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Aung SWKH, Kingston H, Mbogo LW, Sambai B, Monroe-Wise A, Ludwig-Barron NT, Bukusi D, Sinkele W, Gitau E, Masyuko S, Herbeck JT, Farquhar C, Guthrie BL. Prevalence and correlates of violence among sexual and injecting partners of people who inject drugs living with HIV in Kenya: a cross-sectional study. Harm Reduct J 2023; 20:164. [PMID: 37919736 PMCID: PMC10623850 DOI: 10.1186/s12954-023-00895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In Kenya, violence is common among people who inject drugs (PWID) living with HIV and their sexual and injecting partners and may lead to decreased uptake of HIV services, increased HIV risk behaviors, and increased HIV transmission. Violence is defined as any physical harm, threatened harm, or forced sexual acts inflicted on a person in the past year. Understanding the nature of violence and its correlates among PWID and their partners will inform population-specific public health interventions and policy recommendations. METHODS This is a cross-sectional study nested in a prospective cohort study conducted in eight public health centers, methadone clinics, and needle syringe programs in Nairobi, Kilifi, and Mombasa counties in Kenya. 3,302 sexual and/or injecting partners of PWID living with HIV were recruited through assisted partner services and participated in the study. Prevalence and correlates of violence were identified using the Wald test and negative binomial regression. RESULTS Out of 3302 study participants, 1439 (44%) had experienced violence within the past year. Physical violence was the most common form of violence experienced (35%), followed by being threatened (23%) or subjected to sexual violence (7%). In an adjusted analysis, female participants reported higher experiences of sexual violence (prevalence ratio [PR] = 2.46; 95% confidence interval [CI] 1.62, 3.74; p < 0.001) compared to male participants. In adjusted analysis, coastal residents had a higher experience of overall violence (PR = 1.48; 95% CI 1.27, 1.72; p < 0.001) than those living in Nairobi. This regional effect was relatively stronger among the female respondents (pinteraction = 0.025). Participants' sex modified the association between region and experiencing violence after adjusting potential confounding factors. CONCLUSIONS The study reveals the prevalence of violence among PWID and identifies high-risk sub-groups, including women, specifically for sexual violence, and coastal residents. Tailored interventions addressing their unique needs are essential. A holistic approach that combines violence prevention and response, comprehensive harm reduction, healthcare access, and community support is crucial to address the complex issue of drug use and HIV burden among PWID in Kenya for improved health outcomes.
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Affiliation(s)
| | | | - Loice W Mbogo
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | - Betsy Sambai
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | | | | | | | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Esther Gitau
- Support for Addiction Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Sarah Masyuko
- University of Washington, Seattle, WA, USA
- National AIDS and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya
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Daniel AK, Dworkin SL, McDonough A, Hatcher AM, Burger RL, Weke E, Wekesa P, Bukusi EA, Owino G, Odhiambo G, Thirumurthy H, Getahun M, Weiser SD, Cohen CR. The Impact of Land Tenure Security on a Livelihood Intervention for People Living with HIV in Western Kenya. AIDS Behav 2023; 27:245-256. [PMID: 35930199 PMCID: PMC9851924 DOI: 10.1007/s10461-022-03760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.
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Affiliation(s)
- Afkera K Daniel
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington, Bothell, Bothell, WA, USA
| | - Annie McDonough
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Abigail M Hatcher
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - George Owino
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harsha Thirumurthy
- Department of Medical Ethics and Heath Policy, Perelman School of Medicine, Philadelphia, PA, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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Mutumba M, Bhattacharya S, Ssewamala FM. Assessing the social patterning and magnitude of inequalities in sexual violence among young women in Uganda: Findings from 2016 demographic and health survey. Glob Public Health 2022; 17:2826-2840. [PMID: 35167776 DOI: 10.1080/17441692.2022.2037149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual violence (SV) is a significant global public health problem. To develop effectively targeted interventions to prevent SV and allocate resources equitably requires identifying the most vulnerable groups and the magnitude of these social inequities. However, these data are currently lacking. Using the Uganda Demographic and Health Survey, we examined SV among all young women and ever-married young women. We conducted univariate and bivariate analyses to characterise the prevalence and social patterning of SV, and then utilised the World Health Organization Health Equity Assessment Toolkit (HEAT) to assess the magnitude of social inequities in SV. At the national level, 5.5% among all young women and 20.5% of ever-married young women had experienced SV. For all young women, the largest inequities in SV were based on sub-national region of residence. Among the ever-married young women, we found profound education, wealth and place-based inequities in SV, which favoured young women with higher education, in wealthier households, and within central regions of Uganda. Our findings suggest a need for regionally targeted multi-sectoral interventions that take into consideration that multiple intersecting social dimensions such as education, poverty and the safe built environment, to address young women's risk for SV.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Fred M Ssewamala
- Brown School of Social Work, University of Washington at St. Louis, St. Louis, MO, USA
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Associations between sexual identity, living with disability, bully victimisation, and HIV status and intimate partner violence among residents in Nigeria. BMC Public Health 2022; 22:1756. [PMID: 36114566 PMCID: PMC9479364 DOI: 10.1186/s12889-022-14186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Kaggiah A, Wilson K, Richardson BA, Kinuthia J, Farquhar C, McClelland RS. Prevalence and correlates of intimate partner violence among women with HIV in serodifferent relationships in Nairobi, Kenya. PLoS One 2022; 17:e0272640. [PMID: 35976905 PMCID: PMC9385022 DOI: 10.1371/journal.pone.0272640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intimate partner violence (IPV) is a major public health problem and is the most common form of violence against women. Women with HIV in serodifferent relationships may be at an increased risk of IPV compared to women without HIV, hindering their ability to adhere to antiretroviral therapy, clinic appointments, and condom use during sex. This study assessed the prevalence and correlates of IPV in the past year among women with HIV in serodifferent relationships in Nairobi, Kenya. Methods This cross-sectional study included women with HIV in serodifferent relationships who were at least 18 years old and provided written informed consent. Their experience of physical, sexual, or emotional violence in the past year by the current partner was assessed using 13 questions adapted from the World Health Organization survey on violence against women. Standardized instruments were used to assess sociodemographic and behavioral factors. Associations between intimate partner violence and other variables were evaluated using log binomial regression models. Results Of the 159 women enrolled, 47 (29.6%, 95% CI 22.9–37.2%) reported IPV in the past year. Of these, 32 (68.1%) reported emotional, 27 (57.4%) physical, and 27 (57.4%) sexual violence. In the multivariate model, pregnancy (adjusted prevalence ratio [aPR] 2.14, 95% CI 1.09–4.20), alcohol use (minimal drinking aPR 1.91, 95% CI 1.10–3.33; moderate/severe drinking aPR 1.17, 95% CI 0.53–2.59), male partner controlling behavior (aPR 2.09, 95% CI 1.24–3.51), and past physical violence (aPR 1.93, 95% CI 1.22–3.05) remained significantly associated with a higher prevalence of IPV in the past year. Conclusion This study identified a high prevalence of IPV in the past year among women with HIV in serodifferent relationships. Pregnant women and women who had experienced prior violence had a higher prevalence of IPV. These data highlight the need to screen for IPV during clinic visits, and to offer evidence based interventions to support women in serodifferent relationships who have experienced IPV.
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Affiliation(s)
- Anne Kaggiah
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Katherine Wilson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
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Identifying the Impact of Intimate Partner Violence in Humanitarian Settings: Using an Ecological Framework to Review 15 Years of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136963. [PMID: 34209746 PMCID: PMC8297014 DOI: 10.3390/ijerph18136963] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational impact of IPV in humanitarian settings. However, findings highlighted a glaring gap in evidence examining the non-health impact of IPV for survivors in humanitarian settings and across levels of the ecological framework. Without enhanced research of women and girls and the violence they experience, humanitarian responses will continue to underachieve, and the needs of women and girls will continue to be relegated as secondary interests. Investment should prioritize addressing the range of both health and non-health impacts of IPV among individuals, families, and communities, as well as consider how the humanitarian environment influences these linkages.
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Biomndo BC, Bergmann A, Lahmann N, Atwoli L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS One 2021; 16:e0249813. [PMID: 33882084 PMCID: PMC8059826 DOI: 10.1371/journal.pone.0249813] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV's association with poor ART adherence. We investigate this association among a broad group of women. METHODS We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. RESULTS The participants' mean age was 38.6 (range: 18-69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72-80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34-0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31-0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34-0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. CONCLUSION IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.
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Affiliation(s)
- Bornice C. Biomndo
- Institute of Health and Nursing Science, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nils Lahmann
- Clinic for Geriatrics and Geriatric Medicine, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Medical College East Africa, Aga Khan University, Nairobi, Kenya
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Meskele M, Khuzwayo N, Taylor M. Lived experience of intimate partner violence among women using antiretroviral therapy and other outpatient services in Wolaita Zone, Ethiopia: a phenomenological study. Reprod Health 2021; 18:25. [PMID: 33522935 PMCID: PMC7849132 DOI: 10.1186/s12978-020-01044-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia is one of the nations which has an enormous burden of intimate partner violence (IPV), and where it is usually difficult to talk about HIV separately from IPV. OBJECTIVES This research aimed to explore the lived experience of IPV against women using antiretroviral therapy (ART) and other outpatient services in Wolaita Zone, Ethiopia METHODS: We used an Interpretive (hermeneutic) Phenomenological Analysis design among purposively selected adult women aged 18-49 years. A total of 43 women participated in this study, of whom 30 were using ART, and 13 women were using other health services. We used an in-depth interview and focus group discussions until data saturation, while conscious of the need to maintain the scientific rigor, dependability, and credibility. The data were transcribed verbatim and translated into English. We read the transcripts repeatedly to understand the content. We used NVivo 11 software to assist with data organisation, and also, we used the framework analysis method. RESULTS We identified five themes, namely: "women's terrifying experiences of violence," "the effect of violence on women's health," "support/lack of support /partner's controlling behaviours," "women's feelings about the available services," and "IPV prevention strategies from the perspective of women." Interviewees described their violent experiences which included wife-beating, being stigmatised in front of others, having material thrown at the woman's face, wife's hand and teeth were broken, forced sex, restriction of movement, name-calling, threats to hurt, being insulted, being left alone, and the withdrawal of finances. The negative health impacts reported included abortion, infection with HIV and other sexually transmitted diseases, disability, child's death, and depression. The disclosure of HIV test information resulted in violence. Inappropriate punishment of the perpetrator and the lack of a supportive women's network to avert IPV were perceived as legal limitations. CONCLUSIONS IPV is a considerable health burden, varying in its presentation and its negative impact on women's health. Improved laws should provide justice for all victims. Establishing a women's network to assist women at risk of violence, should be emphasised. Unwise HIV test result disclosure leads to IPV; hence HIV disclosure should be facilitated through health care providers.
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Affiliation(s)
- Mengistu Meskele
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa. .,School of Public Health, Wolaita Sodo University, P.O.Box: 138, Soda, Ethiopia.
| | - Nelisiwe Khuzwayo
- School of Nursing and Public Health, Discipline of Rural Health, KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
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Andrews C, Reuter TK, Marsh L, Velazquez JM, Jaoko W, Jolly P. Intimate Partner Violence, Human Rights Violations, and HIV among Women in Nairobi, Kenya. Health Hum Rights 2020; 22:155-166. [PMID: 33390704 PMCID: PMC7762921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study presents qualitative results from a mixed-method investigation conducted between May and August 2012 into the prevalence and consequences of four forms of intimate partner violence among women living with HIV who attended the Comprehensive Care Clinic at the Kenyatta National Hospital in Nairobi. As a part of the research, a quantitative survey found that among 600 sexually active women living with HIV aged 18-69, all reported experiencing emotional abuse; 20%, 17%, and 15% experienced controlling behavior, physical violence, and sexual violence, respectively. Qualitative research using focus group discussions with 19 women from the quantitative survey sought to contextualize these experiences and place them within a larger social structure where institutionalized gender inequality sets the tone for intimate partner violence against women in households. Participants reported that intimate partner violence led to their exposure to the virus and made them leery of disclosing their positive status or seeking support from a male partner for fear of a violent reaction. This fear and the socio-structural conditions in Kenya limit their ability to actively pursue comprehensive care, the stress of which can exacerbate symptoms and make managing the disease more difficult.
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Affiliation(s)
- Courtney Andrews
- Program Manager at the Institute for Human Rights, University of Alabama at Birmingham, and a Credentialed Course Instructor in the Department of Anthropology, University of Alabama at Birmingham, USA
| | - Tina Kempin Reuter
- Director of the Institute for Human Rights, University of Alabama at Birmingham, and an Associate Professor in the Departments of Political Science and Public Administration, Anthropology, and Social Work, University of Alabama at Birmingham, USA
| | - Lauren Marsh
- Graduate student in the Department of Epidemiology, University of Alabama at Birmingham, USA
| | - Judith M. Velazquez
- Graduate student in the Department of Epidemiology, University of Alabama at Birmingham, USA
| | - Walter Jaoko
- Professor in the Department of Medical Microbiology, University of Nairobi, Kenya
| | - Pauline Jolly
- Professor Emerita and the Director of the Minority Health International Research Training Program, University of Alabama at Birmingham, USA
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Sexual Health, HIV Care and Pre-exposure Prophylaxis in the African Immigrant Population: A Needs Assessment. J Immigr Minor Health 2020; 22:134-144. [PMID: 30859481 DOI: 10.1007/s10903-019-00873-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective was to gain insight, from the perspective of healthcare professionals, non-medical service providers and community-based organizations working with a large majority of African immigrant patients or clients, regarding sexual health and the potential for the use of HIV PrEP in this priority population. Thirty key informants participated in a needs assessment. A questionnaire was used to obtain information through focus groups, structured interviews and by self-administration. There are cultural and linguistic barriers to engaging Africans in discussing sexual health issues. Key challenges to uptake of PrEP are multi-dimensional: socioeconomic [immigration status, housing]; cultural [talking about sex 'taboo', HIV related stigma, no concept of preventive care]; provider-related (cultural competency, inadequate PrEP education, language barrier); and individual (lack of awareness, perception of HIV risk). Meeting basic needs like housing, assuring access to care (including PrEP), community-based education, relevant training of providers, and tailored messaging are strongly recommended. Effectively addressing HIV incidence in the African-born immigrant population redonequires a multi-pronged approach.
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Ashimi A, Amole T, Ibrahim H. Domestic violence: The pre- and post-diagnosis experience of women living with HIV in a rural community in Northwest Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meskele M, Khuzwayo N, Taylor M. Intimate partner violence against women living with and without HIV, and the associated factors in Wolaita Zone, Southern Ethiopia: A comparative cross-sectional study. PLoS One 2019; 14:e0220919. [PMID: 31442243 PMCID: PMC6707594 DOI: 10.1371/journal.pone.0220919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/25/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives This study aimed to measure the prevalence and associated factors of Intimate Partner Violence (IPV) among women living with and without HIV in Wolaita Zone, Southern Ethiopia. Methods A comparative cross-sectional study design was used to interview the 816 women between 18–49 years of age (408 = HIV positive, 408 = HIV negative). Using a multistage sampling technique, participants were recruited from nine health facilities based on probability proportional to the number of clients. After data entry (EpiData version 4.4.2.0) the data were exported to STATA/SE 15 software. Binary and multivariable logistic regression analysis were undertaken and the odds ratio (OR) and 95% confidence interval (CI) are presented. Results The lifetime prevalence of IPV among all women was 59.7%, [95% CI: 56.31%-63.05%]. IPV was slightly higher among women living with HIV, 250(61.3%), than those who were HIV negative, 238(58.1%). Lifetime prevalence of emotional violence 413(50.6%), physical violence 349(42.8%), sexual violence 219(26.8%), and controlling behaviours by husbands/partners 489(59.9%) were reported. Associations were found between IPV and controlling behaviour of husband/partner [AOR = 8.13; 95% CI: 4.93–13.42],income [AOR = 3.97; 95% CI:1.81–8.72], bride price payment [AOR = 3.46; 95% CI:1.74–6.87], women’s decision to refuse sex [AOR = 2.99; 95% CI: 1.39–6.41],age group of women [AOR = 2.86; 95% CI:1.67–4.90], partner’s family choosing wife [AOR = 2.83; 95% CI:1.70–4.69], alcohol consumption by partner [AOR = 2.36;95% CI:1.36–4.10], number of sexual partners [AOR = 2.35; 95% CI:1.36–4.09], and if partner ever physically fought with another man [AOR = 1.83; 95% CI:1.05–3.19]. Conclusions There is a high prevalence of IPV against women both living with and without HIV. Policy priorities should therefore involve males in programs of gender-based violence prevention in order to change their violent behaviour, and interventions are required to improve the economic status of women. Both sexes should be advised to have a single partner and marriage arrangements should be by mutual consent rather than being made by parents.
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Affiliation(s)
- Mengistu Meskele
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- * E-mail: ,
| | - Nelisiwe Khuzwayo
- School of Nursing and Public Health, Discipline of Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- School of Nursing and Public Health, Discipline of Public Health, KwaZulu-Natal, Durban, South Africa
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Brooks RD, Jolly PE, Marsh L, Velazquez JM, Padilla L, Jaoko WG. Intimate partner violence among HIV-positive women in Nairobi, Kenya. Int J Womens Health 2019; 11:451-461. [PMID: 31695511 PMCID: PMC6707364 DOI: 10.2147/ijwh.s203327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/09/2019] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- R D Brooks
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - P E Jolly
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - L Marsh
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - J M Velazquez
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - L Padilla
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - W G Jaoko
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
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Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Are interventions focused on gender-norms effective in preventing domestic violence against women in low and lower-middle income countries? A systematic review and meta-analysis. Reprod Health 2019; 16:93. [PMID: 31262331 PMCID: PMC6604322 DOI: 10.1186/s12978-019-0726-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND One in three women experience intimate partner violence worldwide, according to many primary studies. However, systematic review and meta-analysis of intimate partner violence is very limited. Therefore, we set to summarize the findings of existing primary studies to generate evidence for informed decisions to tackle domestic violence against women in low and lower-middle income countries. METHODS Studies were searched from main databases (Medline via PubMed, EMBASE, CINAHL, PopLine and Web of Science), Google scholar and other relevant sources using electronic and manual techniques. Published and unpublished studies written in English and conducted among women aged (15-49 years) from 1994 to 2017 were eligible. Data were extracted independently by two authors, and recorded in Microsoft Excel sheet. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of funnel plot. Statistical analysis was carried out to determine the pooled prevalence using Comprehensive Meta-Analysis software. In addition, sub-group analysis was carried out by study-setting and types of intimate partner violence. RESULTS Fifty two studies were included in the systematic review. Of these, 33 studies were included in the meta-analysis. The pooled prevalence of lifetime intimate partner violence was 55% (95% CI: 52, 59%). Of these, main categories were lifetime physical violence [39% (95% CI: 33, 45%); psychological violence [45% (95% CI: 40, 52%)] and sexual violence [20% (95% CI: 17, 23%)]. Furthermore, the pooled prevalence of current intimate partner violence was 38% (95% CI: 34, 43%). Of these, physical violence [25% (95% CI: 21, 28%)]; psychological violence [30% (95% CI: 24, 36%)] and sexual violence [7.0% (95% CI: 6.6, 7.5%)] were the pooled prevalence for the major types of intimate partner violence. In addition, concurrent intimate partner violence was 13% (95% CI: 12, 15%). Individual, relationship, community and societal level factors were associated with intimate partner violence. Traditional community gender-norm transformation, stakeholders' engagement, women's empowerment, intervention integration and policy/legal framework were highly recommended interventions to prevent intimate partner violence. CONCLUSION Lifetime and current intimate partner violence is common and unacceptably high. Therefore, concerned bodies will need to design and implement strategies to transform traditional gender norms, engage stakeholders, empower women and integrate service to prevent violence against women. PROTOCOL REGISTRATION PROSPERO: 2017: CRD42017079977 .
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Affiliation(s)
- Agumasie Semahegn
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Abubakar Manu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Gezahegn Tesfaye
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
- Population Council/Ghana, Yiyiwa Drive, Accra, Ghana
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Jeffries S, Chuenurah C, Rao P, Park MJY. Women's pathways to prison in Kenya: Violence, poverty, familial caretaking and barriers to justice. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Groves AK, Reyes HLM, Moodley D, Maman S. HIV Positive Diagnosis During Pregnancy Increases Risk of IPV Postpartum Among Women with No History of IPV in Their Relationship. AIDS Behav 2018; 22:1750-1757. [PMID: 28741135 PMCID: PMC5783794 DOI: 10.1007/s10461-017-1868-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There has been limited study of whether and for whom physical intimate partner violence (IPV) is a consequence of an HIV-positive diagnosis. Per the diathesis stress model, the consequences of HIV infection may be worse for women with a history of IPV. We hypothesize that the positive association between HIV diagnosis in pregnancy and postpartum IPV will be exacerbated for women with a history of IPV. Data come from a prospective cohort study with 1015 participants who completed a baseline antenatal and 9-month postpartum visit. Using logistic regression analyses, we found a statistically significant interaction between HIV diagnosis, history of IPV and postpartum IPV (AOR: 0.40, 95% CI 0.17-0.96). The findings were in the opposite direction as expected: HIV-diagnosis was not associated with IPV for women with a history of IPV (AOR: 2.17, 95% CI 1.06, 4.42). However, HIV-positive women without a history of IPV faced more than two times the risk of incident postpartum IPV than HIV-negative women (AOR: 2.17, 95% CI 1.06, 4.42). Interventions to reduce incident and ongoing IPV during the perinatal period are needed.
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Affiliation(s)
- Allison K Groves
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street Nesbitt Hall 4th Floor, Philadelphia, PA, 19140, USA.
| | - H Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Gust DA, Pan Y, Otieno F, Hayes T, Omoro T, Phillips-Howard PA, Odongo F, Otieno GO. Factors associated with physical violence by a sexual partner among girls and women in rural Kenya. J Glob Health 2018; 7:020406. [PMID: 28959439 PMCID: PMC5609512 DOI: 10.7189/jogh.07.020406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Intimate partner physical violence increases women’s risk for negative health outcomes and is an important public health concern. The purpose of the present study was to determine 1) the proportion of girls (≤18 years) and women (>18 years) who experienced physical violence by a sexual partner, and 2) factors (including self–reported HIV infection) associated with girls and women who experienced physical violence by a sexual partner. Methods Cross–sectional surveys conducted in the Gem Health and Demographic Surveillance System (HDSS) area in Siaya County, western Kenya in 2011–2012 (Round 1) and 2013–2014 (Round 2). Findings Among 8003 unique participants (582 girls and 7421 women), 11.6% reported physical violence by a sexual partner in the last 12 months (girls: 8.4%, women: 11.8%). Three factors were associated with physical violence by a sexual partner among girls: being married or cohabiting (nearly 5–fold higher risk), low education, and reporting forced sex in the last 12 months (both with an approximate 2–fold higher risk). Predictive factors were similar for women, with the addition of partner alcohol/drug use and deliberately terminating a pregnancy. Self–reported HIV status was not associated with recent physical violence by a sexual partner among girls or women. Conclusions Gender–based physical violence is prevalent in this rural setting and has a strong relationship with marital status, low education level, and forced sex among girls and women. Concerted efforts to prevent child marriage and retain girls in school as well as implementation of school and community–based anti–violence programs may help mitigate this risk.
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Affiliation(s)
- Deborah A Gust
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Yi Pan
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Fred Otieno
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | | | | | - Fred Odongo
- Kenya Medical Research Institute, Kisumu, Kenya
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18
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Mutisya RK, Ngure K, Mwachari C. A psychosocial intervention to reduce gender-based violence and antepartum depressive symptoms in pregnant women in Kisumu County, Kenya: a quasi-experimental study. Pan Afr Med J 2018; 29:11. [PMID: 29632633 PMCID: PMC5889516 DOI: 10.11604/pamj.2018.29.11.13596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Gender-based violence during pregnancy and its associated adverse health effects are disproportionately higher in developing countries like Kenya where screening for and management of gender-based violence is currently not part of routine antenatal care. This study assessed the effect of a psychosocial intervention on gender-based violence and antepartum depressive symptoms in pregnant women. Methods This quasi-experimental study compared gender-based violence and antepartum depression scores of 288 pregnant women in the two arms; one exposed to a psychosocial intervention and another receiving usual antenatal care. We used analysis of covariance to estimate the intervention effect and Chi-square to test the equality of proportions. Results The difference between the psychosocial intervention and the usual antenatal care group in the total intimate partner violence and physical violence scores was a significant, with small effect sizes of partial eta = 0.196 and 0.305 respectively. The two arms did not differ in terms of the proportion of women reporting other acts of gender-based violence by intimate and non-intimate partners post-intervention. The intervention group had significantly lower mean depression scores compared to the usual care group, post-intervention, with a medium effect size of 0.500. Conclusion This intervention aimed at reduction of gender-based violence and improvement of mental health of pregnant women is promising. Primary health care facilities in resource-constrained settings can take advantage of local capacity to deliver focused non-specialized psychosocial support to pregnant women experiencing violence.
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Affiliation(s)
- Redempta Kalekye Mutisya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Population and Reproductive Health, School of Public Health, Kenyatta University, Nairobi, Kenya
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Ward-Peterson M, Fennie K, Mauck D, Shakir M, Cosner C, Bhoite P, Trepka MJ, Madhivanan P. Using multilevel models to evaluate the influence of contextual factors on HIV/AIDS, sexually transmitted infections, and risky sexual behavior in sub-Saharan Africa: a systematic review. Ann Epidemiol 2017; 28:119-134. [PMID: 29439782 DOI: 10.1016/j.annepidem.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/04/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa. METHODS Ten databases were searched through May 29, 2016. Two reviewers completed screening and full-text review. Studies examining the influence of contextual factors on HIV/AIDS, STIs, and RSB and using MLMs for analysis were included. The Quality Assessment Tool for Quantitative Studies was used to evaluate study quality. RESULTS A total of 118 studies met inclusion criteria. Seventy-four studies focused on HIV/AIDS-related topics; 46 focused on RSB. No studies related to STIs other than HIV/AIDS met the eligibility criteria. Of five studies examining HIV serostatus and community socioeconomic factors, three found an association between poverty and measures of inequality and increased HIV prevalence. Among studies examining RSB, associations were found with numerous contextual factors, including poverty, education, and gender norms. CONCLUSIONS Studies using MLMs indicate that several contextual factors, including community measures of socioeconomic status and educational attainment, are associated with a number of outcomes related to HIV/AIDS and RSB. Future studies using MLMs should focus on contextual-level interventions to strengthen the evidence base for causality.
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Affiliation(s)
- Melissa Ward-Peterson
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL.
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Daniel Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Maryam Shakir
- Office of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Chelsea Cosner
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Prasad Bhoite
- Department of Health, Humanities, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
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Semahegn A, Torpey K, Manu A, Assefa N, Ankomah A. Community based intervention to prevent domestic violence against women in the reproductive age in Northwestern Ethiopia: a protocol for quasi-experimental study. Reprod Health 2017; 14:155. [PMID: 29162117 PMCID: PMC5698924 DOI: 10.1186/s12978-017-0414-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Violence against women is a well understood devastating global pandemic, and human right violation. One in three women experienced intimate partner violence worldwide. In Ethiopia, the level of domestic violence against women is one of the highest in the world. However, Ethiopia is signatory for various conventions and incorporated in legal frameworks. Nevertheless, effective implementation of the existing policy documents, and engaging different stakeholders is very limited. Therefore, we aimed to pilot feasibility of implementing available research evidence and policy documents at community level to prevent domestic violence against women in Awi zone, northwestern Ethiopia. Methods A community-based quasi-experimental study design will be employed using mixed method. Multistage stratified systematic sampling and purposive sampling will be used to recruit quantitative and qualitative study participants, respectively. A total of 1,269 women will be participated in the intervention, active comparator and control groups. Pre and post-test quantitative data will be collected using face-to-face interview. Qualitative data will be collected through in-depth, key informant interview and focus group discussions. Intervention: advocacy meeting will be held to persuade local politicians and sustain the implementation of community based intervention to prevent domestic violence against women. Community representatives will be trained to enhance peer education to promote community awareness and engage stakeholders to transform the traditional gender norm within local context. Awareness creation and husband involvement will be made through integrating the intervention with community health extension program. Only husband involvement will not be promoted in the active comparator to test the role of husband involvement on the domestic violence prevention activities. Intervention progress will be monitored regularly. Gathered data will be entered in Epidata and exported to SPSS (23.0) software for analysis. Descriptive statistics, logistic regressions, intention to treat analysis and difference in differences will be computed. Qualitative data will be transcribed, color coded, thematically analyzed and arranged using Nvivo. Discussion This interventional study is aimed to design, pilot and translate proven research evidence, agreed conventions and country policy document to real setting implementation. We are expecting to initiate implementation of culturally acceptable intervention through engaging stakeholders. Policy makers, planners and any concerned bodies will be benefited. Trial registration ClinicalTrials.gov ID: NCT03265626
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Affiliation(s)
- Agumasie Semahegn
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana. .,College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia.
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Abubakar Manu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Po. Box 235, Harar, Ethiopia
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana
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Okoro ON, Whitson SO. HIV risk and barriers to care for African-born immigrant women: a sociocultural outlook. Int J Womens Health 2017; 9:421-429. [PMID: 28652821 PMCID: PMC5476631 DOI: 10.2147/ijwh.s129355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Data from the Minnesota Department of Health (MDH) HIV/AIDS Surveillance Report 2015 show that African-born (AB) women continue to be disproportionately affected by HIV. In 2015, these women accounted for more than half (54%) of all new cases of HIV reported among females in Minnesota and 34% of all known female cases in the state. This study was a needs assessment for HIV pre-exposure prophylaxis (PrEP) in vulnerable subgroups within the AB population and adequacy of HIV care for AB persons. The primary objective of this study was to gain an insight into the strategies that will limit the spread of HIV infection and enhance HIV care among AB immigrants. Methods Community advocates, community-based organizations (CBOs), clinicians, and other HIV-related service providers were invited to participate in a focus group, structured interview or complete an assessment tool using the same questionnaire about HIV and PrEP among AB persons. A thematic analysis was then conducted on the open-ended questions addressing perceived barriers. Results Findings suggest the following gender-specific sociocultural factors that drive HIV transmission and constitute barriers to HIV treatment for AB women: domestic/intimate partner violence, gender-biased stigma, discriminatory cultural beliefs and normative values/expectations, unprotected sex with husbands who have sex with other men, gender discordance in health care (preference for female provider), and sexual/reproductive health illiteracy. Recommendation Based on recommendations, a community-based sexual and reproductive health education is being initiated with a curriculum that will be 1) broad (inclusive but not limited to HIV), 2) culturally sensitive/responsive, and 3) at appropriate literacy level for all women, including those who have little or no formal education.
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Affiliation(s)
- Olihe N Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth
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Nguyen AH, Giuliano AR, Mbah AK, Sanchez-Anguiano A. HIV/sexually transmitted infections and intimate partner violence: Results from the Togo 2013-2014 Demographic and Health Survey. Int J STD AIDS 2017; 28:1380-1388. [PMID: 28457202 DOI: 10.1177/0956462417705970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Anthony H Nguyen
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anna R Giuliano
- 2 Center for Infection Research on Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alfred K Mbah
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Aurora Sanchez-Anguiano
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
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Rigby SW, Johnson LF. The relationship between intimate partner violence and HIV: A model-based evaluation. Infect Dis Model 2017; 2:71-89. [PMID: 29928730 PMCID: PMC5963327 DOI: 10.1016/j.idm.2017.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Simon W Rigby
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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Achchappa B, Bhandary M, Unnikrishnan B, Ramapuram JT, Kulkarni V, Rao S, Maadi D, Bhat A, Priyadarshni S. Intimate Partner Violence, Depression, and Quality of Life among Women Living with HIV/AIDS in a Coastal City of South India. J Int Assoc Provid AIDS Care 2017; 16:455-459. [PMID: 28176538 DOI: 10.1177/2325957417691137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a severe form of abuse prevalent in urban and rural areas of India with its effects on mental and physical health of the person receiving it, leading to a poorer quality of life. METHODS A cross-sectional study was conducted among 99 women living with HIV, and information was collected using abuse assessment scale. The data were entered and analyzed using SPSS version 17.0. RESULTS The IPV was reported by 19.2% of the respondents, of which psychological (14.1%) was most common followed by physical (4.1%) and sexual abuse (1.0%). The experience of IPV was significantly associated with socioeconomic status, number of children, marital status, and CD4 counts of the participants. CONCLUSION The prevalence of IPV in our study was found to be less compared to previous studies, however, there were significant association among factors such as socioeconomic status, CD4 counts, and marital status of the participants.
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Affiliation(s)
- Basavaprabhu Achchappa
- 1 Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Mahak Bhandary
- 2 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Bhaskaran Unnikrishnan
- 2 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - John T Ramapuram
- 1 Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Vaman Kulkarni
- 2 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Satish Rao
- 1 Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Deepak Maadi
- 1 Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Anish Bhat
- 2 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Shivani Priyadarshni
- 2 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
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Kalokhe AS, Ibegbu CC, Kaur SP, Amara RR, Kelley ME, Del Rio C, Stephenson R. INTIMATE PARTNER VIOLENCE IS ASSOCIATED WITH INCREASED CD4 + T-CELL ACTIVATION AMONG HIV-NEGATIVE HIGH-RISK WOMEN. Pathog Immun 2016; 1:193-213. [PMID: 27668294 PMCID: PMC5034930 DOI: 10.20411/pai.v1i1.120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Biological pathways mediating the link between intimate partner violence (IPV) and increased HIV risk remain unexplored. We hypothesized that IPV-induced stress negatively affects HIV systemic immune defenses and aimed to evaluate whether IPV was associated with immune profiles linked to HIV susceptibility: CD4 activation and diminished regulatory T-cell (Treg) frequency. Methods: Seventy-five HIV-negative high-risk women were surveyed regarding their IPV experience. They provided blood, urine, and (if present) genital ulcer samples for cortisol, immune assays, and STI testing. Using flow cytometry, we assessed activated CD4+ T-cell (%HLA-DR+/ CD38+) and Treg (%CD4+CD25+FoxP3+) frequencies and phenotyping. Nonparametric tests evaluated the association between IPV and immune outcomes. Multivariate regression explored confounding and moderation of the IPV-CD4 activation pathway. Results: Lifetime IPV was associated with increased CD4+ activation (r = 0.331, P = 0.004), a shift in CD4+ phenotype from naïve to effector memory (r = 0.343, P = 0.003), and a decrease in naive (%HLA-DR+/CD45RA-) Treg frequency (r = -0.337, P = 0.003). Experiencing IPV over the past year had similar trends. After controlling for sexual IPV, lifetime physical and psychological abuse remained significantly associated with CD4+ activation (P = 0.004 and P = 0.033, respectively). After controlling for race (the only covariate linked to activation), the lifetime IPV-CD4 activation association remained significant (P = 0.012). Alcohol use and depression were identified as potential pathway moderators. Conclusion: Our data is the first to suggest an immune link between IPV and HIV, and may help explain differences at the individual level in HIV susceptibility and response to biological HIV prevention strategies. The association of psychological and physical abuse with CD4 activation independent of sexual abuse further supports the existence of a stress-induced immune pathway.
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Affiliation(s)
- Ameeta S Kalokhe
- Emory School of Medicine, Division of Infectious Diseases, Atlanta, GA; Emory Rollins School of Public Health, Department of Global Health, Atlanta, GA
| | - Chris C Ibegbu
- Yerkes National Primate Research Center, Emory University, Atlanta, GA; Emory Vaccine Center, Department of Microbiology and Immunology, Atlanta, GA
| | - Surinder P Kaur
- Emory Vaccine Center, Department of Microbiology and Immunology, Atlanta, GA
| | - Rama R Amara
- Yerkes National Primate Research Center, Emory University, Atlanta, GA; Emory Vaccine Center, Department of Microbiology and Immunology, Atlanta, GA
| | - Mary E Kelley
- Emory Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Carlos Del Rio
- Emory School of Medicine, Division of Infectious Diseases, Atlanta, GA; Emory Rollins School of Public Health, Department of Global Health, Atlanta, GA
| | - Rob Stephenson
- University of Michigan School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, MI
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Wielding S, Scott A. What women want: social characteristics, gender-based violence and social support preferences in a cohort of women living with HIV. Int J STD AIDS 2016; 28:486-490. [PMID: 27270691 DOI: 10.1177/0956462416654046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A total of 229 women attend Chalmers Centre (a city-centre integrated sexual health centre in Edinburgh, Scotland) for their HIV care and treatment. Local third-sector agencies provide peer support, but anecdotally, it is not well utilised and some demographic groups are under-represented. The aim of this study was to gain better understanding of the background social characteristics of these women, to ascertain what issues they are affected by, and to better identify what support is required and how it should be provided/facilitated. An anonymous self-completion questionnaire was developed, and all women attending HIV clinics between July and November 2015 were given the opportunity to participate. Additional data were accessed from the National Sexual Health database on cohort size and gender-based violence enquiries. Forty-four women living with HIV completed the questionnaire. 25% are unemployed. 84.6% had a combined household income of less than £30,000 per annum. 16.7% do not know anyone else, and 59.5% know only one other person, who is living with HIV. 32.6% would like to meet other/more women living with HIV, and 25.5% were unsure if they did or not. Of those who would, 42.9% would prefer a one-to-one setting, 42.9% would prefer a group setting, and 14.3% did not mind. 64.3% would prefer to meet off NHS premises. 26.8% were interested in discussion groups on women's issues, and 31.7% were unsure. The most popular suggestions for discussion group topics were stress/anxiety (nine women), HIV disclosure (eight women), diet and nutrition (seven women), and pregnancy and childbirth (six women). 26.8% were interested in attending a "women clinic" staffed by female staff, the same number were unsure if they would utilise this service or not. 50% of women had, at some point, experienced gender-based violence, 13.5% were currently experiencing gender-based violence, and four of these women have children living with them. From National Sexual Health records, only 15.7% of the cohort had ever been asked about gender-based violence. Respondents were demographically representative of our whole cohort. 75% are in employment but it appears that the majority of these women are likely to be earning lower than the national average income. To improve holistic support for these women and facilitate peer support, we need to be flexible in our approach. Gender-based violence appears to be disproportionately affecting women living with HIV in Lothian and, as a team, we are failing to routinely enquire about it. Robust referral/signposting pathways should be developed for women after gender-based violence disclosure.
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Matseke G, Rodriguez VJ, Peltzer K, Jones D. Intimate partner violence among HIV positive pregnant women in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2016; 26:259-266. [PMID: 27574487 PMCID: PMC5001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of the study was to determine the prevalence of intimate partner violence (IPV) and associated factors among pregnant HIV-infected women in primary health care facilities in Nkangala and Gert Sibande districts, Mpumalanga, South Africa. Participants were 673 women who were, on average, 28.39 ± 5.73 years old. Data were collected through Audio Computer Assisted Self Interview (ACASI), and analysed using the IBM Statistical Package for Social Sciences (SPSS). Overall, 56.3% reported having experienced either psychological or physical IPV, and 19.6% reported physical IPV. In logistic multivariable regression analyses, higher levels of depressive symptoms and greater perceived stigma were associated with combined physical and psychological IPV. Psychological IPV and physical IPV were also individually associated with greater perceived stigma and higher levels of depressive symptoms. The design and implementation of evidence-informed interventions that can empower and protect HIV-infected pregnant women from IPV is essential to managing their health-related quality of life.
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Affiliation(s)
- Gladys Matseke
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Karl Peltzer
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
- Department of Research and Innovation, University of Limpopo, Polokwane, South Africa
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
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28
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Matseke G, Rodriguez VJ, Peltzer K, Jones D. Intimate partner violence among HIV positive pregnant women in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1185912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Gladys Matseke
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Karl Peltzer
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
- Department of Research and Innovation, University of Limpopo, Polokwane, South Africa
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
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Inoue M, Uza M, Shinjo M, Akamine I. Development of a clinical nurse recognition scale for female intimate partner violence patients. Jpn J Nurs Sci 2016; 13:437-450. [PMID: 27170521 DOI: 10.1111/jjns.12124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/19/2015] [Accepted: 12/17/2015] [Indexed: 11/27/2022]
Abstract
AIM We aimed to develop a Recognition Scale for Female Intimate Partner Violence (IPV) Patients (RS-FIPVP); measure the levels and clarify the structure of IPV recognition among clinical nurses; and confirm the validity and reliability of the scale. METHODS A cross-sectional, anonymous, self-administered questionnaire was administered to clinical nurses (n = 2570) at seven clinical settings in Okinawa, Japan. As a result, 1855 valid responses were obtained and used in the analysis. The statistical analysis examined an exploratory and confirmatory factor analysis, internal consistency, and construct validity. RESULTS Four factors, comprising 20 items, were extracted for IPV recognition among clinical nurses. The confirmatory factor analysis showed that the indices of fitness supported these results. The Cronbach's alpha coefficient was 0.83 for the total score and 0.71, 0.73, 0.74, and 0.71 for Factors 1, 2, 3, and 4, respectively. Four factors were extracted from the oblique factor analysis, with a cumulative variance of 50.0%: "understanding of the victim's situation", "violence that is difficult to detect", "patient characteristics", and "support and coordination". The four factors had a moderate correlation (0.27-0.47, P < 0.01) with each other, which indicated construct validity. These findings confirmed fit for the RS-FIPVP. CONCLUSIONS The RS-FIPVP, a recognition scale to measure and evaluate the recognition of female IPV patients among clinical nurses, was developed. It may be used to improve the recognition of female IPV patients in nursing continuing education and also to measure and evaluate educational interventions. The reliability and validity of the scale were verified; however, further refining, testing, and evaluation are required.
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Affiliation(s)
- Matsuyo Inoue
- Graduate School of Health Science, University of the Ryukyus, Nishihara, Japan. .,Okinawa Prefectural College of Nursing, Naha, Japan.
| | - Miyoko Uza
- Graduate School of Health Science, University of the Ryukyus, Nishihara, Japan
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30
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Nelson KA, Ferrance JL, Masho SW. Intimate partner violence, consenting to HIV testing and HIV status among Zambian women. Int J STD AIDS 2015; 27:832-9. [PMID: 26185042 DOI: 10.1177/0956462415596299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
Sub-Saharan African countries are heavily burdened with HIV, which disproportionately affects women of reproductive age. Extant literature is inconsistent regarding the link between intimate partner violence and HIV. Data from the 2007 Zambian Demographic Health Survey of women aged 15-49 (n = 5014) were analysed. The influence of abuse by a current or former husband on consent to HIV testing and HIV positivity were evaluated. The unadjusted analysis showed a statistically significant association between intimate partner violence and consent to testing for HIV. Stratified analysis showed that there was a statistically significant association between intimate partner violence and HIV testing in rural areas but not in urban areas. However, the association lost its significance when adjusted for confounding factors. No statistically significant association was found between intimate partner violence and HIV-positive status. It is encouraging that women who experienced intimate partner were testing for HIV. Prevention efforts should continue addressing the needs of this population.
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Affiliation(s)
- Kara A Nelson
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jacquelyn L Ferrance
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Saba W Masho
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA Institute of Women's Health, Virginia Commonwealth University, Richmond, VA, USA
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31
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Durevall D, Lindskog A. Intimate partner violence and HIV in ten sub-Saharan African countries: what do the Demographic and Health Surveys tell us? LANCET GLOBAL HEALTH 2014; 3:e34-43. [PMID: 25539967 DOI: 10.1016/s2214-109x(14)70343-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Dick Durevall
- Department of Economics and Gothenburg Centre of Globalization and Development, University of Gothenburg, Gothenburg, Sweden
| | - Annika Lindskog
- Department of Economics and Gothenburg Centre of Globalization and Development, University of Gothenburg, Gothenburg, Sweden.
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Onsomu EO, Abuya BA, Okech IN, Rosen DL, Duren-Winfield V, Simmons AC. Association between domestic violence and HIV serostatus among married and formerly married women in Kenya. Health Care Women Int 2014; 36:205-28. [PMID: 25127397 DOI: 10.1080/07399332.2014.943840] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Elijah O Onsomu
- a Division of Nursing , Winston-Salem State University , Winston-Salem , North Carolina , USA
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33
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Pack AP, L'engle K, Mwarogo P, Kingola N. Intimate partner violence against female sex workers in Mombasa, Kenya. CULTURE, HEALTH & SEXUALITY 2013; 16:217-230. [PMID: 24329103 DOI: 10.1080/13691058.2013.857046] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Female sex workers are known to be at risk of intimate partner violence (IPV) from numerous sources including clients, pimps, boyfriends and husbands. Better understanding the factors associated with IPV in this population will enhance prevention efforts. This work examines baseline survey data collected as part of a randomised controlled trial for an alcohol-harm reduction intervention. The study sample included 619 sex workers. IPV was common in this sample, with 78.7% of women reporting any IPV in the last 30 days. Multivariate logistic regression results indicated that supporting one to two other people, experiencing child abuse, witnessing mother abuse, and greater alcohol consumption were risk factors for IPV in our sample. Women who frequented Population, Health and Integrated Assistance (APHIA) II drop-in centres located along transport corridors were also at greater risk of recent IPV, as compared with those who frequented other drop-in centres. Only one protective effect was identified in this study: condom use at last sex with a non-paying partner was associated with less recent IPV. Health programmes for women sex workers in Mombasa and elsewhere need to expand beyond HIV prevention - they need to incorporate information on violence prevention and treatment referrals, as well as information on alcohol harm reduction.
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Kouyoumdjian FG, Findlay N, Schwandt M, Calzavara LM. A systematic review of the relationships between intimate partner violence and HIV/AIDS. PLoS One 2013; 8:e81044. [PMID: 24282566 PMCID: PMC3840028 DOI: 10.1371/journal.pone.0081044] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
| | - Nicole Findlay
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Schwandt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Liviana M. Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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