Association Between Intimate Partner Violence Against Women and HIV-Risk Behaviors: Findings From the Nepal Demographic Health Survey

Labor Pains: Work-Related Barriers to Access to Health Care for People Living with HIV in Hyderabad, India

To explore themes regarding work-related barriers to access to health care, we conducted 32 interviews, 16 with third gender people and 16 with cisgender women, all of whom were all living with HIV in Hyderabad, India. Most respondents were members of Dalit castes and had been living with HIV for several years at the time of the interview. Using thematic content analysis, interviews were coded by two researchers using a social determinants of health conceptual framework. Themes highlighted in this study include the burden of taking time off from work, the loss of pay associated with missing work, and the interruption of gendered care work responsibilities that respondents faced when seeking treatment. Findings from this study support the claim that equitable work policies and practices for marginalized laborers can increase access to medical care for people living with HIV.

Examining Women's HIV Protective Behaviors in Nepal

Women's autonomy in decision making has important sexual and reproductive health implications. This study uses a nationwide analysis in Nepal to examine women's autonomy, attitude toward intimate partner violence (IPV) behaviors, and HIV-related knowledge in the execution of HIV protective behaviors such as having one sexual partner or getting an HIV test to prevent HIV transmission. Secondary data analysis was conducted using the nationally represented Nepal Demographic and Health Survey (2016-2021) dataset. The sample included 9,904 women ages 15 to 49 who self-identified as ever married. Factor analysis for women's autonomy, attitude toward IPV behaviors, and HIV-related knowledge were conducted based on social dominance theory. Structural equation modeling was conducted, and the results indicated that higher autonomy decreased the risk of HIV infection through having one sexual partner. Factors related to multiple sex partners included unemployment, religious affiliation, and age. Similarly, higher autonomy, HIV-related knowledge, having a formal job, and urban residence increased women's likelihood of taking an HIV test. Women's higher education, greater wealth, religious affiliation, and youth also correlate with HIV testing. Future HIV prevention interventions should include strategies that support women's social and economic empowerment and enhance women's ability to make informed choices about their health and risks.

Examining Risk Factors of Intimate Partner Violence Victimization in Central America: A Snapshot of Guatemala and Honduras

The current study examines country-specific risk factors of intimate partner violence (IPV) victimization among Guatemalan and Honduran women. More specifically, we examine if (in)equality between partners, experience of controlling or emotionally abusive behavior, and components of the intergenerational transmission of violence significantly affect the risk of lifetime IPV victimization for Guatemalan (N = 5,645) and Honduran women (N = 9,427). We address this by analyzing both the 2014 to 2015 Guatemala Demographic and Health Survey and the 2011 to 2012 Honduras Demographic and Health Survey. Results suggest that equality between partners operates differently across the two nations, which is likely related to social norms in each country. In particular, having more decisional input is a protective factor against IPV victimization for Guatemalan women. Increased educational attainment, however, is a risk factor for IPV victimization among Honduran women. Implications, especially as they pertain to social service agencies and programming, are discussed.

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.

Mediating Roles of Intimate Partner Violence, Stress, and Social Support on Depressive Symptoms Among Thai Women

Prior research has shown that intimate partner violence (IPV), stress, and social support are associated with depressive symptoms. However, a possible mediating role of these variables linking depressive symptoms has not been fully investigated in Thailand. This study was conducted to assess the mediating roles of IPV, stress, and social support in the relationships between childhood abuse (CA), number of sexual partners (NSP), and depressive symptoms among 400 Thai women attending gynecology clinics. Results indicated that IPV was significantly positively correlated with stress and depressive symptoms but negatively correlated with social support. CA and NSP were significantly positively correlated with IPV, stress, and depressive symptoms, but negatively correlated with social support. Structural equation models (SEMs) showed that not only did IPV severity exhibit significantly indirect effect on depressive symptoms (β = .178; p < .05), but it also had a significant, positive total effect on depressive symptoms (β = .252; p < .05). In particular, IPV severity had the fully mediating effect on depressive symptoms through social support (β = -.204; p < .05) and stress (β = .158; p < .05). CA severity and NSP exhibited the significant indirect effect on depressive symptoms through IPV severity, stress, and social support. All the models analyzed showed that stress had an important mediator role (β = .583; p < .05) on depressive symptoms. The model fitted very well to the empirical data and explained 53% of variance. Findings affirmed the important role of these mediators as well as the need to design interventions for reducing stress or increasing support for women experiencing IPV. Utilizing an empowerment approach among female outpatients to decrease stress and depressive symptoms is recommended.

Strengthening Health Systems' Response to Violence Against Women in Three Tertiary Health Facilities of Maharashtra

Background

Domestic violence is known to have a significant impact on the health of women. Despite this, the health system in India is not equipped to respond to women facing violence. This can be attributed to limited information on how the evidence-based guidelines can be implemented in resource-constrained settings. To fill this gap, implementation research was carried out in three tertiary medical teaching hospitals in Maharashtra.

Methods

The project was implemented in the OBGY, Medicine and Emergency department of a medical college and a district hospital in the state of Maharashtra. The intervention included consultation with key providers of three departments and a 5 day training of trainers on VAW. The trainers conducted 2 day onsite training for the health care providers. System-level interventions included the development of SOPs, IEC material, documentation format and identifying places for a private consultation. The research involved a pre- and post-test to assess change in KAP of providers after training, analysis of documentation register and interviews with trained providers and survivors.

Results

Findings indicate a significant change in knowledge, attitude and practice of the providers. Documentation registers introduced in the facility departments showed 531 women facing violence were responded by providers in 9 months. In 59% of cases, the provider suspected violence based on presenting health complaints, indicating the success of the capacity building programmes in the development of skills to identify VAW signs and symptoms, as well as provide psychological support to women/girls. There was a high acceptability of intervention among providers. Survivors also recognised the usefulness of health care facility-based support services for violence.

Conclusion

A multi-component intervention comprising of building capacity of providers and facility readiness is feasible to implement in low- and middle-income countries (LMIC) and can strengthen health systems' response to VAW.

Intimate Partner Violence (IPV) Against HIV-Positive Women in Sub-Saharan Africa: A Mixed-Method Systematic Review and Meta-Analysis

OBJECTIVES

To systematically analyze and summarize the literature on intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa (SSA) and to identify their risk factors for IPV.

METHOD

A comprehensive review of the literature using the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) yielded 1,879 articles (PubMed = 1,251, Embase = 491, Web of Science = 132, and identified additional records = 5). Twenty were selected for quantitative and qualitative assessment and synthesis. We employed a random effects model with generic inverse variance method and estimated the odds ratios.

FINDINGS

Results indicated a high prevalence of physical, sexual, and emotional violence against women living with HIV/AIDS in SSA. Educational background, alcohol use, marital status, previous experiences with IPV, and employment status were identified as significant risk factors. We also assessed the methodological quality of the articles by examining publication bias and some heterogeneity statistics.

CONCLUSION

There is limited research on IPV against HIV-positive women in SSA. However, the few existing studies agree on the importance of targeting HIV-positive women with specific interventions given their vulnerability to IPV and to address factors exacerbating these risks and vulnerabilities.

Intimate Partner Violence, Its Sociocultural Practice, and Its Associated Factors Among Women in Central Ethiopia

Background

Intimate partner violence is a serious and widespread problem worldwide. It is a domestic violence by a spouse or partner in an intimate relationship against the other spouse or partner. Even though Ethiopia is also one of the countries where the condition has been seriously happening, there is a dearth of information in the study area.

Objective

To assess the prevalence of intimate partner violence and its sociocultural practice, and its associated factors among married women in Oromia, Central Ethiopia.

Methods

A community-based cross-sectional study was conducted on 671 women of Ambo district who were in marriage from March 1 to 30, 2018. Multistage sampling method was employed to select study participants. Data were collected using interviewer-administered WHO Multi-country Study on Women’s Health and Life Experiences Questionnaire. Descriptive, bivariate, and multivariate logistic regression analyses were done using SPSS version 20.0.

Results

Out of 671 married women expected to participate, 657 of them participated in the study making a response rate of 98%. Overall, 77% (95% CI 73.7–80.1%), and 62.4% (95% CI, 58.6–66.1%) of the respondents reported that they have experienced intimate partner violence in their lifetime and in the last one year, respectively. Lack of formal education by husband (AOR 2.30, 95% CI 1.28–4.15), housewife occupation of respondents (AOR 2.04, 95% CI 1.02–4.06), number of children (AOR 4.37, 95% CI 1.40–13.66), perceived husband dominance (AOR 1.74, 95% CI 1.15–2.63), grow up in domestic violence (AOR 1.53, 95% CI 1.00–2.35) and partner’s alcohol intake (AOR 1.77, 95% CI 1.12–2.79) were independently associated with intimate partner violence.

Conclusion

Intimate partner violence against women remains an important public health problem. This needs urgent attention at all levels of societal hierarchy including policymakers, stakeholders, and professionals to alleviate the situation.

Are Opportunities Being Missed? Burden of HIV, STI and TB, and Unawareness of HIV among African Migrants

Sub-Saharan African migrants (SSAMs) have been disproportionately affected by infectious disease burden. We aimed to identify correlates of HIV, past sexually transmitted infection (STI) and past Tuberculosis infection (TB), as well as examine HIV seropositivity unawareness and testing history among SSAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive or having a past STI were higher among participants with low socioeconomic status and who experienced violence from a partner. Increased odds of having a past STI were also found among long-term migrants and those who reported sexual risk behaviors. In total, 4.1% of participants had TB in the past; these were more likely male and HIV positive. Unawareness of HIV-positive status was notably high (35%). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases.

Variability and validity of intimate partner violence reporting by couples in Tanzania

In recent years, major global institutions have amplified their efforts to address intimate partner violence (IPV) against women-a global health and human rights violation affecting 15-71% of reproductive aged women over their lifetimes. Still, some scholars remain concerned about the validity of instruments used for IPV assessment in population-based studies. In this paper, we conducted two validation analyses using novel data from 450 women-men dyads across nine villages in Northern Tanzania. First, we examined the level of inter-partner agreement in reporting of men's physical, sexual, emotional and economic IPV against women in the last three and twelve months prior to the survey, ever in the relationship, and during pregnancy. Second, we conducted a convergent validity analysis to compare the relative efficacy of men's self-reports of perpetration and women's of victimization as a valid indicator of IPV against Tanzanian women using logistic regression models with village-level clustered errors. We found that, for every violence type across the recall periods of the last three months, the last twelve months and ever in the relationship, at least one in three couples disagreed about IPV occurrences in the relationship. Couples' agreement about physical, sexual and economic IPV during pregnancy was high with 86-93% of couples reporting concordantly. Also, men's self-reported perpetration had statistically significant associations with at least as many validated risk factors as had women's self-reported victimization. This finding suggests that men's self-reports are at least as valid as women's as an indicator of IPV against women in Northern Tanzania. We recommend more validation studies are conducted in low-income countries, and that data on relationship factors affecting IPV reports and reporting are made available along with data on IPV occurrences.

The Use of Female Sex Workers Among Men in Nepal: Prevalence, STIs/HIV-Related Risk Behaviors, and Gender Ideology

Heterosexual sex involving female sex workers (FSWs) is widely documented for its role in facilitating the spread of sexually transmitted infections (STIs)/HIV. Critical to such studies, and increasingly considered essential to HIV prevention efforts, is the gender constructs and power dynamics within relationships. However, little efforts have been made, which focus on male clients of FSWs, particularly on the relationship between gender ideologies and men’s sexual contact with FSWs, within the Nepali context. The present study aims to fill this critical gap by assessing the prevalence of use of FSWs and its association with STIs/HIV-related risk behaviors and gender ideologies among Nepali men. We used data from the nationally representative Nepal Demographic Health Survey (NDHS) 2011. For the purpose of analyses, we included a sample of 4,121 men, aged 15–49 years. During data analyses, we used multivariate logistic regression models, adjusted for the following variables: age, region, residence, religion, educational level, wealth index, employment status, and cigarette smoking status. Of the total sample, approximately 5% reported the use of FSWs in their lifetime. In regression models, men who had sex with FSWs were more likely to report a history of STIs [adjusted odds ratio (aOR): 3.03; 95% confidence interval (CI): 1.69–5.43; P < 0.001], not using condom all the time (aOR: 1.31; 95% CI: 1.05–2.12; P = 0.010), more than one sexual partner (aOR: 3.75; 95% CI: 2.18–5.23; P < 0.001), and have had early sexual debut (aOR: 2.60; 95% CI: 1.85–3.67; P < 0.001). Respondents reporting the endorsement of violence against wives (aOR: 1.65; 95% CI: 1.01–2.84; P = 0.04) and male sexual entitlement (aOR: 1.63; 95% CI: 1.21–2.32; P = 0.001) were significantly more likely to report sexual contact with FSWs. Our findings highlight the need to develop and implement specifically tailored interventions toward male clients of FSWs, with a particular emphasis on promoting equitable gender roles and beliefs.