Spousal intimate partner violence is associated with HIV and Other STIs among married Rwandan women

Exposure to Armed Conflict and HIV Risk Among Rwandan Women

This article focuses on the link between past exposure to violence and a critical public health issue in sub-Saharan Africa: HIV-positive status in women of reproductive age. Specifically, we use biosocial data from the Rwandan Demographic and Health Survey (2005‒2014) to assess how the timing and intensity of women's exposure to the war and genocide in Rwanda (1990‒1994) may be associated with their HIV status. We find significant differences in risk across age cohorts, with the late adolescence cohort (women born in 1970‒1974, who were aged 16‒20 at the start of the conflict) having the highest risk of being HIV positive 10‒20 years after the violence, even after controlling for current socioeconomic and demographic characteristics. Women who reported two or more sibling deaths, excluding those related to maternal mortality, during the conflict years also had higher odds of being HIV positive, net of cohort and control variables. Age at first sexual intercourse and number of lifetime sexual partners partially-but not fully-explain the associations between cohort and sibling deaths and HIV. These findings advance research related to armed conflict and population health and indicate that experiencing conflict during key stages of the life course and at higher intensity may affect women's long-term sexual health.

Sexual violence and self-reported sexually transmitted infections among women in sub-Saharan Africa

Sexual violence has proven to be associated with sexually transmitted infections (STIs) in sub-Saharan Africa (SSA). We examined the association between sexual violence and self-reported STIs (SR-STIs) among women in sexual unions in 15 sub-Saharan African countries. This was a cross-sectional study involving the analysis of data from the Demographic and Health Surveys (DHS) from 15 countries in SSA. A total sample of 65,392 women in sexual unions were included in the final analysis. A multilevel binary logistic regression analysis was carried out and the results were presented using adjusted odds ratios (aOR) at 95% Confidence Interval (CI). Women who experienced sexual violence in the last 12 months were more likely to self-report STIs compared to those who did not experience sexual violence [aOR = 1.76, 95% CI = 1.59-1.94]. Compared to women in Angola, those who were in Mali, Nigeria, Sierra Leone, Uganda, and Liberia were more likely to self-report STIs while those in Burundi, Cameroon, Chad, Ethiopia, Malawi, Rwanda, South Africa, Zambia, and Zimbabwe were less likely to self-report STIs. The study has revealed variations in the country level regarding the prevalence of sexual violence and SR-STI in the last 12 months among women in sexual unions in the selected countries. This study has demostrated that sexual violence in the last 12 months is associated with SR-STIs among women in sexual unions. Moreover, factors that predict SR-STIs were observed in this study. Policymakers and agencies that matter could consider the factors identified in this study when designing policies or strengthening existing ones to tackle STIs among women in SSA. To accelerate the progress towards the achievement of Sustainable Development Goal 3, its imperative efforts and interventions must be intensified in SSA to reduce sexual violence which will go a long way to reduce SR-STIs among women.

Associations between sexual identity, living with disability, bully victimisation, and HIV status and intimate partner violence among residents in Nigeria

Background

The aim of the study was to determine the associations between sexual identity, disability and HIV status and bullying victimisation, and a history of physical, emotional and sexual violence in Nigeria.

Methods

This was a secondary analysis of a primary dataset generated through an online survey conducted between February 7 and 19, 2021. The 3197 participants for the primary study were recruited through snowballing. The dependent variables were physical, emotional and sexual violence. The independent variables were sexual identity (heterosexual and sexual minority), HIV status (negative, positive and unknown), bullying victimisation (yes/no) and living with disability (yes/no). A multivariate logistic regression model was developed for each form of IPV. Each model was adjusted for age, sex assigned at birth, marital status and education level.

Results

Respondents living with HIV had higher odds for physical (AOR: 2.01; 95% CI: 1.46–2.76; p < 0.001), sexual (AOR: 2.17; 95%CI: 1.55–3.05; p < 0.001), and emotional (AOR: 1.59; 95%CI: 1.24–2.06; p < 0.001) violence. Also, those with history of bullying victimisation had higher odds for physical (AOR: 3.79; 95%CI: 2.86 – 5.68; p < 0.001), sexual (AOR: 3.05; 95%CI: 2.27 – 4.10; p < 0.001) and emotional (AOR: 2.66; 95%CI: 2.10 – 3.37; p < 0.001) violence. In addition, females had higher odds of physical (AOR: 1.52; 95%CI: 1.13–2.043; p < 0.001) and sexual (AOR: 1.83; 95%CI: 1.34 – 2.50; p < 0.001) violence; and respondents cohabiting (AOR: 1.95; 95%CI: 1.12 – 3.28; p = 0.012) had higher odds for emotional violence. Respondents who were married have significantly lower odds of experiencing physical (AOR: 0.66; 95%CI: 0.45 – 9.60; p = 0.029), sexual (AOR: 0.40; 95%CI: 0.26 – 0.62; p < 0.001) and emotional (AOR: 0.68; 95%CI: 0.50 – 0.93; p = 0.015) violence when compared to singles. Younger respondents also had lower odds of experiencing sexual violence (AOR: 0.97; 95%CI: 0.95–0.99; p = 0.016).

Conclusion

HIV positive status and bullying victimisation seem to increase the risk for all forms of IPV while the experience of IPV did not differ by sexual identity and disability status. The associations between age, sex, marital status and IPV may suggest moderating roles of the factors taking cognisance of the cultural context of these relationships. Future relational analysis is necessary to further understand the pathways for the associations found between the variables in this study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14186-6.

Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort

Limited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.

Experiencing Intimate Partner Violence (IPV) Is Associated with Psychosocial Health Problems Among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Nigeria, Africa

Previous research has shown high rates of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBMSM). Experiencing IPV may predispose GBMSM to psychosocial health problems. A vast majority of the research on IPV among GBMSM have been conducted in North America and Europe. To date, no published studies that we are aware of have investigated the prevalence and correlates of IPV among GBMSM in West Africa. To fill this gap in research, the present study investigated the prevalence of IPV and its' association with psychosocial health problems in a large multicity sample of community-recruited GBMSM in Nigeria. Bivariate and multivariable logistic regression analyses were utilized to examine associations between sociodemographic characteristics, psychosocial health problems, sexual risk, and experiences of IPV (N = 389). The prevalence of experiencing emotional, physical, sexual, monitoring behaviors, and controlling behavior were 45%, 31%, 20%, 55%, and 22% respectively. Experiencing all types of IPV, except physical violence, was significantly associated with increased odds of having depressive symptoms (Adjusted OR [AOR] 1.79-2.63; 95% confidence interval [CI]: 1.08-4.60) and anxiety (AOR 1.63-2.63; 95% CI: 1.01-4.18). Experiencing emotional violence (standardized beta [β] = 0.21; standard error [SE] SE = 0.44), physical violence (β = 0.14; SE = 0.48), and controlling behaviors (β = 0.11; SE = 0.54) was associated with increased odds of loneliness. Experiencing all types of IPV was associated with history of suicide thoughts (AOR 2.20-3.68; 95% CI: 1.28-6.32) and suicide attempt (AOR 2.36-3.42; 95% CI: 1.20-6.75). Additionally, we observed a dose-response relationship, whereby increasing number of IPV was associated with a higher likelihood of reporting psychosocial health problems. Lastly, after adjusting for other psychosocial health problems and demographic characteristics, there remained a significant association between experiencing IPV and reporting a history of suicide thoughts and suicide attempt. Consequently, it is imperative that health interventions aimed at improving psychosocial health of GBMSM explore experience and perpetration of IPV.

Sexual autonomy and self-reported sexually transmitted infections among women in sexual unions

BACKGROUND

Sexually transmitted infections (STIs) are major public health challenges worldwide. Despite the importance of sexual autonomy in the prevention and control of sexual and reproductive health disorders such as STIs, there are limited studies on the possible relationship between women's sexual autonomy and self-reported STIs, especially in sub-Saharan Africa (SSA). This study, therefore, examined the association between sexual autonomy and self-reported STIs among women in sexual unions in SSA.

METHODS

Data from the Demographic and Health Survey (DHS) of 31 countries in SSA conducted between 2010 and 2019 were analysed. A total of 234,310 women in sexual unions were included in the study. Data were analysed using binary logistic regression models and the results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs) at 95% confidence interval (CI).

RESULTS

The prevalence of self-reported STIs among women in sexual unions in SSA was 5.8%. Approximately 83.0% of the women surveyed had sexual autonomy. Women who had no sexual autonomy were less likely to have self-reported STIs (cOR=0.52, CI: 0.46-0.54), compared to those who had sexual autonomy. Additionally, higher odds of self-reported STIs were found among women aged 25-29, compared to those aged 15-19 (aOR= 1.21, CI: 1.09-1.35); those who reside in urban areas, compared to those who reside in rural areas (aOR= 1.51, CI: 1.37-1.66) and those who were cohabiting, compared to those who were married (aOR= 1.65, CI: 1.52-1.79). On the other hand, lower odds of self-reported STIs were found among women who were exposed to newspapers (aOR= 0.89, CI: 0.82-0.95), those whose partners had primary education (aOR= 0.84, CI: 0.78-0.91), those who were not exposed to radio (aOR= 0.84, CI: 0.79-0.89), and working women (aOR= 0.86, CI: 0.80-0.93).

CONCLUSIONS

Findings from this study suggest that sexual autonomy is a significant predictor of self-reported STIs among women in sexual unions in SSA. Thus, instituting policies and programs that empower women and improve their levels of sexual autonomy may result in increased self-reporting of symptoms associated with STIs which subsequently help in minimising STI-related complications. Also, policies aimed at enhancing women's sexual autonomy may reduce the burden of STIs in SSA, especially among women in sexual unions.

Association of intimate partner violence and other risk factors with HIV infection among married women in India: evidence from National Family Health Survey 2015-16

Background

Human immunodeficiency virus (HIV) infection remains an important public health concern in many countries. It is fuelled by gender inequality and disparity, which has resulted in a fundamental violation of women’s human rights. This study aims to find out the association of intimate partner violence (IPV) and other risk factors with the prevalence of HIV infection among married women in India.

Methods

This study is based on data from the India National Family Health Survey (2015–16). Bivariate analysis has been performed to estimate the prevalence of HIV. Logistic regression analysis is conducted to find out the association between IPV, factors such as having alcoholic husband and lifetime partner, and HIV infection among currently married women.

Results

Married women who had faced physical, sexual, and emotional violence from their husbands/partners were almost twice more likely to have tested HIV positive compared to married women who did not face violence [OR: 2.14, CI: 1.08–4.50]. The odds of testing for HIV positive was significantly higher among the married women experiencing IPV and having alcoholic husband [OR: 4.48, CI: 1.87–10.70] than those who did not experience IPV and had non-alcoholic husband. The use of condom did not show any significant association with HIV infection. Again, having more than one lifetime partner had a positive association with HIV infection compared to those with one partner [OR: 2.45, CI: 1.21–4.16].

Conclusions

The study revealed that factors such as experiencing all types of IPV, having an alcoholic husband, increased number of lifetime partners, being sexually inactive, belonging to vulnerable social groups, and urban place of residence are important risk factors of HIV infection among married women in India. The results also suggest that gender-based violence and an alcoholic husband may represent a significant factor of HIV infection among married women and interventions should on focus such vulnerable populations.

Intimate Partner Violence and Sexually Transmitted Infections Among Women in Sub-Saharan Africa

Intimate partner violence (IPV) is a serious public health issue that increases risk for sexually transmitted infections (STIs). Data was obtained from women (n = 32,409) who completed the Demographic Health Survey's (DHS) domestic violence module in 7 countries in sub-Saharan Africa between 2011 and 2015. DHS questions assessed lifetime physical, emotional and sexual IPV, cumulative exposure to IPV as well as the presence of a STI in the past 12 months. Multivariate logistic regression examined the association between IPV and STIs adjusting for potentially influential covariates. Data were weighted and analyzed using STATA Software (version 14.0). Women who had experienced physical, emotional sexual and cumulative IPV were significantly more likely to have had a STIs in the past 12 months. In order to reduce the burden of STIs, initiatives may need to address underlying mechanisms such as gender norms and power inequalities which perpetuate IPV.

Development and Validation of a Sociodemographic and Behavioral Characteristics-Based Risk-Score Algorithm for Targeting HIV Testing Among Adults in Kenya

To inform targeted HIV testing, we developed and externally validated a risk-score algorithm that incorporated behavioral characteristics. Outpatient data from five health facilities in western Kenya, comprising 19,458 adults ≥ 15 years tested for HIV from September 2017 to May 2018, were included in univariable and multivariable analyses used for algorithm development. Data for 11,330 adults attending one high-volume facility were used for validation. Using the final algorithm, patients were grouped into four risk-score categories: ≤ 9, 10-15, 16-29 and ≥ 30, with increasing HIV prevalence of 0.6% [95% confidence interval (CI) 0.46-0.75], 1.35% (95% CI 0.85-1.84), 2.65% (95% CI 1.8-3.51), and 15.15% (95% CI 9.03-21.27), respectively. The algorithm's discrimination performance was modest, with an area under the receiver-operating-curve of 0.69 (95% CI 0.53-0.84). In settings where universal testing is not feasible, a risk-score algorithm can identify sub-populations with higher HIV-risk to be prioritized for HIV testing.

Sexual and Reproductive Health Outcomes of Violence Against Women and Girls in Lower-Income Countries: A Review of Reviews

Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.

Association between Intimate Partner Violence, Knowledge and Use of Contraception in Africa: Comparative Analysis across Five African Regions

BACKGROUND OR OBJECTIVES

Intimate partner violence (IPV) against women is common globally, and is associated with several adverse consequences. This study provides a comparative analysis of potential regional differences in the association between IPV and knowledge and use of contraceptives within Africa.

METHODS

A multi-country cross-sectional study was conducted using data on women of reproductive age 15-49 years from the Demographic and Health Surveys covering five African regions. Exposure and outcome variables were IPV and reproductive literacy (comprising modern contraception knowledge and contraception usage) respectively. We used survey log-binomial regression models to generate prevalence ratios that estimated the association between IPV versus knowledge and usage of modern contraception.

RESULTS

Overall IPV prevalence in Africa was 30.8% with notable regional differences. Demographic, socioeconomic, and reproductive history markers of IPV were more pronounced in younger women, rural residents, women of low socioeconomic status and those with copious knowledge but poor usage of modern contraception. The level of knowledge of contraception was 84% greater among African women who were victims of IPV compared to their counterparts who were not victims of IPV (p < 0.0001). IPV was not associated with actual usage of modern contraception (p = 0.21).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

IPV against women in Africa may incentivize knowledge seeking of modern contraception as protective mechanisms. Regional variations notwithstanding, understanding the existing and new characteristics predictive of IPV may inform policy development, resource allocation and prevention of IPV globally.

Association between intimate partner violence and HIV status among Haitian Women

The prevalence of intimate partner violence (IPV) among women living in Haiti increased from 25% in 2006-29% in 2012, with escalating reports of crisis in the last several years. We examined the association between IPV and HIV status among these women in Haiti. Participants were drawn from a larger sample of women (n = 513) with a history of IPV. Women living with HIV (n = 55) were matched to uninfected women (n = 110) to form a control group. Attitudes towards gender roles, mental and physical well-being, and partner violence were assessed and compared. Logistic regressions were utilised to calculate multivariable-adjusted odds ratios. Women living with HIV were more likely to report more severe forms of psychological violence (p < 0.01), and severe physical violence (p < 0.0001). Women who experienced severe forms of IPV were 3.5 times more likely to have an HIV positive status compared to those who did not experience severe IPV (p < 0.0001). There were significant associations between severe forms of IPV, and HIV status among Haitian women. IPV severity should be integrated into eligibility screening for biomedical strategies of prevention such as pre-exposure prophylaxis (PrEP) among Haitian women.

Intimate partner violence among HIV-positive women in Nairobi, Kenya

Purpose

This study was conducted to identify the prevalence and sociodemographic factors associated with four forms of intimate partner violence (IPV) among HIV-positive women attending the Comprehensive Care Centre at the Kenyatta National Hospital in Nairobi, Kenya.

Methods

A cross-sectional study was conducted among 600 sexually active HIV-positive women aged 18–69 years from May to August of 2012. A structured questionnaire including questions pertaining to sociodemographic characteristics, health care decisions, and forms of IPV (controlling behavior, emotional abuse, physical violence, and sexual violence) was administered to each woman.

Results

All women reported experiencing emotional abuse; 20%, 17%, and 15% experienced controlling behavior, physical violence, and sexual violence, respectively. Women who reported low/below average socioeconomic status (SES) had a greater likelihood of experiencing controlling behavior than women with high/average SES (adjusted odds ratio [aOR] =1.62, 95% CI 1.05–2.51). Women who were unemployed had greater odds of experiencing physical violence than those who were employed (aOR =2.35, 95% CI 1.31–4.23). Non-Christian women had higher odds of experiencing controlling behavior, physical violence, and sexual violence than Christian women (aOR =4.41, 95% CI 1.81–10.76 and aOR =3.33, 95% CI 1.43–7.80).

Conclusion

Based on the prevalence of IPV and the sociodemographic factors identified to be associated with IPV among women in this study it may be beneficial to include IPV screening as part of routine clinic visits for HIV-positive and other women. Furthermore, women who report emotional abuse or controlling behavior from spouse should not be overlooked, as these two forms of IPV may precede or accompany physical and sexual IPV. Women who report experiencing IPV during clinic visits may be referred to organizations and resources available to battered women in Kenya. Increased funding for anti-IPV programs and changes in policy may also contribute to a reduction in IPV among HIV-positive and other women in Kenya.

Polygamy and birth outcomes among Bedouin women of the Negev: The contribution of social determinants and pregnancy complications

Polygamy has been associated with adverse health outcomes. We examined the association between polygamy and adverse birth outcomes (composite score of preterm birth, low birth weight, small for gestational age, Apgar score < 7) using survey data linked to retrospective medical data of 9,872 cohort Bedouin women who bore live singletons in a large medical center in Southern Israel between 2008 and 2014. Women in polygamous marriages (18%) were more likely to have adverse birth outcomes after considering different factors (AOR = 1.28, 95% CI = 1.09-1.51), indicating that polygamy is an independent risk factor for birth outcomes that should be considered in research and clinical practice.

Marital Rape and HIV Risk in Uganda: The Impact of Women's Empowerment Factors

This study used Uganda Demographic Health Survey data (2011) to examine the role of women's empowerment in reducing HIV risk among married women who experienced sexual violence in Uganda. The sample size was 8,674 ever-married women aged 15-49 years. Significant differences were revealed for marital rape, women's empowerment variables, and reducing HIV risk according to sociodemographic characteristics. Women's labor force participation partially mediated the relationship between sexual violence and reducing HIV risk, but decision making did not. Findings highlight the need for the development and implementation of policies and programs to address marital rape and reduce HIV risk within institutions of marriage.

A longitudinal study of the relationship between intimate partner violence and postpartum unsafe sex among newly diagnosed HIV-infected South African women

HIV-positive women who engage in postpartum unsafe sex are at risk for sexually transmitted infection (STI), unintended pregnancy, and secondary transmission of HIV to uninfected partners. One factor that may increase risk for postpartum unsafe sex among HIV-positive women is intimate partner violence (IPV) victimization; few studies, however, have examined this association. This longitudinal study examined whether patterns of psychological, physical, and sexual IPV, assessed during pregnancy, predicted unsafe sex at 14 weeks postpartum among South African women diagnosed as HIV-positive during pregnancy (n = 561). In a latent class analysis, we identified three distinct patterns of IPV victimization: non-victims (74%), moderate IPV (20%), and multiform severe controlling IPV (5%). Compared to non-victims, victims of multiform severe controlling IPV were significantly more likely to engage in postpartum unsafe sex (p = .01), even after adjusting for potential confounding factors. Moderate IPV was not associated with postpartum unsafe sex. Findings support the need for targeted sexual risk reduction interventions for HIV-positive pregnant women who have experienced severe patterns of IPV.

Intimate Partner Sexual Violence: An Often Overlooked Problem

BACKGROUND

Intimate partner sexual violence (IPSV) is a common but often overlooked form of intimate partner violence (IPV) that may have unique consequences for those who experience it. We aimed to explore how outcomes associated with IPSV differ from outcomes associated with other forms of intimate partner and sexual violence.

METHODS

We conducted a narrative review of the English-language literature, including original research studies and reports that focused on outcomes associated with IPSV. We aimed to quantify the risk for health outcomes associated with exposure to IPSV in comparison with exposure to other forms of interpersonal violence or nonexposure to interpersonal violence.

RESULTS

Twenty-eight publications were reviewed, most were small observational studies focused on women exposed to IPSV. Reported outcomes were related to mental health (n = 20 studies), physical and sexual health (n = 19 studies), and health of children with a parent exposed to IPSV (n = 1 study). Compared with other forms of interpersonal violence, exposure to IPSV was associated with greater risk for posttraumatic stress disorder and depressive symptoms, problematic substance use, suicidality, pain and other somatic symptoms, adverse sexual health problems, specific physical injuries including strangulation, and death by homicide. Children with an exposed parent were at higher risk for internalizing symptoms such as depression, anxiety, and somatization.

CONCLUSIONS

Sexual violence in intimate partner relationships is common and has distinct consequences compared with other forms of interpersonal violence including elevated risks for suicidality and death by homicide. It should be given special consideration within the assessment and management of interpersonal violence.

Intimate Partner Violence, Sexual Autonomy and Postpartum STD Prevention Among Young Couples: A Mediation Analysis

CONTEXT

The transition to parenthood is a stressful time for young couples and can put them at risk for acquiring STDs. Mechanisms underlying this risk-particularly, intimate partner violence (IPV) and sexual autonomy-have not been well studied.

METHODS

Between 2007 and 2011, a prospective cohort study of the relationships and health of pregnant adolescents and their male partners recruited 296 couples at four hospital-based obstetrics and gynecology clinics in the U.S. Northeast; participants were followed up six and 12 months after the birth. Structural equation modeling identified associations among IPV at baseline and six months, sexual autonomy at six months and STD acquisition at 12 months. Mediating effects of sexual autonomy were tested via bootstrapping.

RESULTS

Females were aged 14-21, and male partners were 14 or older. For females, IPV victimization at baseline was positively associated with the likelihood of acquiring a postpartum STD (coefficient, 0.4); level of sexual autonomy was inversely associated with the likelihood of acquiring an STD and of having a male partner who acquired one by the 12-month follow-up (-0.4 for each). For males, IPV victimization at baseline was negatively correlated with a female partner's sexual autonomy (-0.3) and likelihood of acquiring an STD (-0.7); victimization at six months was positively related to a partner's sexual autonomy (0.2). Sexual autonomy did not mediate these relationships.

CONCLUSIONS

Females' sexual autonomy appears to protect against postpartum STDs for both partners. Future research should explore the efficacy of IPV-informed approaches to improving women's sexual and reproductive health.

Factors Associated with Receiving Late HIV Testing Among Women Delivering at Hung Vuong Hospital, Ho Chi Minh City, Vietnam, 2014

HIV testing during pregnancy facilitates timely antiretroviral treatment for HIV-positive women. This study identifies reasons for late HIV testing among pregnant women delivering at a hospital in Ho Chi Minh City. We conducted a case-control study in which 160 cases were women who were tested for HIV late (i.e., at labor and delivery) and 160 controls were women who were tested during antenatal care (ANC). In multivariable logistic regression analysis, six variables were associated with late HIV testing: age less than 30 years, nine or fewer years of education, working as a homemaker or worker/farmer, living 20 km or more from the hospital, having received ANC at a private clinic/hospital only, and not believing that HIV testing is important during pregnancy. We recommend that national programs should provide additional effort for HIV testing during pregnancy to young women, less educated women, homemakers, and those receiving ANC at private clinics and hospitals.

Marital violence and sexually transmitted infections among women in post-revolution Egypt

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.

HIV/sexually transmitted infections and intimate partner violence: Results from the Togo 2013-2014 Demographic and Health Survey

Among clinic-based studies, intimate partner violence (IPV) has been shown to contribute to HIV/AIDS among young girls and women. Results from studies among the general population have been less consistent. This study evaluated the associations between HIV infection, any sexually transmitted infections (STIs), and IPV in a population-based sample of Togolese women. Data from the Togo 2013-2014 Demographic and Health Survey were utilized for these analyses. Women aged 15-49, who were currently married, had HIV test results, and answered the Domestic Violence Module were analyzed (n = 2386). Generalized linear mixed-models adjusting for sociodemographic variables, risk behaviors, and cluster effect were used to estimate HIV and STI risks with experience of IPV. HIV prevalence was 2.8%. Prevalence of IPV was 39% among HIV-positive women and 38% among HIV-negative women. Significant associations between IPV and HIV infection were not detected. Adjusted models found significant associations between experience of any IPV and having had STIs (OR 2.05, 95% CI 1.25-3.35). The high rates of violence in this setting warrant community-based interventions that address abuse and gender inequity. These interventions should also discuss the spectrum of STIs in relation to IPV.

[Prevalence of intimate partner violence and associated factors after disclosing the diagnosis of a sexually transmissible disease]

The objective of this study was to investigate factors associated with intimate partner violence after disclosing the diagnosis of sexually transmissible diseases (STDs) in Fortaleza, Ceará State, Brazil. This cross-sectional study enrolled 221 individuals treated at STD clinics. Multivariate logistic regression was performed. A total of 28.1% of individuals committed some type of intimate partner violence after disclosure of the diagnosis. Committing intimate partner violence was associated with alcohol use (OR = 2.79; 95%CI: 1.25-6.22; p = 0.012), the partner having relations with someone else during the current relationship (OR = 4.71; 95%CI: 2.24-9.91; p = 0.000), a history of violence prior to the STD (OR = 2.87; 95%CI: 1.22-6.73; p = 0.015), and having suffered violence after diagnosis of the STD (OR = 6.53; 95%CI: 3.06-13.93; p = 0.000). Intimate partner violence following disclosure of the STD signals that health professionals should identify patients' difficulties in revealing an STD diagnosis to their partners.

Women's Autonomy and Attitudes toward Condom Use: A Multicountry Analysis

Autonomy gives women the ability to negotiate safe sex and make decisions on their health. This study explores the gender stratification framework to understand the intertwined nature of HIV and women's autonomy using the nationally representative Demographic Health Survey. It examines women's autonomy and attitudes toward condom use for prevention of HIV/AIDS in four culturally diverse countries. Findings from the logistic regression indicate that labor force participation, individual autonomy, and decision making significantly increased the odds of always using a condom during sex in all countries. Promoting prevention policies highlighting women's autonomy may contribute in reducing the spread of HIV infection.

The relationship between intimate partner violence and HIV: A model-based evaluation

Background

Many studies have shown that women who have experienced intimate partner violence (IPV) are at a greater risk of HIV, but the factors accounting for this association are unclear, and trials of interventions to reduce IPV have not consistently reduced HIV incidence.

Methods

This study uses an agent-based model, calibrated to South African data sources, to evaluate hypotheses about likely causal pathways linking IPV, HIV, and other confounding factors. Assumptions about associations between IPV and HIV risk behaviours were based on reviews of international literature.

Findings

There is an association between past IPV experience and HIV incidence even when no causal effects are assumed (IRR 1.28, 95% CI 1.23–1.34), because women with a propensity for multiple partners are more likely to have ever been in a relationship with a violent partner. If, in addition, men with a propensity for concurrent relationships are more likely to perpetrate IPV, the IRR increases to 1.42 (95% CI 1.36–1.48), consistent with empirical IRR estimates. Alternative scenarios in which experience of IPV is assumed to cause changes in women's sexual behaviour have little effect on the IRR. An intervention that reduces IPV by 50% could be expected to reduce HIV incidence by at most 1.3%.

Interpretation

Much of the observed association between IPV and HIV is likely to be due to confounding behavioural factors. Although interventions to reduce IPV are important, these interventions alone are unlikely to have a substantial impact on HIV incidence.

Diagnosis and Disclosure of HIV Status: Implications for Women's Risk of Physical Partner Violence in the Postpartum Period

INTRODUCTION

This study prospectively examined whether HIV leads to elevated risk for intimate partner violence (IPV) for women and how this risk varies depending on HIV status disclosure to a partner.

METHODS

We ran a series of logistic regression models using data from 1092 pregnant and postpartum women enrolled in an RCT in Durban, South Africa. Model 1 assessed whether baseline HIV status predicted 14-week postpartum physical IPV, controlling for baseline physical IPV, disclosure to partner, and demographic and study covariates. Model 2 added the interaction between HIV status and disclosure.

RESULTS

HIV was not associated with 14-week physical IPV in the main effects model [adjusted odds ratio: 1.34, 95% confidence interval (CI): 0.88 to 2.05]. However, there was a statistically significant positive interaction between HIV and disclosure (adjusted odds ratio: 0.22, 95% CI: 0.05 to 0.96). Among women who disclosed their HIV status, HIV was not significantly associated with 14-week IPV (adjusted odds ratio: 1.12, 95% CI: 0.71 to 1.89). However, among women who had not disclosed, the odds of reporting IPV at 14 weeks was 5.15 times higher for HIV-positive women as compared with HIV-negative women (95% CI: 1.25 to 21.00).

DISCUSSION

Although we established that HIV does not increase incidence of IPV for all HIV-positive women, we found an elevated risk of IPV among the HIV-positive women who chose not to disclose their status to their partner. Nondisclosure is likely a marker for other problematic aspects of the relationship, and counselors should either find alternative safe options for disclosure or support women's decisions not to disclose.

From first love to marriage and maturity: a life-course perspective on HIV risk among young Swazi adults

This paper uses a life-course approach to explore the sexual partnerships and HIV-related risk of men and women in Swaziland throughout their adolescence, 20s and 30s. Twenty-eight Swazi men and women between the ages of 20 and 39 discussed their life histories in 117 in-depth interviews, with an average follow-up of nine months. Many participants described painful childhood experiences, including a lack of positive role models for couple relationships. Women's first sexual partnerships often involved coercion or force and resulted in pregnancy and abandonment by partners, leaving women economically vulnerable. Most men and women reported a desire to marry and associated marriage with respectability and monogamy. Men typically did not feel ready to marry until their 30s, while women often married only after years in tumultuous relationships. A high degree of relationship instability and change was observed over the study period, with half of participants reporting concurrency within their primary relationship. Participants' narratives revealed significant sources and circumstances of risk, particularly multiple and concurrent sexual partnerships, violence and lack of mutual trust within relationships, as well as social ideals that may provide opportunities for effective HIV prevention.

Prevalence and correlates of intimate partner violence in HIV-positive women engaged in transactional sex in Mombasa, Kenya

We evaluated the prevalence and correlates of intimate partner violence (IPV) in the past year by a regular male partner in HIV-positive female sex workers (FSWs) in Mombasa, Kenya. This cross-sectional study included HIV-positive women ≥18 years old who reported engagement in transactional sex at the time of enrolment in the parent cohort. We asked 13 questions adapted from the World Health Organization survey on violence against women about physical, sexual, or emotional violence in the past year by the current or most recent emotional partner (index partner). We used standardised instruments to assess socio-demographic and behavioural characteristics as possible correlates of IPV. Associations between IPV and these correlates were evaluated using univariate and multivariate logistic regression. Overall, 286/357 women (80.4%) had an index partner, and 52/357 (14.6%, 95% confidence interval 10.9%-18.2%) reported IPV by that partner in the past year. In multivariate analysis, women with severe alcohol problems (adjusted odds ratio 4.39, 1.16-16.61) and those experiencing controlling behaviours by the index partner (adjusted odds ratio 4.98, 2.31-10.74) were significantly more likely to report recent IPV. Recent IPV was common in HIV-positive FSWs. Interventions targeting risk factors for IPV, including alcohol problems and partner controlling behaviours, could help to reduce recurrent violence and negative health outcomes in this key population.

Sexual Behavior and Risk Practices of HIV Positive and HIV Negative Rwandan Women

It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75 % of participants were HIV positive and ~50 % reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents' age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors.

Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women's use of contraception.

METHODS

We searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women's use of contraception.

RESULTS

Of the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women's experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I2 = 92%; 95% CII2: 87%, 96%). Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%).

CONCLUSIONS

IPV is associated with a reduction in women's use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women's experiences of IPV.

Intimate partner violence and HIV in ten sub-Saharan African countries: what do the Demographic and Health Surveys tell us?

BACKGROUND

Many studies have identified a significant positive relation between intimate partner violence and HIV in women, but adjusted analyses have produced inconsistent results. We systematically assessed the association, and under what condition it holds, using nationally representative data from ten sub-Saharan African countries, focusing on physical, sexual, and emotional violence, and on the role of male controlling behaviour.

METHODS

We assessed cross-sectional data from 12 Demographic and Health Surveys from ten countries in sub-Saharan Africa. The data are nationally representative for women aged 15-49 years. We estimated odds ratios using logistic regression with and without controls for demographic and socioeconomic factors and survey-region fixed effects. Exposure was measured using physical, sexual, emotional violence, and male controlling behaviour, and combinations of these. The samples used were ever-married women, married women, and women in their first union. Depending on specification, the sample size varied between 11 231 and 45 550 women.

FINDINGS

There were consistent and strong associations between HIV infection in women and physical violence, emotional violence, and male controlling behaviour (adjusted odds ratios ranged from 1·2 to 1·7; p values ranged from <0·0001 to 0·0058). The evidence for an association between sexual violence and HIV was weaker and only significant in the sample with women in their first union. The associations were dependent on the presence of controlling behaviour and a high regional HIV prevalence rate; when women were exposed to only physical, sexual, or emotional violence, and no controlling behaviour, or when HIV prevalence rates are lower than 5%, the adjusted odds ratios were, in general, close to 1 and insignificant.

INTERPRETATION

The findings indicate that male controlling behaviour in its own right, or as an indicator of ongoing or severe violence, puts women at risk of HIV infection. HIV prevention interventions should focus on high-prevalence areas and men with controlling behaviour, in addition to violence.

FUNDING

Swedish National Science Foundation and Gothenburg Centre of Globalization and Development, University of Gothenburg, Gothenburg, Sweden.

Association between domestic violence and HIV serostatus among married and formerly married women in Kenya

The prevalence of both domestic violence (DV) and HIV among Kenyan women is known to be high, but the relationship between them is unknown. Nationally representative cross-sectional data from married and formerly married (MFM) women responding to the Kenya Demographic and Health Survey 2008/2009 were analyzed adjusting for complex survey design. Multivariable logistic regressions were used to assess the covariate-adjusted associations between HIV serostatus and any reported DV as well as four constituent DV measures: physical, emotional, sexual, and aggravated bodily harm, adjusting for covariates entered into each model using a forward stepwise selection process. Covariates of a priori interest included those representing marriage history, risky sexual behavior, substance use, perceived HIV risk, and sociodemographic characteristics. The prevalence of HIV among MFM women was 10.7% (any DV: 13.1%, no DV: 8.6%); overall prevalence of DV was 43.4%. Among all DV measures, only physical DV was associated with HIV (11.9%; adjusted odds ratio: 2.01, p <.05). Efforts by the government and women's groups to monitor and improve policies to reduce DV, such as the Sexual Offences Act of 2006, are urgently needed to curb HIV, as are policies that seek to provide DV counseling and treatment to MFM women.

Evidence of increased STI/HIV-related risk behavior among male perpetrators of intimate partner violence in Guatemala: results from a national survey

Intimate partner violence (IPV) is a significant public health problem with a demonstrated link to increased sexually transmitted infection (STI)/HIV-related risk and vulnerability. While IPV is an important issue in Central America, the link to STI/HIV risk has not been explored in this region. In this study, the relationship between emotional and physical/sexual IPV and the STI/HIV-related risk behaviors of sex worker patronage and infidelity is assessed among male IPV perpetrators using data from a national survey conducted in 2009 in Guatemala (n = 4773 married/partnered men). Bivariate associations between background characteristics and emotional and physical IPV perpetration were explored. Logistic regression models were run to test associations between IPV for each sexual risk behavior. Perpetration of emotional and physical/sexual IPV was more common among married/partnered men who were older than 24, had more education, lived in urban areas, or were in common law versus married unions. Reports of past-year emotional IPV perpetration increased as wealth quintile increased. After adjusting for demographics and other characteristics, physical/sexual IPV perpetration was associated with past-year infidelity (AOR 1.9, 95% CI: 1.1-3.6). Lifetime emotional IPV (AOR 1.4, 95% CI: 1.1-1.7) and physical/sexual IPV 1.6 (95% CI 1.2-2.0) were positively associated with a history of sex worker patronage. Endorsement of traditional gender role norms showed a marginally positive association with past-year infidelity in the adjusted model (AOR 1.3, 95% CI 1.0-1.8). The study findings from Guatemala reinforce the growing evidence globally that male IPV perpetrators are more likely to engage in risky sexual behavior, including sex worker patronage and main partner infidelity. The concurrency of violence and increased STI/HIV risk may compound the health risks for female victims of IPV who also face injury and psychological trauma. Integration of prevention and screening of IPV and STI/HIV prevention services should be adopted in Guatemala and other similar contexts.

Predictors of extra-marital partnerships among women married to fishermen along Lake Victoria in Kisumu County, Kenya

BACKGROUND

The vulnerability of women to HIV infection makes establishing predictors of women's involvement in extra-marital partnerships critical. We investigated the predictors of extra-marital partnerships among women married to fishermen.

METHODS

The current analyses are part of a mixed methods cross-sectional survey of 1090 gender-matched interviews with 545 couples and 12 focus group discussions (FGDs) with 59 couples. Using a proportional to size simple random sample of fishermen as our index participants, we asked them to enrol in the study with their spouses. The consenting couples were interviewed simultaneously in separate private rooms. In addition to socio-economic and demographic data, we collected information on sexual behaviour including extra-marital sexual partnerships. We analysed these data using descriptive statistics and multivariate logistic regression. For FGDs, couples willing to participate were invited, consented and separated for simultaneous FGDs by gender-matched moderators. The resultant audiofiles were transcribed verbatim and translated into English for coding and thematic content analysis using NVivo 9.

RESULTS

The prevalence of extra-marital partnerships among women was 6.2% within a reference time of six months. Factors that were independently associated with increased likelihood of extra-marital partnerships were domestic violence (aOR, 1.45; 95% CI 1.09-1.92), women reporting being denied a preferred sex position (aOR, 3.34; 95% CI 1.26-8.84) and spouse longer erect penis (aOR, 1.34; 95% CI 1.00-1.78). Conversely, women's age--more than 24 years (aOR, 0.33; 95% CI 0.14-0.78) and women's increased sexual satisfaction (aOR, 0.92; 95% CI 0.87-0.96) were associated with reduced likelihood of extra-marital partnerships.

CONCLUSION

Domestic violence, denial of a preferred sex positions, longer erect penis, younger age and increased sexual satisfaction were the main predictors of women's involvement in extra-marital partnerships. Integration of sex education, counselling and life skills training in couple HIV prevention programs might help in risk reduction.

Client perspectives on design and implementation of a couples-based intervention to reduce sexual and drug risk behaviors among female sex workers and their noncommercial partners in Tijuana and Ciudad Juárez, México

This mixed-methods study examined the acceptability of a hypothetical couples-based HIV prevention program for female sex workers and their intimate (non-commercial) male partners in Mexico. Among 320 participants, 67 % preferred couples-based over individual programs, particularly among men. Reasons cited for preferring couples-based programs included convenience and health benefits for both partners. Participants reported that they would benefit from general health information and services, HIV counseling and testing, job training (particularly for men) and other services. However, qualitative interviews revealed that barriers relating to the environment (i.e., poor access to services), providers (i.e., lack of a therapeutic alliance), and intimate relationships (i.e., mistrust or instability) would need to be addressed before such a program could be successfully implemented. Despite women's concerns about privacy and men's preferences for gender-specific services, couples-based HIV prevention programs were largely acceptable to female sex workers and their intimate male partners.

Intimate partner violence and HIV infection among women: a systematic review and meta-analysis

INTRODUCTION

To assess evidence of an association between intimate partner violence (IPV) and HIV infection among women.

METHODS

Medline/PubMed, Embase, Web of Science, EBSCO, Ovid, Cochrane HIV/AIDS Group's Specialized Register and Cochrane Central Register of Controlled Trials were searched up to 20 May 2013 to identify studies that examined the association between IPV and HIV infection in women. We included studies on women aged ≥15 years, in any form of sexually intimate relationship with a male partner.

RESULTS

Twenty-eight studies [(19 cross-sectional, 5 cohorts and 4 case-control studies) involving 331,468 individuals in 16 countries - the US (eight studies), South Africa (four studies), East Africa (10 studies), India (three studies), Brazil (one study) and multiple low-income countries (two studies)] were included. Results were pooled using RevMan 5.0. To moderate effect estimates, we analyzed all data using the random effects model, irrespective of heterogeneity level. Pooled results of cohort studies indicated that physical IPV [pooled RR (95% CI): 1.22 (1.01, 1.46)] and any type of IPV [pooled RR (95% CI): 1.28 (1.00, 1.64)] were significantly associated with HIV infection among women. Results of cross-sectional studies demonstrated significant associations of physical IPV with HIV infection among women [pooled OR (95% CI): 1.44 (1.10, 1.87)]. Similarly, results of cross-sectional studies indicated that combination of physical and sexual IPV [pooled OR (95% CI): 2.00 (1.24, 3.22) and any type of IPV [pooled OR (95% CI): 1.41 (1.16, 1.73)] were significantly associated with HIV infection among women.

CONCLUSIONS

Available evidence suggests a moderate statistically significant association between IPV and HIV infection among women. To further elucidate the strength of the association between IPV and HIV infection among women, there is a need for high-quality follow-up studies conducted in different geographical regions of the world, and among individuals of diverse racial/cultural backgrounds and varying levels of HIV risks.

A public health approach to intimate partner violence prevention in Uganda: the SHARE Project

Research from Rakai, Uganda, suggests intimate partner violence (IPV) is common and attitudes condoning it are widespread. We used a public health approach to develop and implement an evidence-based IPV prevention intervention named the Safe Homes and Respect for Everyone (SHARE) Project. SHARE was designed on the Transtheoretical Model of behavior change and adapted IPV prevention strategies from Raising Voices and Stepping Stones. SHARE was implemented in four regions of Rakai. This article describes the design and implementation of SHARE, provides details on strategies and activities used, discusses challenges and lessons learned, and provides recommendations for other violence prevention programmers.

A systematic review of the relationships between intimate partner violence and HIV/AIDS

BACKGROUND

Intimate partner violence (IPV) is a significant health problem that has been associated with HIV infection in numerous studies. We aimed to systematically review the literature on relationships between IPV and HIV in order to describe the prevalence of IPV in people with HIV, the prevalence of HIV in people experiencing IPV, the association between IPV and HIV, and evidence regarding mechanisms of risk and interventions.

METHODS

Data sources were 10 electronic databases and reference lists. Studies were included if they reported data on the relationship between IPV and HIV. All records were independently reviewed by two authors at the stages of title and abstract review and full text review. Any abstract considered eligible by either reviewer was reviewed in full, and any disagreement regarding eligibility of full texts or data extracted was resolved by discussion.

RESULTS

101 articles were included. Experiencing IPV and HIV infection were associated in unadjusted analyses in most studies, as well as in adjusted analyses in many studies. The findings of qualitative and quantitative studies assessing potential mechanisms linking IPV and HIV were variable. Few interventions have been assessed, but two identified in this review were promising in terms of preventing IPV, though not HIV infection.

CONCLUSIONS

Experiencing IPV and HIV infection tend to be associated in unadjusted analyses, suggesting that IPV screening and linkage with relevant programs and services may be valuable. It is unclear whether there is a causal association between experiencing IPV and HIV infection. Research should focus on defining parameters of IPV which are relevant to HIV infection, including type of IPV and period of exposure and risk, on assessing potential mechanisms, and on developing and assessing interventions which build on the strengths of existing studies.

Behavioural interventions to reduce sexual risk for HIV in heterosexual couples: a meta-analysis

OBJECTIVES

The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.

METHODS

A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.

RESULTS

Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.

CONCLUSIONS

Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.

Are female sex workers able to negotiate condom use with male clients? The case of mobile FSWs in four high HIV prevalence states of India

Introduction

Condom promotion among female sex workers (FSWs) is a key intervention in India’s National AIDS Control Program. However, there is limited understanding of how FSWs negotiate condom use with male clients, particularly in the context of their mobility for sex work. The objective of this study is to examine the factors associated with the mobile FSWs’ ability to refuse unsafe sex and successfully negotiate condom use with unwilling male clients.

Methods

Data for 5498 mobile FSWs from a cross-sectional survey conducted in 22 districts of four states in southern India were analyzed. Questions assessed FSWs’ ability to refuse clients unprotected sex, convince unwilling clients for condom use and negotiate condom use in a new location. Logistic regression models were constructed to examine the association between socio-demographics, economic vulnerability, sex work practice, and program exposure and condom negotiation ability.

Results

A majority of FSWs (60%) reported the ability to refuse clients for unprotected sex, but less than one-fifth reported the ability to successfully convince an unwilling client to use a condom or to negotiate condom use in a new site. Younger and older mobile FSWs compared to those who were in the middle age group, those with longer sex work experience, with an income source other than sex work, with program exposure and who purchased condoms for use, reported the ability to refuse unprotected sex, to successfully negotiate condom use with unwilling clients and to do so at new sites.

Conclusion

FSWs need to be empowered to not only refuse unprotected sex but also to be able to motivate and convince unwilling clients for condom use, including those in new locations. In addition to focusing on condom promotion, interventions must address the factors that impact FSWs’ ability to negotiate condom use.

Risk factors for intimate partner violence in women in the Rakai Community Cohort Study, Uganda, from 2000 to 2009

BACKGROUND

Intimate partner violence (IPV) is a significant public health problem. There is a lack of data on IPV risk factors from longitudinal studies and from low and middle income countries. Identifying risk factors is needed to inform the design of appropriate IPV interventions.

METHODS

Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Female participants who had at least one sexual partner during this period and had data on IPV over the study period were included in analyses (N = 15081). Factors from childhood and early adulthood as well as contemporary factors were considered in separate models. Logistic regression was used to assess early risk factors for IPV during the study period. Longitudinal data analysis was used to assess contemporary risk factors in the past year for IPV in the current year, using a population-averaged multivariable logistic regression model.

RESULTS

Risk factors for IPV from childhood and early adulthood included sexual abuse in childhood or adolescence, earlier age at first sex, lower levels of education, and forced first sex. Contemporary risk factors included younger age, being married, relationships of shorter duration, having a partner who is the same age or younger, alcohol use before sex by women and by their partners, and thinking that violence is acceptable. HIV infection and pregnancy were not associated with an increased odds of IPV.

CONCLUSIONS

Using longitudinal data, this study identified a number of risk factors for IPV. These findings are useful for the development of prevention strategies to prevent and mitigate IPV in women.

Intimate partner violence in Rwanda: the mental health of victims and perpetrators

Exposure to intimate partner violence (IPV) is a common feature of women living in low- and middle-income countries. Several studies have shown a significant association between IPV against women and mental health in both developed and in low- and middle-income countries. In postconflict settings, the relationship between IPV and mental health is likely more complex, given the high levels of violence experienced by the population as a whole. In this cross-sectional study the authors explore the association between IPV and common mental health disorders (CMD), and more specifically, suicidal ideation, among inhabitants of postgenocide Rwanda. The authors use the concept of "mutual partner violence," thereby exploring the association between IPV and CMD in victims, perpetrators, and those who state they are both. Data of 241 married men and women were used. Symptoms suggestive of CMD were established by use of the Self-Reporting Questionnaire (SRQ-20), and physical intimate partner violence was measured using the Conflict Tactics Scale, Short Version (CTS2S). The authors applied multivariate logistic regressions with total SRQ-20 scores (above/below cutoff) and suicidal ideation as the outcome measures and corrected for age and gender. The study findings suggest that reported IPV is associated with CMD (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 0.92-3.15) and suicidal ideation (OR = 1.6, 95% CI = 0.70-3.53). Those who state to be both victim and perpetrator (OR = 1.75, 95% CI = 0.82-3.72), or only perpetrator (OR = 3.13, 95% CI = 0.49-20.0), are more likely to report mental health problems than victims and people who do not report IPV. In a postconflict situation, perpetrators of IPV may suffer from mental health problems as much as, or even more than, victims. Longitudinal data are needed to clarify the complex relationship between CMD and IPV, especially if outcomes may also be related to other forms of violence experienced in the past.

Intimate partner violence is associated with HIV infection in women in Kenya: a cross-sectional analysis

BACKGROUND

The relationship between intimate partner violence (IPV) and women's risk of HIV infection has attracted much recent attention, with varying results in terms of whether there is an association and what the magnitude of association is. Understanding this relationship is important for HIV surveillance and intervention programs.

METHODS

We analyzed data from the 2008-2009 Demographic and Health Survey (DHS) in Kenya, on 1,904 women aged 15-49. A generalized linear mixed model was adapted to explore the relationship between IPV and HIV prevalence, controlling for sociodemographic variables, and treating DHS survey clusters, province and ethnicity as random effects. We used principal components analysis (PCA) to calculate a single IPV score for each woman. The effect of HIV risk behaviours on the association between IPV and HIV was also assessed.

RESULTS

Controlling for relevant sociodemographic factors, we found that HIV risk was significantly associated with IPV (P <0.01). After adjustment for risk factors as well as sociodemographic variables, the positive association between IPV and HIV remained significant (P=0.035). The estimated effect size of this model corresponds to an odds ratio of 1.55 for HIV infection comparing a woman who experienced no IPV and a woman at the 95th percentile for our IPV index.

CONCLUSION

This study provides further evidence that IPV and HIV are associated. In addition, we found that this association remains even when we controlled for several HIV risk factors. This implies that IPV can be used as a marker of potential HIV risk, and may be causally associated with HIV risk. Further, these results suggest that IPV monitoring and prevention may have a useful role in HIV prevention in Kenya. Further research, ideally based on longitudinal observations, is needed to disentangle these relationships.

Intimate partner violence is associated with incident HIV infection in women in Uganda

OBJECTIVES

To quantify the association between intimate partner violence (IPV) and incident HIV infection in women in the Rakai Community Cohort Study between 2000 and 2009.

DESIGN AND METHODS

Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Longitudinal data analysis was used to estimate the adjusted incidence rate ratio (IRR) of incident HIV associated with IPV in sexually active women aged 15-49 years, using a multivariable Poisson regression model with random effects. The population attributable fraction was calculated. Putative mediators were assessed using Baron and Kenny's criteria and the Sobel-Goodman test.

RESULTS

Women who had ever experienced IPV had an adjusted IRR of incident HIV infection of 1.55 (95% CI 1.25-1.94, P = 0.000), compared with women who had never experienced IPV. Risk of HIV infection tended to be greater for longer duration of IPV exposure and for women exposed to more severe and more frequent IPV. The adjusted population attributable fraction of incident HIV attributable to IPV was 22.2% (95% CI 12.5-30.4). There was no evidence that either condom use or number of sex partners in the past year mediated the relationship between IPV and HIV.

CONCLUSION

IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the adjusted population attributable fraction is modest. The prevention of IPV should be a public health priority, and could contribute to HIV prevention.

Mental and Physical Health and Intimate Partner Violence against Women: A Review of the Literature

Associations between intimate partner violence (IPV) and poor physical and mental health of women have been demonstrated in the international and national literature across numerous studies. This paper presents a review of the literature on this topic. The 75 papers included in this review cover both original research studies and those which undertook secondary analyses of primary data sources. The reviewed research papers published from 2006 to 2012 include quantitative and qualitative studies from Western and developing countries. The results show that while there is variation in prevalence of IPV across various cultural settings, IPV was associated with a range of mental health issues including depression, PTSD, anxiety, self-harm, and sleep disorders. In most studies, these effects were observed using validated measurement tools. IPV was also found to be associated with poor physical health including poor functional health, somatic disorders, chronic disorders and chronic pain, gynaecological problems, and increased risk of STIs. An increased risk of HIV was reported to be associated with a history of sexual abuse and violence. The implications of the study findings in relation to methodological issues, clinical significance, and future research direction are discussed.

Violence toward women, men's sexual risk factors, and HIV infection among women: findings from a national household survey in Rwanda

OBJECTIVES

We used the third Rwanda demographic and health survey data to examine the relationship between violence toward women, men sexual risk factors, and HIV prevalence among women.

METHODS

The Rwanda demographic and health survey was conducted in 10,272 households in 2005. Analyses were restricted to 2715 women and 2461 men who were legally married or cohabiting. We used logistic regression to analyze associations between HIV and violence toward women. Couple-specific analyses were carried out for assessing the relationship between men sexual risk factors and intimate partner violence (IPV) reported by their wives.

RESULTS

Respectively, 29.2%, 22.2%, and 12.4% of women reported having experienced physical, psychological, and sexual IPV, whereas 52.1% reported control practices by their partners. There was a positive link between IPV reported by women and attitudes justifying wife beating endorsed by their husband. After controlling for sociodemographic variables and women sexual risk factors, the odds of HIV prevalence was 3.23 (confidence interval: 1.30 to 8.03) among women with a score from 3 to 4 on the psychological IPV scale compared with those with a score from 0 to 2. Women who reported having experienced interparental violence (father who beat mother) were more likely to test HIV positive as follows: adjusted odds ratio: 1.95; 95% confidence interval: 1.11 to 3.43. There was also a statistically significant relationship between men risky sexual factors and experience of IPV and HIV prevalence among women.

CONCLUSIONS

Violence toward women is associated with HIV in Rwanda. Intervention to reduce gender-based violence should be integrated into HIV/AIDS policy.

Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study

There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster randomized controlled trial of an HIV behavioral intervention, Stepping Stones. Data was obtained through the administration of a questionnaire at baseline. Of the 1,293 women who had ever been partnered, 189 (14.6%) had experienced only emotional abuse in their lifetimes. Three hundred sixty-six women (28.3%) experienced emotional abuse with physical and/or sexual abuse in their lifetimes, and one hundred forty-four women (11.1%) experienced physical and/or sexual abuse without emotional abuse. Hazardous drinking was associated with the experience of physical and/or sexual abuse, with (OR 6.0, 95% CI [1.0, 36.6]) and without emotional abuse (OR 5.8, 95% CI [1.1, 29.4]). Illicit drug use (OR 5.6, 95% CI [2.4, 12.6]), having depressive symptoms (OR 2.9, 95% CI [1.2, 4.2]), having psychological distress (OR 1.9, 95% CI [1.4, 2.6]), and suicidality (OR 79.0, 95% CI [17.3, 359.6]) was associated with the experience of emotional abuse with physical and/or sexual abuse. Suicidality was also strongly associated with having experienced emotional abuse alone (OR 79.5, 95% CI [16.7, 377.4]). This study showed that emotionally abused young women had a greater risk of suicidality than those experiencing no abuse and that the combined experience of emotional with physical and/or sexual abuse was strongly associated with poor mental health outcomes.

Linkages between gender equity and intimate partner violence among urban Brazilian youth

PURPOSE

Gender inequity is a risk factor for intimate partner violence (IPV), although there is little research on this relationship that focuses on youth or males. Using survey data collected from 240 male and 198 female youth aged 15-24 in Rio de Janeiro, Brazil, we explore the association between individual-level support for gender equity and IPV experiences in the past 6 months and describe responses to and motivations for IPV.

METHODS

Factor analysis was used to construct gender equity scales for males and females. Logistic and multinomial logistic regression models were used to examine the relationship between gender equity and IPV.

RESULTS

About half of female youth reported some form of recent IPV, including any victimization (32%), any perpetration (40%), and both victimization and perpetration (22%). A total of 18% of male youth reported recently perpetrating IPV. In logistic regression models, support for gender equity had a protective effect against any female IPV victimization and any male IPV perpetration and was not associated with female IPV perpetration. Female victims reported leaving the abusive partner, but later returning to him as the most frequent response to IPV. Male perpetrators said the most common response of their victims was to retaliate with violence. Jealousy was the most frequently reported motivation of females perpetrating IPV.

CONCLUSION

Gender equity is an important predictor of IPV among youth. Examining the gendered context of IPV will be useful in the development of targeted interventions to promote gender equity and healthy relationships and to help reduce IPV among youth.

Community-level HIV risk behaviors and HIV prevalence among women and men in Zimbabwe

Most studies on HIV risk in sub-Saharan Africa focus on individual-level sociodemographic and behavioral correlates of risk. Only recently have researchers and programmers considered the context within which individuals live. This study uses the 2005-6 Zimbabwe Demographic and Health Survey to examine the correlation between the prevalence of HIV at the community level and the prevalence of HIV risk-taking behaviors. Results show that women and men living in communities with higher HIV prevalence in the opposite sex are at increased risk of HIV. In addition, rural women and men living in communities with greater premarital and nonmarital sex are at greater risk of HIV. Finally, HIV prevalence is higher among women and men living in urban areas with higher intimate partner violence. Programs should address community-level social norms that make high-risk behaviors acceptable and thus increase all women and men's risk of HIV, not just those engaged in high-risk behaviors.