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Miller AP, Appa A, Muyindike W, Fatch R, Kekibiina A, Beesiga B, Adong J, Emenyonu N, Marson K, Getahun M, Kamya M, Chamie G, Camlin CS, Hahn JA. A Qualitative Exploration of Intimate Partner Violence Among HIV/TB Coinfected Persons With Problematic Alcohol Use Participating in an Incentive-Based Alcohol/Medication Adherence Intervention in Uganda During COVID-19. Violence Against Women 2024:10778012231225229. [PMID: 38196278 PMCID: PMC11231058 DOI: 10.1177/10778012231225229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
In Uganda, four in ten women report experiencing intimate partner violence (IPV) in the past year. Salient drivers of IPV in sub-Saharan Africa include stress related to household finances, alcohol use, and partner infidelity. We conducted 42 interviews with participants (n = 32) in the Drinkers' Intervention to Prevent Tuberculosis (DIPT) study which included economic incentives, and their partners (n = 10) to understand how participating in DIPT during COVID-19 lockdown restrictions impacted relationship dynamics in intimate partnerships. Our findings highlight the need to develop policies to address root causes of IPV and to ensure continuity of IPV services in future pandemics. Policy and programming recommendations based on study results are presented.
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Affiliation(s)
- Amanda P Miller
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Julian Adong
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka Emenyonu
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kara Marson
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Moses Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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DeHond A, Brady F, Kalokhe AS. Prevention of Perpetration of Intimate Partner Violence by Men and Boys in Low- and Middle-Income Countries: A Scoping Review of Primary Prevention Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:2412-2428. [PMID: 35511498 DOI: 10.1177/15248380221097441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intimate partner violence (IPV) affects the health of women across the globe, with the greatest burden encountered by women in low- and middle-income countries (LMICs). This scoping review aims to summarize and critically examine primary prevention interventions addressing IPV perpetration by men and boys in LMICs and identify gaps in the evidence base. PubMed, EMbase, and PsychINFO were searched for articles published between January 2001 and October 2020 that examined the efficacy of primary prevention interventions to prevent IPV perpetration by men/boys in LMICs and reported on a quantitative outcome examining IPV perpetration. Data on study population, setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Effective Public Health Practice Project tool. Of 8,392 articles, 16 intervention studies met inclusion criteria. All 16 were of moderate or weak quality. The majority were conducted in Africa, delivered by peers, theoretically grounded, and included content to challenge IPV acceptance and gender norms. Half demonstrated intervention efficacy in prevention of IPV perpetration; these studies tended to intervene at multiple levels of the Socio-Ecological Model, be delivered over a minimum of eight sessions, and utilize a validated IPV measure to assess intervention impact. In conclusion, the field of IPV perpetration prevention research in LMICs is rapidly evolving, with many interventions demonstrating promise. Future intervention studies should consider expanding to LMICs outside Africa, targeting school-age youth, exploring whether shorter intervention durations are effective, and addressing the methodological shortcomings noted in the quality assessment.
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Affiliation(s)
- Allayna DeHond
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Forrest Brady
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Ameeta S Kalokhe
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, USA
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Walsh AR, Stephenson R. Intimate Partner Violence Perpetration Denial and Underreporting in Cisgender Male Couples. INTERVENCION PSICOSOCIAL 2023; 32:109-121. [PMID: 37383641 PMCID: PMC10294463 DOI: 10.5093/pi2023a8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/10/2023] [Indexed: 06/30/2023]
Abstract
Intimate partner violence (IPV) perpetrators often deny their actions, limiting opportunities for intervention. Cisgender male couples experience similar IPV rates to mixed-gender couples, yet less is known about how men in same-sex relationships deny or report their IPV behavior. This study aimed to describe perpetration denial across emotional, monitoring/controlling, and physical/sexual IPV, and to identify correlates of perpetration denial, in a convenience sample of male couples (N = 848; United States, 2016-2017). Past-year victimization and perpetration were measured with the IPV-Gay and Bisexual Men (GBM) scale; perpetration deniers were men whose self-reported perpetration contradicted their partner's reported victimization. Individual-, partner-, and dyadic-correlates of perpetration denial, by IPV-type, were identified using actor-partner interdependence models. We identified 663 (78.2%) perpetrators: 527 emotional; 490 monitoring/controlling; 267 physical/sexual. Thirty-six percent of physical/sexual-, 27.7% of emotional-, and 21.43% of monitoring/controlling-perpetrators categorically denied their actions. Depression was negatively associated with denying monitoring/controlling-perpetration (odds ratio 95% confidence interval: 0.91 [0.84, 0.99]) and physical/sexual-perpetration (0.91 [0.83, 0.97]); dyadic differences in depression were associated with emotional-perpetration denial (0.95 [0.90, 0.99]). Recent substance users had 46% lower odds of monitoring/controlling-denial (0.54 [0.32, 0.92]), versus non-users. Partner-race and employment were also significantly associated with emotional perpetration denial. This study highlights IPV denial's complexities, including differences across IPV types. Further investigations into how cisgender men in same-sex couples perceive and report various types of IPV perpetration will provide valuable insight into how an underserved and understudied population experiences IPV.
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Affiliation(s)
- Alison R. Walsh
- University of MichiganCenter for Sexuality and Health DisparitiesAnn ArborUSACenter for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Rob Stephenson
- University of MichiganCenter for Sexuality and Health DisparitiesAnn ArborUSACenter for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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Castilla C, Murphy DMA. Bidirectional intimate partner violence: Evidence from a list experiment in Kenya. HEALTH ECONOMICS 2023; 32:175-193. [PMID: 36221234 DOI: 10.1002/hec.4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/17/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Intimate Partner Violence (IPV) continues to be a major public health concern that can both respond to economic policies and affect economic outcomes. Few studies regarding IPV, however, take a gender inclusive approach towards its identification. Using a sample of both men and women from rural Kenya, we are the first, to our knowledge, to conduct a list experiment with cohabiting married couples to identify the prevalence of physical violence on both men and women. We find that 14 percent of respondents agree with the statement "my spouse regularly hits me". In contrast to other survey evidence that uses direct elicitation, we find no differences in the prevalence of male-to-female and female-to-male violence. We provide supporting evidence that bidirectional IPV accounts for the lack of gender differences. A complete understanding of the typology of IPV can be crucial for policies seeking IPV reduction.
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Howard JA, Gibson MA. Testing evolutionary conflict theories for sexual and physical intimate partner violence in Sub-Saharan Africa. EVOLUTIONARY HUMAN SCIENCES 2022; 5:e6. [PMID: 37587946 PMCID: PMC10426027 DOI: 10.1017/ehs.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
Intimate partner violence (IPV) refers to physical, sexual and psychological violence. Here an evolutionary approach is used to compare risk factors for male-to-female IPV perpetration, analysing physical and sexual IPV separately. Two hypotheses based on sexual conflict theory have been applied to IPV perpetration, but they remain largely untested using empirical data: (a) men perpetrate IPV in response to a perceived threat to their paternity certainty; and (b) IPV is caused by men pursuing a higher fertility optima than their partners, either within marriage (reproductive coercion) or outside marriage (paternal disinvestment). Demographic Health Survey data from couples in 12 sub-Saharan African countries (n = 25,577) were used to test these evolutionary hypotheses, using multilevel models and controlling for potential social and environmental confounds. The results show that evolutionary theory provides important insight into different risk factors by IPV type. Indicators of paternity concern are associated with an increased risk of both physical and sexual IPV, indicators of paternal disinvestment are associated with an increased risk of physical IPV only, while reproductive coercion is not associated with either IPV type. The risk factors identified here correspond with proximate-level explanations for IPV perpetration, but an evolutionary interpretation explains why these particular factors may motivate IPV in certain contexts.
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Affiliation(s)
- Janet A. Howard
- Department of Anthropology and Archaeology, University of Bristol, 43 Woodland Road, Bristol BS8 1UU, UK
| | - Mhairi A. Gibson
- Department of Anthropology and Archaeology, University of Bristol, 43 Woodland Road, Bristol BS8 1UU, UK
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Leight J, Deyessa N, Sharma V. Predictors of Discordance and Concordance in Reporting of Intimate Partner Violence: Evidence From a Large Sample of Rural Ethiopian Couples. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP23156-NP23179. [PMID: 35324368 DOI: 10.1177/08862605221076163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intimate partner violence (IPV) is a major worldwide health challenge, and addressing this challenge requires high-quality data. This analysis uses a large-scale survey of 5033 households in rural Ethiopia in which both men and women were surveyed about past-year IPV in order to quantify the degree of discordance, including both husband only reporting and wife only reporting, for multiple forms of IPV (emotional, physical, and sexual). In addition, logistic regression is employed to analyze the effects of demographic characteristics and individual norms and behaviors on the probability of discordant reporting. The results suggest that almost half of households (44%) are characterized by discordant reporting in at least one dimension of IPV. Given the high level of discordance, 61.4% of households report any physical and/or sexual IPV using the household-level measure, compared to a rate of 41.9% from the women's data only. In addition, men who report more gender-equitable attitudes and behaviors (failing to concur with justifications for IPV, reporting higher support for gender equitable norms, and reporting a higher level of female engagement in decision-making and intrahousehold task-sharing) are more likely to be members of wife only reporting households: that is, they are less likely to report perpetration of IPV. Women who report more gender-equitable attitudes and behaviors, by contrast, are more likely to be members of husband only reporting households.
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Affiliation(s)
| | | | - Vandana Sharma
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Kilgallen JA, Schaffnit SB, Kumogola Y, Galura A, Urassa M, Lawson DW. Positive Correlation Between Women's Status and Intimate Partner Violence Suggests Violence Backlash in Mwanza, Tanzania. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20331-NP20360. [PMID: 34802316 DOI: 10.1177/08862605211050095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Urbanization in low and middle-income nations is characterized by economic and demographic shifts largely understood to be beneficial to women's empowerment. These changes include increased education and wage-labor opportunities, a disruption of traditional patrilocal residence systems, and reductions in spousal age gap and fertility. However, such changes may drive a "violence backlash," with men increasing intimate partner violence (IPV) in efforts to challenge women's shifting status. To date, tests of this idea primarily relate to women's changing economic status, with less known about the demographic correlates of IPV in urbanizing settings. Addressing this, we conducted a cross-sectional study of IPV behavior and attitudes in an urbanizing community in Mwanza, northern Tanzania (n = 317). Consistent with a violence backlash, IPV was reported more often among women educated at higher levels than their husband, and women earning similar, rather than lower, wages to their husband were more likely to report that he condones IPV. These findings were independent of women's absolute education and income. Furthermore, less frequent paternal kin contact, and relatively small spousal age gaps, generally understood to boost women's empowerment, were associated with an increased risk of experiencing IPV. Less frequent paternal kin contact was also associated with an increased likelihood that a husband condones IPV. Contrary to our predictions, relatively lower fertility, generally linked to higher women's empowerment, did not predict IPV behavior and women with high, rather than low, fertility were more likely to report that their husband condones IPV. Overall, our results support the notion of a violence backlash corresponding to economic changes for women that accompany urbanization. In contrast, demographic changes associated with urbanization have more variable relationships. Drawing on these results, we suggest future research avenues for better understanding the vulnerability of women to IPV in urbanizing settings.
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Affiliation(s)
- Joseph A Kilgallen
- Department of Anthropology, 8786University of California, Santa Barbara, CA, USA
| | - Susan B Schaffnit
- Department of Anthropology, 8786University of California, Santa Barbara, CA, USA
| | - Yusufu Kumogola
- 119151National Institute for Medical Research, Mwanza, Tanzania
| | - Anthony Galura
- Department of Anthropology, 8786University of California, Santa Barbara, CA, USA
| | - Mark Urassa
- 119151National Institute for Medical Research, Mwanza, Tanzania
| | - David W Lawson
- Department of Anthropology, 8786University of California, Santa Barbara, CA, USA
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Miller AP, Fatch R, Lodi S, Marson K, Emenyonu N, Kekibiina A, Beesiga B, Chamie G, Muyindike WR, Hahn JA. Unhealthy alcohol use and intimate partner violence among men and women living with HIV in Uganda. BMC Public Health 2022; 22:1886. [PMID: 36217183 PMCID: PMC9552439 DOI: 10.1186/s12889-022-14295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/25/2022] [Accepted: 09/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Intimate partner violence (IPV) and alcohol use are interrelated public health issues. Heavy and frequent alcohol use increase the risk of IPV, but the relationship between alcohol use and IPV (including recent and lifetime IPV victimization and perpetration) has not been well described among persons living with HIV (PWH) in sub-Saharan Africa. Methods We used baseline data from the Drinker’s Intervention to Prevent Tuberculosis study. All participants were PWH co-infected with tuberculosis and had an Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) positive score (hazardous drinking) and positive urine ethyl glucuronide test, indicating recent drinking. High-risk drinking was defined as AUDIT-C > 6 and/or alcohol biomarker phosphatidylethanol (PEth) ≥ 200 ng/mL. We measured IPV using the Conflict Tactics Scale. We estimated the association between alcohol use level and recent (prior six months) IPV victimization (recent perpetration was too low to study) using multivariable logistic regression models adjusted for gender, age, assets, education, spouse HIV status, religiosity, depressive symptoms, and social desirability. We additionally estimated the interaction of alcohol use and gender on IPV victimization and the association between alcohol use and lifetime victimization and perpetration. Results One-third of the 408 participants were women. Recent IPV victimization was reported by 18.9% of women and 9.4% of men; perpetration was reported by 3.1% and 3.6% of women and men. One-fifth (21.6%) of those reporting recent IPV victimization also reported perpetration. In multivariable models, alcohol use level was not significantly associated with recent IPV victimization (p = 0.115), nor was the interaction between alcohol use and gender (p = 0.696). Women had 2.34 times greater odds of recent IPV victimization than men (p = 0.016). Increasing age was significantly associated with decreased odds of recent IPV victimization (p = 0.004). Conclusion Prevalence of IPV victimization was comparable to estimates from a recent national survey, while perpetration among men was lower than expected. Alcohol use level was not associated with IPV victimization. It is possible that alcohol use in this sample was too high to detect differences in IPV. Our results suggest that women and younger PWH are priority populations for IPV prevention.
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Affiliation(s)
- Amanda P Miller
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Robin Fatch
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sara Lodi
- Boston University School of Public Health, Boston, MA, USA
| | - Kara Marson
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nneka Emenyonu
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Winnie R Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Judith A Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Christopher E, Drame ND, Leyna GH, Killewo J, Bärnighausen T, Rohr JK. Disclosure of intimate partner violence by men and women in Dar es Salaam, Tanzania. Front Public Health 2022; 10:928469. [PMID: 36225776 PMCID: PMC9549336 DOI: 10.3389/fpubh.2022.928469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Intimate Partner Violence (IPV) has severe health consequences, though may be underreported due to stigma. In Tanzania, estimates of IPV prevalence range from 12 to >60%. List experiments, a technique of indirectly asking survey questions, may allow for more accurate prevalence estimates of sensitive topics. We examined list experiment and direct questions about experiences of physical and sexual IPV from a 2017 cross-sectional survey among 2,299 adults aged 40+ years in Dar es Salaam. List experiment prevalence estimates were determined through quantitative analysis and compared qualitatively to direct question prevalence estimates. The list experiment estimated a higher prevalence of IPV in all cases except for physical violence experienced by women. This study contributes to the estimation of IPV prevalence. If the list experiment estimates yield an unbiased estimate, findings suggest women openly report experiencing physical IPV, and IPV experienced by men is underreported and understudied.
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Affiliation(s)
- Enryka Christopher
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States,*Correspondence: Enryka Christopher ;
| | - Ndeye D. Drame
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States
| | - Germana H. Leyna
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States
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Abramsky T, Harvey S, Mosha N, Mtolela G, Gibbs A, Mshana G, Lees S, Kapiga S, Stöckl H. Longitudinal inconsistencies in women's self-reports of lifetime experience of physical and sexual IPV: evidence from the MAISHA trial and follow-on study in North-western Tanzania. BMC Womens Health 2022; 22:120. [PMID: 35428296 PMCID: PMC9013096 DOI: 10.1186/s12905-022-01697-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/05/2022] [Indexed: 11/14/2022] Open
Abstract
Background Intimate partner violence (IPV) against women is pervasive throughout the world, with profound consequences for women’s health. Research to understand the extent, causes and consequences of IPV relies on self-reported data on violence, and yet there is a paucity of research into the consistency with which women report lifetime IPV over time. Methods We use data from the control group of the cluster randomised trial and a follow-on longitudinal study in Tanzania to examine discrepancies in women’s reported experience of lifetime physical IPV and sexual IPV over three time-points (T0, T29, T53 months). Among those reporting lifetime history of IPV at T0, we calculate the proportion who subsequently report no lifetime history at T29 and/or T53 (‘discrepant’ reporting). We use logistic regression to explore associations between discrepant reporting and respondent baseline characteristics, the nature of their IPV experiences at baseline, and situational factors at T53. Results Complete IPV data were available for 301 women. At T0, 154 (51%) women reported lifetime history of physical IPV, of whom 62% gave a discrepant ‘never’ report in a subsequent round. Among 93 (31%) with lifetime history of sexual IPV at T0, 73% provided a subsequent discrepant report. 73% of women reported lifetime physical IPV, and 55% lifetime sexual IPV in at least one survey round. For both IPV outcomes, women were less likely to provide discrepant reports if they had recent IPV at baseline, poor mental health (T53) and poor communication with partner (T53). For physical IPV only, reduced discrepant reporting was also associated with baseline household-level financial hardship and more severe or extensive experience of IPV. Conclusions A large proportion of women provided discrepant reports over the course of the study. Prevalence estimates of lifetime IPV from one-off cross-sectional surveys are likely to be underestimates, biased towards more recent and severe cases. To improve the stability of IPV measures, researchers should explicitly clarify the meaning of reference periods such as ‘ever’, consider using shorter reference periods (e.g. past-year), and avoid filter questions that use positive reports of lifetime IPV as a gateway to asking about more recent experiences. Trial registration: Maisha CRT01 registered at ClinicalTrials.gov #NCT02592252, registered retrospectively (13/08/2015). Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01697-y.
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Affiliation(s)
- Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
| | - Neema Mosha
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
| | - Grace Mtolela
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, 491 Peter Mokaba Road, Durban, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania.,National Institute for Medical Research, Isamilo Road, Mwanza, Tanzania
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, PO Box 11936, Mwanza, Tanzania.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Heidi Stöckl
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, München, Germany. .,Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, München, Germany.
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Gibson MA, Gurmu E, Cobo B, Rueda MM, Scott IM. Measuring Hidden Support for Physical Intimate Partner Violence: A List Randomization Experiment in South-Central Ethiopia. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP4238-NP4257. [PMID: 32370582 PMCID: PMC8980453 DOI: 10.1177/0886260520914546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Understanding how and why physical intimate partner violence (IPV) persists in high-risk communities has proven difficult. As IPV is both sensitive and illegal, people may be inclined to misreport their views and experiences. By embedding a list randomization experiment (LRE), which increases respondent privacy, in a survey of 809 adult Arsi Oromo men and women in rural south-central Ethiopia, we test the reliability of direct questioning survey methods (e.g., used in the Demographic and Health Surveys) for measuring attitudes that underpin the acceptability of IPV. Participants were randomly assigned versions of the survey in which they were asked either directly or indirectly about the acceptability of wife-beating. By comparing responses across these surveys, we identify the extent to which views are being misreported using direct questioning methods, as well as identifying the "true" predictors of continued support for wife-beating. Indirect questioning reveals that almost one third of the sample believe that wife-beating is acceptable. Adults (particularly men) who are less educated (<3 years schooling) or living in households where women do not participate in economic decision making are among those most likely to identify wife-beating as justifiable (>50% endorsement). These individuals, however, are also more inclined to hide their approval when asked directly by an interviewer. That we find high but underreported support for wife-beating among some members of the community demonstrates a clear need to encourage a more open dialogue, to prevent violence toward women remaining undetected and thus unchanged. This finding also raises questions about the accuracy of traditional direct questioning for capturing information on IPV attitudes and norms. Of relevance to policy, we find that wife-beating is entirely absent only among adults with higher levels of education, living in households where decision making is shared between couples.
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Goyomsa GG, Albe TA, Debela SA, Kitaw LD. Current intimate partner violence and associated factors among sero-positive women attending Adama town ART Clinics, Central Ethiopia 2019. Int J Equity Health 2022; 21:44. [PMID: 35361220 PMCID: PMC8973560 DOI: 10.1186/s12939-022-01647-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence against women is a behavior within an intimate relationship that causes physical, sexual, or psychological harm to the victim. It is well recognized as a gross violation of human rights and affects the health of women, families, and the community at large. However, the level to which Human Immuno Deficiency virus sero-positive women are experiencing recent intimate partner violence and its associated factors have not been well investigated as the majority of the study done so far were focused on the study of lifetime violence and violence among women in the general population. The study was conducted to determine the prevalence and factors associated with current intimate partner violence among sero-positive women. METHODS A facility-based cross-sectional study was conducted from March 2019 to April 2019 among 396 sero-positive women visiting anti-retroviral therapy (ART) units of Adama town public health facilities. A systematic random sampling technique was used to select individual participants. Validated World Health Organization (WHO) tools were used to collect information on the outcomes and key independent variables. The collected data were entered into Epidata version 4.4.6 and analyzed using SPSS version 24. Descriptive statistics were used to compute summary statistics and proportion. Variables at a cut-off value of 0.25 on bivariate analysis and 0.05 during multivariate logistic regression were used to identify factors associated with recent intimate partner violence. RESULT The response rate in this study was 100% since all women approached took part in this study. The prevalence of current intimate partner violence was 32.3% while lifetime intimate partner violence (IPV) was 45.5%. Exposure to coerced first sexual intercourse [AOR = 3.0 (1.73, 5.44)], male multi-partnership [AOR = 2.2 (1.21, 4.06)], believing in the husband's right to sex [AOR = 2.3 (1.29, 4.12)], contraceptive use [AOR = 3.33 (1.67, 6.62)], and having farmer partner [AOR = 3.9 (1.43, 10.79)] were significantly associated with current intimate partner violence. CONCLUSION One-in-three women reported at least 2 or more forms of violence from their intimate partner. Individual-level factors (Exposure to coerced first sexual intercourse, partner's occupation, contraceptive use, and believing in husband's right to sex and relationship factor (Male multi-partnership) were significantly associated with recent intimate partner violence. Combined efforts are required to avert intimate partner violence among women on ART while targeting risky sexual behavior practiced among male partner factors significantly associated with violence.
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Affiliation(s)
| | - Teklu Arga Albe
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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Callands TA, Gilliam SM, Sileo KM, Taylor EN, Hunter-Jones JJ, Hansen NB. Examining the Influence of Trauma Exposure on HIV Sexual Risk Between Men and Women in Post-Conflict Liberia. AIDS Behav 2021; 25:1159-1170. [PMID: 33180254 PMCID: PMC7979480 DOI: 10.1007/s10461-020-03088-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
The adverse impact of exposure to war-related traumatic events on mental health is well documented. Few studies, however, have focused on the impact of exposure to war-related traumatic events on HIV sexual risk behavior in post-conflict countries such as Liberia. We investigated whether exposure to war-related traumatic events was linked to HIV sexual risk behavior, and identified potential mediators of this relationship, including stressful life events, problematic alcohol use, and intimate partner violence (IPV) among women and men in Liberia. Data were collected from a sample of 395 participants in Monrovia, Liberia. Results from the serial multiple mediator model did not support direct or indirect effects between war-related traumatic events and HIV sexual risk behavior among women. For men, we found both direct and indirect effects between war-related traumatic events and HIV sexual risk behavior. Findings from this research highlight the need for trauma-informed HIV prevention strategies in Liberia.
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Affiliation(s)
- Tamora A Callands
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall, Athens, GA, 321D30602-6522, USA.
| | - Shantesica M Gilliam
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall, Athens, GA, 321D30602-6522, USA
| | - Katelyn M Sileo
- Department of Public Health, College of Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | - Erica N Taylor
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall, Athens, GA, 321D30602-6522, USA
| | - Josalin J Hunter-Jones
- School of Social Work, College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall, Athens, GA, 321D30602-6522, USA
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Abramsky T, Kapinga I, Mshana G, Lees S, Hansen CH, Hashim R, Stöckl H, Kapiga S, Harvey S. Couples data from north-western Tanzania: Insights from a survey of male partners of women enrolled in the MAISHA cluster randomized trial of an intimate partner violence prevention intervention. PLoS One 2020; 15:e0240112. [PMID: 33006997 PMCID: PMC7531846 DOI: 10.1371/journal.pone.0240112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Globally, around 30% of ever-partnered women have experienced physical and/or sexual intimate partner violence (IPV) during their lifetime. To date, most research into causes and prevention of IPV involves surveys of women, with little research into risk-factors for male perpetration. This paper describes a survey of male partners of women participating in the MAISHA cluster randomised trial (CRT) of an IPV prevention intervention, in Mwanza City, Tanzania. Using linked couples' data, we explore man-, woman-, and relationship-/household-level factors associated with physical and sexual IPV. METHODS Women were interviewed at baseline and 29-months follow-up. At follow-up, women were asked for consent to invite their partner to participate in the male survey. We describe response rates for the women's follow-up and male partners' surveys, and identify factors associated with women's consent to approach partners. Multivariate logistic regression was used to explore factors associated with women's past-year experiences of physical and sexual IPV. RESULTS 512 (65%) partnered women consented for the partner to be approached, higher among intervention than control women. 425 (83%) male partners were interviewed. Women consenting were disproportionately likely to be in longer-term relationships. Past-year IPV was associated with lower consent among control women, but greater consent in the intervention arm. Factors associated with increased odds of physical IPV were women's childhood experiences of abuse, young age, women's lower income and women's attitudes justifying IPV. Sexual IPV was associated with women's childhood experiences of abuse, young age, educational disparity within couple, men's alcohol use and women's poor mental health. CONCLUSIONS We successfully conducted a survey of male partners with the full consent of women trial participants. The breadth of factors associated with IPV demonstrates the need for IPV prevention interventions to work with women and men, and specifically couples. Interventions should address risk-factors for both physical and sexual IPV.
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Affiliation(s)
- Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Imma Kapinga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Heidi Stöckl
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
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Stephenson R, Sharma A, Mimiaga MJ, Garofalo R, Brown E, Bratcher A, Wimbly T, Hidalgo MA, Hoehnle S, Thai J, Sullivan PS, Suarez NA. Concordance in the reporting of intimate partner violence among male-male couples. JOURNAL OF FAMILY VIOLENCE 2019; 34:677-686. [PMID: 32773962 PMCID: PMC7413602 DOI: 10.1007/s10896-019-00076-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Intimate partner violence (IPV) among male couples is increasingly recognized as a public health concern. Research on IPV in opposite sex couples indicates frequent underreporting of IPV and high levels of discordance in reporting among dyads. Concordance studies inform refinement methods to measure the experience of IPV among dyads; however the lack of dyadic studies of male couples impedes our understanding of the extent to which IPV is differentially reported in male-male dyads. This study utilized baseline data from a randomized controlled trial of a behavioral intervention to optimize antiretroviral therapy (ART) adherence among 160 sero-discordant male couples in three US cities and provides the first analysis of concordance in reporting IPV among male couples. Low degrees of concordance in the reporting of IPV were identified among male dyads, with a greater proportion of men reporting violence perpetration than experiencing violence. The greater reporting of IPV perpetration may be linked to adherence to concepts of masculinity. The results underscore the unique experiences of IPV among male couples and the need to reexamine current IPV measurement and intervention strategies.
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Affiliation(s)
- R Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - A Sharma
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - M J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - R Garofalo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - E Brown
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - A Bratcher
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - T Wimbly
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M A Hidalgo
- Center for Trans Youth Health and Development, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Hoehnle
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - J Thai
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - P S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - N A Suarez
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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