Prevalence and factors associated with intimate partner violence among the adolescent girls and young women in South Africa: findings the 2017 population based cross-sectional survey

Multilevel determinants of physical violence among ever-partnered women in South Africa

BACKGROUND

Violence against women continues to be a challenge in many countries. Many women suffer physical violence at the hands of their intimate partners and sometimes this leads to their deaths. This study aimed to examine the multilevel determinants of physical violence among ever-partnered women in South Africa.

METHODS

We used data from the 2016 South Africa Demographic and Health Survey. The study has a weighted sample size of 4169 ever-partnered women aged 18-49 years, based on the domestic violence module. We included univariate, bivariate and multilevel logistic regression analysis. We included a two-level model to measure the relationship between the selected background characteristics and physical violence.

RESULTS

The prevalence of physical violence among ever-partnered women was 20.6%. The bivariate findings showed that educational status, employment status, witness to inter-parental violence, partner's drinking habits, household wealth, educational difference, and province were statistically associated with physical violence. The multilevel analysis showed some evidence of between-cluster variation in physical violence. We found that age, education, employment status, witness to inter-parental violence, partner's drinking habits, household wealth, education difference, place of residence, and province were key predictors of physical violence. The odds of physical violence were more than two-fold in the Eastern Cape and Mpumalanga compared to Gauteng.

CONCLUSION

The study highlighted various key factors explaining physical violence. The findings suggest the need for targeted interventions aimed at specific communities of women, such as those from the Eastern Cape and Mpumalanga, as well as interventions that will empower women and address gender inequalities.

Male perspectives on intimate partner violence: A qualitative analysis from South Africa

BACKGROUND

Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV.

METHODS

We explored adult men's perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework.

RESULTS

Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence.

CONCLUSION

Interventions aimed at reducing IPV should consider the cultural and social impact on men's use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women.

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

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

Prevalence of Adverse Childhood Experiences in sub-Saharan Africa: A multicountry analysis of the Violence Against Children and Youth Surveys (VACS)

BACKGROUND

Adverse Childhood Experiences are traumatic events early in life and have been associated with significant negative health outcomes.

OBJECTIVE

To estimate the prevalence of ACEs in five low- and middle-income sub-Saharan African countries.

PARTICIPANTS AND SETTING

Nationally representative data from the Cote d'Ivoire (2018), Kenya (2019), Lesotho (2018), Mozambique (2019), and Namibia (2019) Violence Against Children and Youth Surveys (VACS) were used. Analyses were restricted to youth ages 18-24 years (n = 8766 females and 2732 males).

METHODS

VACS data were analyzed to generate sex-stratified weighted prevalence of individual ACEs (including sexual, physical, and emotional violence; witnessing interparental violence and violence in the community; and orphanhood) and aggregate ACEs (total ACEs; 0, 1-2, and 3 or more), for each country and combined.

RESULTS

The most common type of ACEs among both females and males was witnessing physical violence (males: 55.0 % [95 % CI: 51.1-58.8] and females: 37.2 % [95 % CI = 34.3-40.1]) followed by experiencing physical violence (males: 49.7 % [95 % CI = 45.5-53.9] and in females: 36.5 % [95 % CI = 33.8-39.2]). Prevalence of sexual violence was significantly higher in females than in males (16.0 % [95 % CI = 13.9-18.2] vs 8.3 % [95 % CI = 7.0-9.8]; p < 0.001). About 72 % of females and 82 % of males have experienced at least one form of ACE with 20 % of females and 24.2 % of males experiencing 3 or more ACEs.

CONCLUSION

This study demonstrated that majority of the children in countries in sub-Saharan Africa have experienced multiple ACEs in their lifetime. Understanding the extent of the problem will help design early interventions to reduce childhood exposure to ACEs or mitigate against the harmful impact of ACEs.

The role of a community health worker-delivered preconception and pregnancy intervention in achieving a more positive pregnancy experience: the Bukhali trial in Soweto, South Africa

BACKGROUND

A patient-centered, human-rights based approach to maternal care moves past merely reducing maternal mortality and morbidity, towards achieving a positive pregnancy experience. When evaluating an intervention, particularly in the context of the complex challenges facing maternal care in South Africa, it is therefore important to understand how intervention components are experienced by women. We aimed to qualitatively explore (i) factors influencing the pregnancy and postpartum experience amongst young women in Soweto, South Africa, and (ii) the influence of Bukhali, a preconception, pregnancy, and early childhood intervention delivered by community health workers (CHWs), on these experiences.

METHODS

Semi-structured, in-depth interviews were conducted with 15 purposively sampled participants. Participants were 18-28-year-old women who (i) were enrolled in the intervention arm of the Bukhali randomized controlled trial; (ii) were pregnant and delivered a child while being enrolled in the trial; and (iii) had at least one previous pregnancy prior to participation in the trial. Thematic analysis, informed by the positive pregnancy experiences framework and drawing on a codebook analysis approach, was used.

RESULTS

The themes influencing participants' pregnancy experiences (aim 1) were participants' feelings about being pregnant, the responsibilities of motherhood, physical and mental health challenges, unstable social support and traumatic experiences, and the pressures of socioeconomic circumstances. In terms of how support, information, and care practices influenced these factors (aim 2), four themes were generated: acceptance and mother/child bonding, growing and adapting in their role as mothers, receiving tools for their health, and having ways to cope in difficult circumstances. These processes were found to be complementary and closely linked to participant context and needs.

CONCLUSION

Our findings suggest that, among women aged 18-28, a CHW-delivered intervention combining support, information, and care practices has the potential to positively influence women's pregnancy experience in South Africa. In particular, emotional support and relevant information were key to better meeting participant needs. These findings can help define critical elements of CHW roles in maternal care and highlight the importance of patient-centred solutions to challenges within antenatal care.

TRIAL REGISTRATION

Pan African Clinical Trials Registry PACTR201903750173871, 27/03/2019.

Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic

BACKGROUND

Young women and Lesbian, Gay, Bisexual, Trans, Non-binary/no gender, or Questioning (LGBTQ+) youth in South Africa face some of the highest global levels of intimate partner violence (IPV). Given limited evidence in the wake of the COVID-19 pandemic, which has fuelled IPV globally, we aimed to describe and compare experiences and perpetration of IPV of youth aged 16-24 by sexual orientation and gender identity (SOGI).

METHODS

During the study period (December 2021-May 2022), youth aged 16-24 from eThekwini district, South Africa completed an online survey to understand multilevel impacts of the pandemic on youth. Participants were asked about experiences and perpetration of physical IPV since the start of the COVID-19 pandemic (March 2020). Descriptive statistics and adjusted logistic regressions compared the likelihood of experiencing and/or perpetrating physical IPV between cisgender and transgender inclusive heterosexual men; heterosexual women; gay, bisexual, or questioning men [GBQM]; lesbian, gay, bisexual, or questioning women [LGBQW]; or gender/sexual non-conforming youth [non-conforming].

RESULTS

Of 1,588 youth (mean age = 21.7 [SD = 2.3]; 71.7% Black) with non-missing SOGI and physical IPV data, 238 (15.0%) were LGBTQ+ (40.3% LGBQW and 36.1% non-conforming). Overall, 14.6% of respondents experienced physical IPV and 9.8% perpetrated physical IPV since the start of the pandemic, which differed by SOGI (12.3% of heterosexual men, 13.9% of heterosexual women, 22.0% of GBQM, 18.2% of LGBQW, and 25.0% of non-conforming youth experienced and 10.3% of heterosexual men; 7.7% of heterosexual women; 10.0% of GBQM; 18.2% of LGBQW; and 16.7% of non-conforming youth perpetrated). In adjusted models, compared to heterosexual women, non-conforming youth had increased odds of experiencing (adjusted odds ratio [aOR] = 2.36; 95%CI, 1.26-4.39) physical IPV and compared to heterosexual men, non-conforming youth had greater odds of perpetrating physical IPV (aOR = 2.19; 95%CI, 1.07-4.48) during the pandemic.

CONCLUSION

Over one in six youth in our study experienced and one in ten perpetrated physical IPV since the onset of the COVID-19 pandemic, with gender and sexual non-conforming youth experiencing and perpetrating IPV at significantly greater rates than cisgender/heterosexual peers. Our findings highlight the need for gender transformative efforts that move beyond the gender binary to support healthy relationships and IPV prevention for LGBTQ + youth in South Africa and globally.

Prevalence and comparison of psychological trauma and stressors in functional seizure patients from a public and private hospital

PURPOSE

To date not much is known about the differences, if any, between patients with functional seizures (FS) from different socioeconomic backgrounds. We sought to compare the psychological stress and trauma profiles of patients with FS from a private and public hospital in Cape Town, South Africa.

METHODS

Only video-electroencephalography-confirmed patients with FS were eligible for the study. In this retrospective case-control study we collected data on self-reported demographic and psychological stressor/trauma variables using digital patient records starting with the earliest available digital patient record for each hospital.

RESULTS

A total of 321 patients from a private hospital and 68 patients from a public hospital were included in the study. Most factors showed no significant differences. However, public hospital patients had higher odds of being older (p = 0.002), almost nine times the odds of reporting physical violence by an intimate partner (aOR = 8.65, 95% CI [1.70, 44.08]), more than eight times the odds of reporting psychological stress in the form of death and/or sickness in the family (aOR = 8.56, 95% CI [1.81, 40.41]) and almost three times the odds for other general psychosocial stressors (aOR = 2.82, 95% CI [1.08, 7.42]) compared to those attending the private hospital. They also had half the odds of being female compared to the private hospital patients (aOR = 0.47, 95% CI [0.23, 0.95]) and 93% fewer odds of reporting coming from an abusive home (aOR = 0.07, 95% CI [0.01, 0.52]).

CONCLUSION

History and psychological trauma and stressor profiles showed many similarities between the public and private hospital groups; however, some differences were noted and could benefit further exploration and consideration in therapeutic and diagnostic contexts.

'With this study, we have hope that something is coming': community members' perceptions of HIV cure-related research in Durban, South Africa - a qualitative focus group study

BACKGROUND

Developing a cure for HIV remains a global scientific priority. In 2022, the Females Rising through Education, Support and Health (FRESH) cohort launched an HIV cure-related trial involving an analytical treatment interruption (ATI) in Durban, South Africa.

OBJECTIVES

To explore community perspectives about HIV cure-related research.

METHODS

Between July-August 2022, we conducted three focus groups with community members. We transcribed audio recordings verbatim and used content analysis to analyze the data.

RESULTS

Twenty community members (13 women and 7 men) participated in three focus groups (HIV status not included). Participants viewed HIV cure-related research as a way to address the issue of defaulting on (not taking) HIV treatment. Participants expressed hesitancy around ATIs, since these contradict longstanding treatment adherence messages. Participants shared concerns around the risk of side effects from experimental interventions balanced against potential efficacy. They advocated for trial participants to have the right to decide whether to inform their sex partners about their HIV status and ATI participation, rather than research teams making disclosure mandatory. Focus group participants also emphasized the importance of using simple language to explain HIV cure-related research.

CONCLUSIONS

With HIV cure trials set to launch across Africa in the future, there is a critical need to better understand and respond to local community needs and preferences and to adopt this as standard practice prior to regional trial implementation.

Intimate Partner Violence in Khaliji Women: A Review of the Frequency and Related Factors

The Gulf Cooperation Council (GCC), locally known as Khaliji, is a group of six Arab nations, including Saudi Arabia, Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates (UAE). Intimate partner violence (IPV) is a significant public health concern in the aforementioned region, but research that synthesises this trend has remained scarce. The present narrative review examines existing research on the prevalence and frequency of IPV among Khaliji women who inhabit the GCC nations. This review synthesised studies on physical and sexual violence, emotional abuse, and controlling behaviours perpetrated by an intimate partner. The prevalence rates of IPV among Khaliji women were observed to be high: women reported facing different types of abuse from their partners, namely physical (7-71%), sexual (3.7-81%), financial (21.3-26%), and psychological (7.5-89%), which is a culmination of controlling behaviour (36.8%), emotional violence (22-69%), and social violence (34%). Existing studies in the GCC region suggest that the most endorsed IPV was psychological abuse (89%), followed by sexual violence (81%). Qualitative analysis of the content of associated factors resulted in four significant descriptors, such as victim demographics, sociocultural factors, socioeconomic factors, and perpetrator-related issues. Research on IPV is still in its nascent stages, with very few studies emanating from the GCC region. The way forward will require developing culturally appropriate interventions that address the unique risk factors for IPV among the Khaliji population, strengthening institutional responses, and increasing awareness and social support for victims of IPV.

Intimate partner violence victimization during pregnancy increases risk of postpartum depression among urban adolescent mothers in South Africa

BACKGROUND

It is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study's purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers.

METHODS

Adolescent mothers (14-19 years) were recruited at a regional hospital's maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6-9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates.

RESULTS

Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6-9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97-2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06-2.49; p = 0.03).

CONCLUSIONS

Poor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers' well-being and their baby's health.

Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: multilevel analysis based on 2016 Ethiopian Demographic and Health Survey

BACKGROUND

The period of youth is important for the foundation of healthy and stable relationships, women's health and well-being. Youth women face a higher risk of experiencing violence than older women. Intimate partner violence (IPV) against youth women is a significant public health concern. Despite paramount negative health consequences of IPV for the survivor, as per our knowledge, research study on IPV and associated factors among youth women in Ethiopia is scarce. Therefore, this study aimed to assess the magnitude and associated factors of IPV among youth women in Ethiopia.

METHODS

The data was accessed from 2016 Ethiopia demographic and health survey (EDHS) which was a cross sectional population based household survey. It was also conducted using a multi-stage stratified random cluster sampling approach. The data were cleaned, weighted, and analyzed using STATA Version 14 software. The total weighted sample of 1077 youth women were used in this study. Multilevel logistic regression modeling was used to determine factors associated with IPV among youth women. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to declare the significant variables.

RESULTS

Among the total participants, 30.27% (95% CI 27.59, 33.09) of youth women experienced IPV. Individual level variables such as: Being widowed/divorced/separated (AOR = 2.28; 95% CI 1.33, 3.91), having a partner who drinks alcohol (AOR = 5.76; 95% CI 3.42, 9.69), witnessing inter-parental violence during childhood (AOR = 3.45; 95% CI 2.21, 5.37), being afraid of partners (AOR = 7.09; 95% CI 4.30, 11.68), and from community level variables, youth women residing in communities with a low proportion of educated youth women (AOR = 0.31; 95% CI 0.13, 0.78) were significantly associated with having experience of IPV.

CONCLUSION

The magnitude of intimate partner violence among youth women in Ethiopia was relatively high as compared to the global estimate of IPV. Individual and community level variables such as currently widowed/divorced/separated women, having a partner who drinks alcohol, witnessing inter-parental violence, being afraid of partner, and women from a low proportion of community level youth women's education were significantly associated with intimate partner violence. To decrease this public health problem, it is better to strengthen legislation on the purchase and sale of alcohol, provide legal protection for separated/divorced women, establish effective legal response services for IPV, promote gender equality, and provide psychological support for those who witnessed inter-parental violence during childhood to reduce IPV.

Bringing social context into global biomedical HIV cure-related research: An urgent call to action

Advances in science have ushered in a wave of new potential curative and control strategies for HIV that could eliminate the current requirement for life-long antiretroviral therapy (ART) for people living with HIV (PLWH). In this article, we argue that it is critical to consider social contexts in the development of HIV cure trial protocols. The biological and behavioral risk factors for HIV acquisition by study participants are inseparable from the social context in which these participants live. The article discusses an example of a cohort established to further HIV cure research that included social context, called the FRESH Acute HIV study, which combines a sociostructural intervention while conducting HIV prevention, treatment and cure-related research in Durban, South Africa. We make an urgent call to action to include sociobehavioral components as instrumental in future HIV cure trials in global context.

Socio-economic differences in the uptake of HIV testing and associated factors in South Africa

BACKGROUND

Improved understanding of barriers to HIV testing is important for reaching the first of the UNAIDS 90-90-90 targets, which states that 90% of HIV positive individuals ought to know their HIV status. This study examined socio-economic status (SES) differences in HIV testing uptake and associated factors among youth and adults 15 years and older in South Africa.

METHODS

This study used data from a national cross-sectional, population-based household survey conducted in 2017 using a multi-stage sampling design. A composite SES score was created using multiple correspondence analyses of household assets; households were classified into wealth quintiles and dichotomised into low SES/poorest (lowest 3 quintiles) and high SES/less-poor (highest 2 quintiles). Bivariate and multivariate logistic regression models were used to examine factors associated with the uptake of HIV testing in low and high SES households.

RESULTS

HIV testing uptake was 73.8 and 76.7% among low and high SES households, respectively, both of which were below the first 90 targets. Among both low and high SES households, increased HIV testing uptake was significantly associated with females than males. The decreased likelihood was significantly associated with residing in rural formal areas than urban areas, those with no education or low levels of educational attainment and alcohol drinkers among low SES households. Whites and Indians/Asians had a decreased likelihood than Black Africans in high SES households.

CONCLUSIONS

HIV testing interventions should target males, residents in rural formal areas, those with no or low education and those that consume alcohol in low SES households, including Whites and Indians/Asians from high SES households in order to bridge socio-economic disparities in the uptake of HIV testing. This should entail expanding HIV testing beyond traditional centres for voluntary counselling and testing through outreach efforts, including mobile testing and home-based testing.