify latent factors that may be contributing to this relation. Although women's baseline FPU did not predict changes in IPV over time, this may be because women used pornography less frequently than men.

Intimate Partner Violence and Mental Health: Sex-Disaggregated Associations Among Adolescents and Young Adults in Uganda

Experiences of intimate partner violence (IPV) victimization have well-established associations with poor mental health. There is also burgeoning evidence regarding the association between IPV perpetration and mental health in a small number of countries. However, there is a paucity of data about the gendered differences for these IPV experiences within sub-Saharan African. This study examines the association between IPV victimization, perpetration, and mental health outcomes for male and female adolescents and young adults in Uganda. Data on IPV perpetration were available for a nationally representative sample of 1,373 males and 2,022 females in Uganda. Observations were weighted to be representative of 13- to 24-year-olds in Uganda. Study procedures used multivariate logistic regression models to examine associations between ever-perpetration of IPV and four self-reported mental health variables: severe sadness, feelings of worthlessness, suicide ideation, and alcohol abuse. Models controlled for age, marital status, schooling, and past exposure to violence. Models were sex-disaggregated to examine sex-specific associations. Standard errors were adjusted for sampling stratification and clustering. Data analysis showed that males were more than twice as likely as females to perpetrate IPV (14% vs. 6%, respectively; p < .001), while odds of perpetration for both sexes were higher for those ever experiencing IPV (adjusted odds ratio [aOR] = 12.12 for males; aOR=4.73 for females). Male perpetrators had 2.93 greater odds of experiencing suicidal ideation (95% confidence interval [CI]: [1.78, 4.82], p < .001) and increased drinking behaviors (2.21, 95% CI: [1.39, 3.50], p < .001) when compared with non-perpetrating males. In addition, female perpetrators had 2.59 times greater odds of suicidal ideation (95% CI: [1.34,4.99], p < .01), as compared with non-perpetrating females. Our findings among youth and adolescents demonstrated associated but different experiences for males and females. Findings indicate the importance of understanding the relationship between IPV victimization and perpetration, and addressing these correlates with a gender-sensitive perspective to inform policy and programming.

Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention

Although global rates of suicide have dropped in the last 30 years, youth in low- and middle-income countries (LMICs) continue to be highly represented in suicide statistics yet underrepresented in research. In this review we present the epidemiology of suicide, suicidal ideation, and suicide attempts among youth in LMICs. We also describe population-level (attitudes toward suicide, socioeconomic, and societal factors) and individual-level clinical and psychosocial risk factors, highlighting specific considerations pertaining to youth in LMICs. These specific considerations in risk factors within this population can inform how multi-level prevention strategies may be targeted to meet their specific needs. Prevention and intervention strategies relying on the stepped-care framework focusing on population-, community-, and individual level targets while considering locally- and culturally relevant practices are key in LMICs. In addition, systemic approaches favoring school-based and family-based interventions are important among youth. Cross-culturally adapted multimodal prevention strategies targeting the heterogeneity that exists in healthcare systems, suicide rates, and risk factors in these countries should be accorded a high priority to reduce the burden of suicide among youth in LMICs.

Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data

Background

Understanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis.

Methods

We developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised.

Findings

Case studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras.

Interpretation

Researchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health.

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This article presents effective methods to study gender norms in existing global health survey data.

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We devised conceptual pathways linking gender norms to gender-based health disparities.

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We identified gender norms proxies and reference groups enforcing the norm.

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We tested hypotheses linking gender norms to health.

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These methods can aid policy and programme design to advance gender equality and health.

Predicting adolescent boys' and young men's perpetration of youth violence in Colombia

Youth violence poses a substantive public health burden in Latin America, particularly among adolescent boys and young men. Understanding predictors of youth violence perpetration among boys and young men is critical to more effectively target and tailor prevention programs, especially in Colombia, which has endured decades-long internal armed conflict. This study uses Colombia's nationally representative 2018 Violence Against Children and Youth Survey data to examine risk and protective factors associated with violence perpetration among 13- to 24-year-old male. Amongst adolescent boys and young men in Colombia, the prevalence of ever perpetrating violence against someone other than an intimate partner was approximately 23%. Multivariable logistic regression models revealed that physical violence victimization by peers, emotional violence victimization by caregivers, having lost or been separated from a mother during childhood, and witnessing community violence were all associated with lifetime perpetration of youth violence. Programs targeting reduction of youth violence among boys might consider addressing the previously identified predictors earlier in the life course and at the individual, family and community levels.