Determinants of Intimate Partner Violence Among HIV-Positive and HIV-Negative Women in India

Global Prevalence and Factors Related to Intimate Partner Violence Amongst People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression

Reviews of intimate partner violence (IPV) have primarily focused on women and same-sex relationships, but little is known about the global epidemiology of IPV among people living with HIV/AIDS (PLWHA). This review employed meta-analytic approaches to determine the worldwide prevalence and factors related to different forms of IPV among PLWHA. Databases including PubMed, Cochrane review, EMBASE, Scopus, PsycINFO, CINAHL, ProQuest, and registers, were systematically reviewed until November 5, 2021. The meta-analysis was conducted using the metafor package in R software. The Newcastle Ottawa Scale and Cochrane Risk of Bias Tool version 1 were used to assess the study quality and risk of bias, respectively. A total of 49 published articles and 42,280 participants, were included in the meta-analysis. Over their lifetime, four in ten PLWHA have experienced some type of IPV. Over a quarter have experienced physical, emotional, or psychological IPV. One in five PLWHA experienced at least one form of IPV during the recall period of last year, with emotional IPV being the most prevalent. Rates of physical and any types of IPV differed substantially between IPV measurements. IPV rates also varied significantly by the study design, with physical (29%) and sexual (18%) IPV rates being more prevalent in cross-sectional studies. Public health measures are critical for preventing and combating IPV among PLWHA. Additional cross-national research using robust sampling methods is required to obtain more representative samples and thus a more reliable prevalence estimate of IPV prevalence.

Intimate partner violence and associated factors among HIV positive women attending antiretroviral therapy clinics in Gondar city, Northwest Ethiopia

INTRODUCTION

Intimate partner violence against women is a behavior within an intimate relationship that causes sexual, physical, or psychological harm to the women. It occurs among all socioeconomic, religious, and cultural groups in all settings, and affects the health of women, families, and the community at large. Determining the magnitude and determinants of intimate partner violence against HIV positive women could help to design preventive and control strategies. However, there is a dearth of information regarding the magnitude and determinants of intimate partner violence against HIV positive women in Ethiopia. Thus, this study aimed to assess the magnitude and associated factors of intimate partner violence against HIV positive women in Gondar city, Northwest Ethiopia.

METHOD

A facility-based cross-sectional study was carried out from February to May 2021 in selected public health facilities of Gondar city among 626 HIV positive women. A systematic random sampling technique was used to select study participants. Data were analyzed using Statistical Package of Social Science (SPSS) version 20 software. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify determinants of intimate partner violence. Statistical significance was considered at a p value < 0.05.

RESULTS

The overall prevalence of intimate partner violence against HIV positive women within the last 12 months was 64.2% (95% CI 60.4, 68.2). Physical violence was the most common type (54.8%), followed by sexual (51.1%) and emotional (48.9%) violence. Intimate partner violence among HIV positive women was associated with women's age 19-24 (AOR = 0.13, 95% CI 0.02, 0.79), monthly income of 500-2500 (AOR = 6.5, 95% CI 1.72, 25.0), urban residence (AOR = 0.35, 95% CI 0.13, 0.91), partner drink alcohol (AOR = 2.14, 95% CI 1.42, 4.06), and a husband with no multiple sexual partners (AOR = 0.75, 95% CI 0.34, 0.94).

CONCLUSION

The result of this study revealed that intimate partner violence against HIV positive women was found to be high. Thus, protective measures that could increase the community's and women's awareness about the consequences of various forms of violence, and women empowerment are paramount. Priorities in programs of gender-based violence prevention should involve women from rural residences, older age, and males who consume alcohol.

Violence Against Women in India: An Analysis of Correlates of Domestic Violence and Barriers and Facilitators of Access to Resources for Support

Purpose

Domestic violence (DV) is a significant public health problem in India, with women disproportionately impacted. This study a) identified risk and protective correlates of DV and, b) barriers and facilitators for seeking and receiving help for DV among women in India.

Methods

A systematic search of 5 databases was performed to identify correlates of DV in the quantitative literature. The search resulted in inclusion of 68 studies for synthesis. For qualitative exploration, data were collected from 27 women in India.

Results

While factors such as social norms and attitudes supportive of DV were both risk correlates and barriers to addressing DV, omen's empowerment, financial independence and informal sources of support were both protective correlates of DV as well as facilitators in addressing DV.

Conclusions

Strong efforts in India are needed to reduce DV-related risk factors and strengthen protective factors and enhance access to care for women in abusive relationships.

Mixed studies review of domestic violence in the lives of women affected by HIV stigma

We conducted a mixed studies review to examine domestic violence and stigma against women affected by HIV. We searched Medline, Web of Science, PsycINFO and EMBASE databases with no starting date limit. Studies that reported on experiences of stigma, discrimination, or domestic violence against women affected by HIV in any country were included. Because the review focused on HIV stigma-related violence, we only included studies that reported violence following an HIV diagnosis or at the time of HIV testing. A total 1056 records were screened; 89 articles were assessed for full text eligibility and 49 studies were selected for evidence synthesis. A convergent approach was used and study findings were analysed thematically. Four broad themes emerged: (1) being affected by HIV increases domestic violence, (2) supportive reactions from partners, (3) HIV stigma is associated with domestic violence, and (4) domestic violence associated with HIV-stigma is gendered. Research gaps identified included the burden of intersectional stigma of domestic violence and HIV, and the mediating role of HIV stigma in domestic violence for women with HIV, highlighting the need for further research in this area to reduce violence against women living with HIV.

Current intimate partner violence and associated factors among sero-positive women attending Adama town ART Clinics, Central Ethiopia 2019

BACKGROUND

Intimate partner violence against women is a behavior within an intimate relationship that causes physical, sexual, or psychological harm to the victim. It is well recognized as a gross violation of human rights and affects the health of women, families, and the community at large. However, the level to which Human Immuno Deficiency virus sero-positive women are experiencing recent intimate partner violence and its associated factors have not been well investigated as the majority of the study done so far were focused on the study of lifetime violence and violence among women in the general population. The study was conducted to determine the prevalence and factors associated with current intimate partner violence among sero-positive women.

METHODS

A facility-based cross-sectional study was conducted from March 2019 to April 2019 among 396 sero-positive women visiting anti-retroviral therapy (ART) units of Adama town public health facilities. A systematic random sampling technique was used to select individual participants. Validated World Health Organization (WHO) tools were used to collect information on the outcomes and key independent variables. The collected data were entered into Epidata version 4.4.6 and analyzed using SPSS version 24. Descriptive statistics were used to compute summary statistics and proportion. Variables at a cut-off value of 0.25 on bivariate analysis and 0.05 during multivariate logistic regression were used to identify factors associated with recent intimate partner violence.

RESULT

The response rate in this study was 100% since all women approached took part in this study. The prevalence of current intimate partner violence was 32.3% while lifetime intimate partner violence (IPV) was 45.5%. Exposure to coerced first sexual intercourse [AOR = 3.0 (1.73, 5.44)], male multi-partnership [AOR = 2.2 (1.21, 4.06)], believing in the husband's right to sex [AOR = 2.3 (1.29, 4.12)], contraceptive use [AOR = 3.33 (1.67, 6.62)], and having farmer partner [AOR = 3.9 (1.43, 10.79)] were significantly associated with current intimate partner violence.

CONCLUSION

One-in-three women reported at least 2 or more forms of violence from their intimate partner. Individual-level factors (Exposure to coerced first sexual intercourse, partner's occupation, contraceptive use, and believing in husband's right to sex and relationship factor (Male multi-partnership) were significantly associated with recent intimate partner violence. Combined efforts are required to avert intimate partner violence among women on ART while targeting risky sexual behavior practiced among male partner factors significantly associated with violence.

Severity of Lifetime Physical Intimate Partner Violence and Controlling Behavior in Sub-Saharan Africa

Evidence suggests women in sub-Saharan Africa may be more likely to experience intimate partner violence (IPV) than women anywhere else in the world. Data was obtained from women (n = 29,444) who completed the Demographic Health Survey's (DHS) domestic violence module in seven countries in sub-Saharan Africa countries between 2011 and 2015. Women who reported controlling behavior by a spouse/partner were more likely to have experienced less severe lifetime physical violence (adjusted odds ratio (AOR) 3.02, 95% confidence interval (CI) 2.63, 3.47) and severe violence (AOR 4.27, 95% CI 3.32, 5.49). Partner's controlling behavior may increase the likelihood of experiencing both less severe and severe lifetime physical violence.

Opening closed doors: using machine learning to explore factors associated with marital sexual violence in a cross-sectional study from India

Objectives

Sexual violence against women is pervasive in India. Most of this violence is experienced in the context of marriage, and rates of marital sexual violence (MSV) have been relatively stagnant over the past decade. This paper machine learning algorithms paired with qualitative thematic analysis to identify new and potentially modifiable factors influencing MSV in India.

Design, setting and participants

This cross-sectional analysis of secondary data used data from in-person interviews with ever-married women aged 15–49 who responded to gender-based violence questions in the nationally representative 2015–2016 National Family Health Survey (N=66 013), collected between 20 January 2015 and 4 December 2016. Analyses included iterative thematic analysis (L-1 regularised regression followed by iterative qualitative thematic coding of L-2 regularised regression results) and neural network modelling.

Outcome measure

Participants reported their experiences of sexual violence perpetrated by their current (or most recent) husband in the previous 12 months. These responses were aggregated into any vs no recent MSV.

Results

Nearly 7% of women experienced MSV in the past 12 months. Major themes associated with MSV through iterative thematic analysis included experiences of/exposure to violence, sexual behaviour, decision making and freedom of movement, sociodemographics, access to media, health knowledge, health system interaction, partner control, economic agency, reproductive and maternal history, and health status. A neural network model identified variables that largely corresponded to these themes.

Conclusions

This analysis identified several themes that may be promising avenues to identify and support women experiencing MSV, and to mitigate these traumatic experiences. In particular, amplifying screening activities at health encounters, especially among women who appear to have compromised health or restricted agency, may enable a greater number of women access to essential physical and emotional support services, and merits further consideration.

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.

Controlling Behavior and Lifetime Physical, Sexual, and Emotional Violence in sub-Saharan Africa

Intimate partner violence (IPV), commonly accompanied by controlling behavior, is a serious public health concern in sub-Saharan Africa. Data from women (n = 37,115) aged 15 to 49 years who completed the Demographic Health Survey's (DHS) domestic violence module in eight countries in sub-Saharan Africa (Cameroon, Democratic Republic of the Congo [DRC], Côte d'Ivoire, Namibia, Rwanda, Sierra Leone, Togo, and Zambia) between 2011 and 2015 were obtained. DHS questions assessed lifetime physical, emotional, and sexual violence (ever vs. never). Controlling behavior was measured by a revised Conflict Tactics Scale. Multivariate logistic regression examined the association between controlling behavior and IPV adjusting for all covariates, including age, education, marital status, wealth, urban/rural setting, and occupation. An interaction term was included to evaluate the consistency of effect estimates across countries. In all, 45.60% of women reported experiencing one or more forms of IPV (physical, sexual, or emotional violence) in their lifetime, ranging from 31.16% in Côte d'Ivoire to 57.37% in Cameroon. Women who reported controlling behavior by a spouse/partner were more likely to have experienced lifetime physical (adjusted odds ratio [AOR] = 3.57, 95% confidence interval [CI] = [3.31, 3.85], sexual (AOR = 3.98, CI = [3.47, 4.57]) or emotional (AOR = 3.52, CI = [3.22, 3.85]) violence than women who did not report controlling behavior. Women who reported controlling behavior were also more likely to have experienced one (AOR = 2.57, CI = [2.36, 2.81]) or two/three types (AOR = 5.34, CI = [4.80, 5.94]) of violence. AORs did not significantly differ across countries. Further research is needed to evaluate whether policies, programs, and education aimed at preventing or modifying controlling behavior may reduce IPV.

Prevalence and Factors Associated With Intimate Partner Violence Among Young Women Aged 15 to 24 Years in India: A Social-Ecological Approach

Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband's controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women's odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India.

Socio-demographic predictors of gender inequality among heterosexual couples expecting a child in south-central Uganda

BACKGROUND

Gender inequality is a pervasive problem in sub-Saharan Africa, and has negative effects on health and development.

OBJECTIVE

Here, we sought to identify socioeconomic predictors of gender inequality (measured by low decision-making power and high acceptance of intimate partner violence) within heterosexual couples expecting a child in south-central Uganda.

METHOD

We used data from a two-arm cluster randomized controlled HIV self-testing intervention trial conducted in three antenatal clinics in south-central Uganda among 1,618 enrolled women and 1,198 male partners. Analysis included Cochran Mantel-Haenzel, proportional odds models, logistic regression, and generalized linear mixed model framework to account for site-level clustering.

RESULTS

Overall, we found that 31.1% of men had high acceptance of IPV, and 15.9% of women had low decision-making power. We found religion, education, HIV status, age, and marital status to significantly predict gender equality. Specifically, we observed lower gender equality among Catholics, those with lower education, those who were married, HIV positive women, and older women.

CONCLUSION

By better understanding the prevalence and predictors of gender inequality, this knowledge will allow us to better target interventions (increasing education, reducing HIV prevalence in women, targeting interventions different religions and married couples) to decrease inequalities and improve health care delivery to underserved populations in Uganda.

Public health impact of marital violence against women in India

The public health ramifications of marital violence are well documented and include injury, mental health concerns and physical health consequences for women and their offspring. Unfortunately, there remains social tolerance and even acceptance of these abuses against women, and health systems in India have done little to support victims despite their greater health risks. However, there are promising efforts and important advancements in India that could be built on for more effective prevention and support for women. Men and boys should be engaged in gender transformative interventions with male role models to alter men's attitudes of acceptability of and justification for marital violence and consequently their actual abusive behaviours. Given the strong demonstrated connection between men's risky and problem alcohol use and marital violence, alcohol interventions may also be beneficial. We must support women and girls vulnerable to marital violence, a group disproportionately affected by violence in their natal families as well, so they know that violence need not be part of their marriage relationship, and have skills on how to engage and communicate with or even leave their male partners to reduce their risk for violence. Formal services should be expanded for those in immediate danger and particularly for rural areas, where prevalence of marital violence is highest and supports are weakest. Finally, given the pervasiveness of attitudes accepting husbands' marital violence against women, and the fact that these have remained largely unchanged in India for a decade, large scale community and social change efforts are needed.

Sexual Violence in Women with HIV Positive Spouse and Their Mental Health

Background: Sexual violence (SV) against women is one of the most important issues in women's health. We aimed to investigate the related variable for SV against women with HIV spouse and its relationship with mental problems in them.

Study design: A cross-sectional study.

Methods: This study was performed on 143 women referred to Hamadan and Malayer Risky Behavior Related Disease Clinic (Triangular Clinic), located in Comprehensive Health Service centers, Iran in 2019. SV and mental problems were assessed using standard questionnaires, based on interview. All analyses performed using SPSS. The significance level of all analyses was considered 0.05.

Results: Totally, 407 HIV+ patients were diagnosed from 1998 to 2018, in Hamadan and Malayer cities. We assessed the wives of survivors who allowed about SV. Mean of SV in women with HIV positive spouse was significantly higher than control group (P=0.004). Among all variables, unsafe sex, extramarital relationship, smoking, alcohol, multi-partner and suicide were significantly related to SV; but age, living area, educational status, income and job in both men and women had not statically significant relationship with SV.

Conclusion: SV besides its complications and mental problems in women with HIV positive spouses must be considered in interventional programs in order to improve sexual rights in this vulnerable group in the future.