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Sheira LA, Wekesa P, Cohen CR, Weke E, Frongillo EA, Mocello AR, Dworkin SL, Burger RL, Weiser SD, Bukusi EA. Impact of a livelihood intervention on gender roles and relationship power among people with HIV. AIDS 2024; 38:95-104. [PMID: 37788108 PMCID: PMC10842405 DOI: 10.1097/qad.0000000000003742] [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] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To evaluate the impact of an agricultural livelihood intervention on gender role conflict and sexual relationship power among people with HIV (PWH) in western Kenya. DESIGN Study participants were enrolled in Shamba Maisha , a cluster randomized controlled trial of an agricultural intervention conducted among PWH across 16 health facilities during 2016-2020. Intervention participants received a water pump, seeds, and agricultural and financial training; control participants received standard of HIV care. METHODS We assessed men's views on masculinity and gender roles via the validated gender role conflict score (GRCS; range 18-78, higher = greater gender role conflict). We measured gender power imbalances among women via the validated Sexual Relationship Power Scale (SRPS), which combines subscales of relationship control and decision-making dominance (range 1-4, higher = female holds more power). We compared changes over the study period by arm using longitudinal multilevel difference-in-difference linear regression models accounting for clustering of facilities using the intention-to-treat cohort. RESULTS We enrolled 720 participants (366 intervention, 354 control); 2-year retention was 94%. Median age was 40 and approximately 55% of participants were female. Among men, after 24-months the decrease in GRCS scores was 4.3 points greater in the intervention than the control arm ( P < 0.001). Among women, the intervention resulted in 0.25 points greater increase in the SRPS compared to the control arm ( P < 0.001). CONCLUSIONS Shamba Maisha resulted in less gender role conflict in men and greater sexual relationship power for women. Agricultural livelihood interventions may be a powerful tool to improve gender power imbalances, which may subsequently mitigate poverty and food insecurity.
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Affiliation(s)
- Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington, USA
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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Selestine V, Harvey S, Mshana G, Kapiga S, Lees S. The Role of Structural Factors in Support-Seeking Among Women Experiencing Intimate Partner Violence (IPV) in Mwanza, Tanzania: Findings From a Qualitative Study. Violence Against Women 2023; 29:1024-1043. [PMID: 35213259 DOI: 10.1177/10778012221077130] [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] [Indexed: 11/16/2022]
Abstract
In this qualitative study of women participating in an intimate partner violence (IPV) prevention trial, experiences of IPV and the context that shapes support-seeking were explored through in-depth interviews and focus groups discussions. Decisions to seek support were influenced by a range of factors including fear of further abuse, shame, acceptance of IPV as normal, belief that IPV is a private matter between the couple, economic dependence on male partners, and a poorly responsive legal and justice system. Gender empowerment programs need to intervene at the social, cultural, political, and economic levels that shape justification and meanings attached to IPV and women's decisions in seeking support.
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Affiliation(s)
- Veronica Selestine
- 558110Mwanza Intervention Trials Unit, 119151National Institute of Medical Research, Mwanza, Tanzania
| | - Sheila Harvey
- 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Gerry Mshana
- 558110Mwanza Intervention Trials Unit, 119151National Institute of Medical Research, Mwanza, Tanzania
| | - Saidi Kapiga
- 558110Mwanza Intervention Trials Unit, 119151National Institute of Medical Research, Mwanza, Tanzania
- 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Shelley Lees
- 4906London School of Hygiene and Tropical Medicine, London, UK
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Makkan H, Maenetje P, Chetty-Makkan CM, Muchiri E, Latka MH, Edward VA, Price MA, Omosa-Manyonyi G, Lindan C. Attitudes Toward Gender-Based Violence Among Sexually Active Adult Men at High Risk for HIV in Rustenburg, South Africa. Am J Mens Health 2022; 16:15579883221106331. [PMID: 35748400 PMCID: PMC9234859 DOI: 10.1177/15579883221106331] [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] [Indexed: 11/17/2022] Open
Abstract
Gender-based violence (GBV) toward women is widespread and has been associated with increased HIV risk. We investigated attitudes toward GBV among men living in Rustenburg, South Africa, who were enrolled in a longitudinal HIV incidence study. Participants were 18 to 49 years old, reported high risk sexual activity in the last 3 months, and were HIV-uninfected. Attitudes toward GBV were evaluated using responses to a five-item standardized questionnaire about men perpetrating physical violence on a female spouse; responses to each item were scaled from 1 (no agreement) to 4 (strong agreement) and summed. Total scores >10 were considered permissive toward GBV. Among the 535 men analyzed, nearly half (N = 229, 42.8%) had a GBV score >10. Being young (18-24 years) (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] [1.06, 2.22]), having less years of education (aOR = 1.61, 95% CI [1.11, 2.32]), and reporting no current sexual partner at baseline (aOR = 2.10, 95% CI [1.06, 4.14]) were independently associated with permissive attitudes toward GBV. The following behaviors reported in the last 3 months were also associated with high GBV scores: having a new female partner (aOR = 1.78, 95% CI [1.02, 3.10]), and having had an STI (aOR = 1.85, 95% CI [1.15, 2.99]). Consuming alcohol prior to sex in the last month (aOR = 1.59, 95% CI [1.09, 2.31]) was also associated with high GBV scores. A large proportion of South African HIV-uninfected men in this analysis reported permissive attitudes toward GBV. These attitudes were associated with HIV risk behavior. Integrating GBV and HIV prevention programs is essential.
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Affiliation(s)
- Heeran Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands
| | - Pholo Maenetje
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evans Muchiri
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Mary H Latka
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Vinodh A Edward
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.,School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matt A Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,IAVI, New York, NY, USA
| | - Gloria Omosa-Manyonyi
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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4
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Dwarumpudi A, Mshana G, Aloyce D, Peter E, Mchome Z, Malibwa D, Kapiga S, Stöckl H. Coping responses to intimate partner violence: narratives of women in North-west Tanzania. CULTURE, HEALTH & SEXUALITY 2022:1-15. [PMID: 35244501 DOI: 10.1080/13691058.2022.2042738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
This study sought to explore the variety of coping strategies that women employ in response to intimate partner violence. Coping strategies can help women tolerate, minimise and deal with difficult challenges or conflicts in their relationships, such as learning to be independent from their husbands and surviving trauma. Drawing on 18 in-depth interviews conducted in Mwanza, Tanzania, we examined two different coping strategies - engagement and disengagement coping - with respect to how women react to economic, emotional, physical and sexual intimate partner violence. While the choice of coping methods remains a complex issue, most women employed engagement strategies as a response to economic violence and disengagement coping for sexual violence. We explore the implications of gender and societal roles for coping decisions and analyse how access to resources may provide women with the tools to limit future violence.
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Affiliation(s)
- Annapoorna Dwarumpudi
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Diana Aloyce
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Esther Peter
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Zaina Mchome
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
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Characterizing a sexual health and HIV risk stratification scale for sexually active adolescent girls and young women (AGYW) in Tanzania. PLoS One 2021; 16:e0248153. [PMID: 33735253 PMCID: PMC7971553 DOI: 10.1371/journal.pone.0248153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/20/2021] [Indexed: 11/30/2022] Open
Abstract
Adolescent girls and young women (AGYW) aged 15 to 24 years face disproportionately high risks of acquiring HIV and other sexually transmitted infections (STIs). A sexual health risk stratification tool can support the development and implementation of tailored HIV and STI prevention services for sub-groups of at-risk AGYW. Data were collected among sexually active AGYW aged 15 to 24 years in Tanzania between April 2015 and March 2017. Exploratory and confirmatory factor analyses were conducted to construct and assess the latent structure of a ten-item scale for rapid assessment of sexual health risks. Items with high factor loadings and minimal cross loadings were retained in the final scale. Scale performance was appraised against condomless sex (defined as unprotected vaginal or anal intercourse) reported by AGYW for construct validity. A three-factor structure of vulnerability to HIV among AGYW was supported with subscales for socioeconomic vulnerability; lack of adult support; and sexual behavioral risks. The chi-square goodness-of-fit test, root mean square error of approximation, comparative fit index, and Tucker-Lewis index indicated a strong goodness-of-fit of the three-factor scale. Cronbach alphas (0.55 for socioeconomic vulnerability, 0.55 for lack of support, and 0.48 for sexual risk) indicated sub-optimal internal consistency for all sub-scales. The factor-item and factor-factor correlations identified in these analyses were consistent with the conceptual framework of vulnerability of HIV infection in AGYW, suggesting good construct validity. The scale also demonstrated a statistically significant association with condomless sex and could be potentially used for sexual health risk stratification (OR = 1.17, 95% CI: 1.12, 1.23). The sexual health and HIV risk stratification scale demonstrated potential in identifying sexually active AGYW at high risk for HIV and other STIs. Ultimately, all AGYW in Tanzania are not at equal risk for HIV and this scale may support directing resources towards those at highest risk of HIV.
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Mwanukuzi C, Nyamhanga T. "It is painful and unpleasant": experiences of sexual violence among married adolescent girls in Shinyanga, Tanzania. Reprod Health 2021; 18:1. [PMID: 33388066 PMCID: PMC7777290 DOI: 10.1186/s12978-020-01058-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/15/2020] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND While the situation of married adolescent girls in Tanzania is increasingly documented, empirical evidence concerning the ways in which child marriage impacts girls' and young women's sexual lives is limited. Specifically, little is known about lived experiences on sexual violence among married adolescent girls in Tanzania. METHODS This article reports on a qualitative study using a phenomenological approach to describe married girls' experiences of sexual violence in the Shinyanga Region, an area with the highest prevalence (59%) of child marriage in Tanzania. Data were collected from 20 married girls aged 12-17 years. RESULTS The study identified four analytical themes regarding the experience of sexual violence, namely: forced sex; rape; struggling against unpleasant and painful sex; and inculcation of the culture of tolerance of sexual violence. CONCLUSION The study highlights the voices of married adolescents on an important but a neglected topic of relevance to Tanzania's public health. Findings from this study suggest that married adolescent girls suffer sexual coercion in silence. Child marriage is a major public health problem in sub-Saharan Africa in general and in Tanzania in particular. However, there is limited research on the ways in which it impacts sexual lives of married adolescent girls. In response to the inadequacy of information, married adolescent girls in Shinyanga Region of Tanzania were requested to voice out their experiences of sexual violence. Three themes were identified from the responses, namely: forced sex; rape, struggling against unpleasant and painful sex; and the inculcation of the culture of tolerance of sexual violence. In conclusion, this study has echoed voices of married adolescent girls on the sexual troubles they experience. Their main concern is that they suffer sexual coercion in silence, which increases their risk of acquiring sexually transmitted infections and/or unwanted pregnancies. Recommendations for sexual violence prevention strategies are discussed.
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Affiliation(s)
| | - Tumaini Nyamhanga
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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7
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Hershow RB, Bhadra M, Mai NVT, Sripaipan T, Ha TV, Go VF. A Qualitative Study With Women Living With HIV on Perceived Gender Norms and Experiences of Intimate Partner Violence in Northern Vietnam. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:5905-5925. [PMID: 29294869 DOI: 10.1177/0886260517724834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although the prevalence of intimate partner violence (IPV) in Southeast Asia is one of the highest in the world, IPV remains understudied in the region, especially among women living with HIV (WLWH). This study aims to understand how gender and violence norms influence how WLWH interpret and prioritize violence as a health issue. We also explore whether HIV disclosure was seen as a trigger for IPV. We conducted in-depth interviews with 20 WLWH (median age = 35.5 years; range = 28-54 years) in northern Vietnam. Participants were recruited from an outpatient antiretroviral treatment (ART) clinic. Semi-structured interviews were transcribed, translated, and analyzed to identify themes using a gender-focused theoretical framework. Twelve participants reported experiencing IPV by their current or former husbands, most of which occurred before their HIV diagnoses. Only one participant felt her HIV status was a factor for the IPV she experienced; the remaining participants did not explicitly link IPV and HIV. None expressed fear or experience of IPV after disclosing to their husbands. When asked about a woman's role in society, the majority spoke about the responsibility to build family harmony by doing housework, raising children, making a steady income, and being faithful to her husband. Participants viewed marital conflict as the woman's problem to avoid by acting docile or to resolve peacefully by bearing violence quietly. Almost all reported contracting HIV from their husbands. Regardless of whether their children were infected (n = 8) or not (n = 10), participants spoke about being compelled to initiate and adhere to ART to care for their children emotionally and financially. In the context of Vietnamese gender norms, participants expressed low urgency for help-seeking after experiencing IPV and high urgency for help-seeking after being diagnosed with HIV. Multilevel interventions are needed to shift social norms around acceptability of IPV.
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Affiliation(s)
| | | | | | | | - Tran Viet Ha
- The University of North Carolina at Chapel Hill, USA
| | - Vivian F Go
- The University of North Carolina at Chapel Hill, USA
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Mchome Z, Mshana G, Aloyce D, Peter E, Malibwa D, Dwarumpudi A, Kapiga S, Stöckl H. " Don't You Think It Is Violence Forcing Me to Have Sex While Not Happy?" Women's Conceptualization of Enjoyable Sex and Sexual Intimate Partner Violence in Mwanza, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217937. [PMID: 33138073 PMCID: PMC7662311 DOI: 10.3390/ijerph17217937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022]
Abstract
Intimate partner violence is a recognized public health and development issue that is consistently and comparatively measured through women's experience of physical and/or sexual acts by their partner. While physical intimate partner violence is covered by a wide range of behaviors, sexual intimate partner violence (SIPV) is often only measured through attempted or completed forced sex, ignoring less obvious forms of sexual intimate partner violence. We explored women's conceptualizations of SIPV by conducting in-depth interviews with 18 Tanzanian women. Using a thematic approach, we identified key features of women's sexual intimate relationships and their perceptions of them. The women clearly defined acts of positive sexual relationships that occurred with mutual consent and seduction and SIPV that included acts of forced sex and sex under the threat of violence. They also identified several acts that were crossing the line, whereby a discrepancy of views existed whether they constituted SIPV, such as having sex when out of the mood, sex being the duty of the wife, sex during the menses, requests for anal sex, having sex to not lose the husband, husband refusing sex and husband having other partners. Women in this study felt violated by a far wider range of sexual acts in their relationships. Future studies need to improve the measurement of sexual intimate partner violence to allow the collection of encompassing, yet comparable, data on this harmful phenomenon.
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Affiliation(s)
- Zaina Mchome
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- National Institute for Medical Research, Mwanza Centre, P.O. Box 1462 Mwanza, Tanzania
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- National Institute for Medical Research, Mwanza Centre, P.O. Box 1462 Mwanza, Tanzania
| | - Diana Aloyce
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Esther Peter
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Donati Malibwa
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Annapoorna Dwarumpudi
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Heidi Stöckl
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
- Correspondence: ; Tel.: +44-2079272506
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Maina BW, Orindi BO, Sikweyiya Y, Kabiru CW. Gender norms about romantic relationships and sexual experiences among very young male adolescents in Korogocho slum in Kenya. Int J Public Health 2020; 65:497-506. [PMID: 32270236 PMCID: PMC7275025 DOI: 10.1007/s00038-020-01364-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the association between gender norms about romantic relationships and sexual experiences of very young male adolescents (VYMA) living in Korogocho slum in Nairobi, Kenya. Methods We used cross-sectional data from a sample of 426 VYMA living in Korogocho slum. We conducted an exploratory factor analysis and confirmatory factor analysis to, respectively, explore and validate the factor structure underlying gender norms scale items. We used structural equation modelling to assess the association between gender norms and sexual experiences of VYMA. Results We found high endorsement of heteronormative beliefs about romantic relationships and low endorsement of sexual double standards. Sexual experience was associated with low endorsement of heteronormative beliefs, being pre-pubertal, school absenteeism and being below recommended grade for age. Sharing a sleeping room with more than two people, been born outside Nairobi, and living in households headed by older persons lowered the likelihood of sexual experience. Conclusions Our findings underscore the need for further research to understand how gender norms evolve as young boys transition through adolescence to adulthood and how these changes impact on sexual behaviors Electronic supplementary material The online version of this article (10.1007/s00038-020-01364-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beatrice W. Maina
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Benedict O. Orindi
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Caroline W. Kabiru
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Council, Nairobi, Kenya
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10
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Prevalence and correlates of partner violence among adolescent girls and young women: Evidence from baseline data of a cluster randomised trial in Tanzania. PLoS One 2019; 14:e0222950. [PMID: 31593577 PMCID: PMC6782098 DOI: 10.1371/journal.pone.0222950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania. Methods A cross-sectional analysis of data from AGYW aged 15–23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association. Results 2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence. Conclusions Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW. Trial registration ClinicalTrials.gov—IDNCT03597243.
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Siril H, Kaale A, Minja A, Kilewo J, Mugusi F, Sunguya B, Todd J, Kaaya S, Smith Fawzi MC. Improving communication about HIV prevention among people living with HIV and their at-risk social network members in Dar es Salaam, Tanzania. COGENT MEDICINE 2019; 6. [PMID: 31355302 PMCID: PMC6660010 DOI: 10.1080/2331205x.2019.1600230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although a number of HIV prevention programs have been implemented, such as mass media campaigns, high rates of unprotected and concurrent sexual partnerships, as well as low uptake HIV testing and limited HIV knowledge, persist in Tanzania. We examined the effect and predicting factors of HIV prevention communication among people living with HIV (PLH) exposed to NAMWEZA intervention, and their at-risk social network members (NMs) Quantitative data were collected from 326 participants at baseline and 24 months of follow-up. In-depth interviews with 20 PLH were conducted at follow-up. Results indicated specific communication about condom use and HIV testing increased; (mean increase of 0.28 (SD = 0.14) scores, P = 0.012 and 0.42 (SD = 0.11) scores, p < 0.001 respectively while general discussion about protecting other people from HIV did not change significantly; mean increase was 0.01 scores (SD = 0.005), p = 0.890. Positive predictors of communication included being single; OR = 1.10, p = 0.01, female; OR = 1.15, p = 0.03, aged 30 years or older; OR = 1.23, p < 0.01, HIV knowledge, dose of NAMWEZA participation; OR = 1.01, p < 0.001, and high self-efficacy for condom use; OR = 1.4, p < 0.001. Stigma demonstrated a significant but negative association with communication for condom use; OR = 1.01, p < 0.01.Qualitative data reflected perceived possession of more individual skills and ability to address some personal/cultural obstacles to communicating about HIV prevention including those observed in the quantitative data. NAMWEZA improved communication about HIV prevention among PLH with their at-risk-NMs. The approach is a promising complement to media campaigns in similar populations. Future research and program evaluation efforts should explore how communities perceive and communicate about protecting others from HIV.
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Affiliation(s)
- Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Public Health Evaluations and Quality Improvement, Management and Development for Health, Dar es Salaam, Tanzania
| | - Anna Kaale
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Anna Minja
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Japheth Kilewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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12
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Mengo C, Okumu M, Ombayo B, Nahar S, Small E. Marital Rape and HIV Risk in Uganda: The Impact of Women's Empowerment Factors. Violence Against Women 2019; 25:1783-1805. [PMID: 30672397 DOI: 10.1177/1077801218821444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study used Uganda Demographic Health Survey data (2011) to examine the role of women's empowerment in reducing HIV risk among married women who experienced sexual violence in Uganda. The sample size was 8,674 ever-married women aged 15-49 years. Significant differences were revealed for marital rape, women's empowerment variables, and reducing HIV risk according to sociodemographic characteristics. Women's labor force participation partially mediated the relationship between sexual violence and reducing HIV risk, but decision making did not. Findings highlight the need for the development and implementation of policies and programs to address marital rape and reduce HIV risk within institutions of marriage.
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13
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Reuben Mahiti G, Mbekenga CK, Dennis Kiwara A, Hurtig AK, Goicolea I. Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: a qualitative study. Glob Health Action 2018; 10:1361184. [PMID: 28882101 PMCID: PMC5645690 DOI: 10.1080/16549716.2017.1361184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Men play an important role in maternal health. The postpartum period is a critical stage, yet there is a scarcity of research that explores men’s involvement during this stage. Objective: The aim of the study was to explore male partners’ perceptions of the cultural practices during postpartum care in rural Tanzania. Methods: Fourteen focus group discussions were conducted with 93 men, with an age range of 19–65 years, in August 2013. The study was conducted in the Kongwa District, located in the Dodoma region in central Tanzania. Qualitative data were digitally recorded, transcribed verbatim and analyzed using content analysis. Results: Four categories emerged, namely: ‘Men as providers and, occasionally, care takers’, ‘Men as decision makers’, ‘Diverse perceptions of sexual abstinence’ and ‘Barriers for men in using/accompanying partners to use reproductive and child healthcare services’. The cross-category theme ‘Men during postpartum: remaining powerful but excluded’ refers to how men are in a powerful position above women in different aspects of life. Elderly women played an important role in caring for postpartum mothers and their newborns, but men were the ones making the final decision about where to seek care. Traditional practices isolated men from their partners for a certain period, and enforced sexual abstinence for the women during the postpartum period. However, cultural norms permitted men to engage in extramarital relations. Reproductive and child healthcare services were perceived by men as not welcoming the male partners, and local gender norms discouraged men from accompanying their partners to seek services. Conclusions: In this study, we found that men perceived their role during the postpartum period as financial providers, decision makers and, occasionally, care givers. Men also held diverse perceptions with regard to sexual abstinence and felt excluded from participating in maternal healthcare services.
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Affiliation(s)
- Gladys Reuben Mahiti
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Columba K Mbekenga
- b School of Nursing and Midwifery , Agakhan University , Dar es Salaam , Tanzania
| | - Angwara Dennis Kiwara
- a Department of Development Studies, School of Public Health and Social Sciences , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Anna-Karin Hurtig
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
| | - Isabel Goicolea
- c Division of Epidemiology and Global Health, Faculty of Medicine , Umeå University , Umeå , Sweden
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14
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Warren EA, Paterson P, Schulz WS, Lees S, Eakle R, Stadler J, Larson HJ. Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review. PLoS One 2018; 13:e0198680. [PMID: 29902205 PMCID: PMC6002067 DOI: 10.1371/journal.pone.0198680] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use. OBJECTIVES This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use. DATA SOURCES We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance. STUDY ELIGIBILITY CRITERIA Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included. STUDY APPRAISAL AND SYNTHESIS METHODS Included publications were quality assessed using the Hawker method and coded thematically. RESULTS 10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may-or may not-choose to use prevention interventions. LIMITATIONS This literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings. CONCLUSIONS AND IMPLICATIONS When considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection.
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Affiliation(s)
- Emily A. Warren
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - William S. Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robyn Eakle
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Jonathan Stadler
- Department of Anthropology and Development Studies, University of Johannesburg, Johannesburg, South Africa
| | - Heidi J. Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health, University of Washington, Seattle, United States of America
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15
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Mtenga SM, Pfeiffer C, Tanner M, Geubbels E, Merten S. Linking gender, extramarital affairs, and HIV: a mixed methods study on contextual determinants of extramarital affairs in rural Tanzania. AIDS Res Ther 2018; 15:12. [PMID: 29880001 PMCID: PMC5991469 DOI: 10.1186/s12981-018-0199-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extramarital sex is a potential driver of human immunodeficiency virus (HIV) transmission for long-term couples in sub-Saharan Africa. It is increasingly recognized that preventing sexual risk behaviours requires an understanding and adjustment of sexual relationship factors beyond the individual level. We investigated the association between extramarital affairs and HIV status, factors associated with extramarital affairs, and created insights in the context and pathways for married men and women in rural Tanzania who engage in extramarital affairs. METHODS A cross-sectional sequential explanatory mixed method design was employed. The WHO-Social determinants of health perspective guided the study. Using logistic regression, we analysed the MZIMA project community surveillance representative sample of 3884 married partners aged 15+ residing in Ifakara town, Tanzania (2012-2013). Multinomial logistic regression analysis established the relative risk ratio (RRR) of different social and economic factors with lifetime (proxy) and recent (12 months prior to survey) extramarital affairs. Logistic regression analysis determined the association between extramarital affairs and HIV status. Semi-structured interviews and focus group discussions explored the quantitative findings, capturing the experiences and norms regarding extramarital affairs. RESULTS We found a significant association between lifetime (proxy) extramarital affairs and HIV infection among women only. The RRR of having extramarital affairs (lifetime proxy) was significantly higher among Village Community Bank (VICOBA) members, the re-married, consumers of alcohol, those from southern regions, non-Muslims, and those with older age. In the case of recent extramarital affairs (12 months prior to survey), associations were significant for the same variables except for religion, having an income was also associated with the outcome. Qualitative narratives reflected that, desire to prove manhood (masculinity) supported by societal normative beliefs such as; 'it is not realistic for a man to stay without extramarital partner' and religious beliefs; 'a man shall dominate a woman' encouraged men's extramarital affairs. For women, striving for financial autonomy, obligations to pay back debts borrowed from several VICOBA, and limited support from their husbands encouraged their engagement in extramarital affairs. Low relationship quality (conflict and sexual dissatisfaction) were reported to encourage both men and women's extramarital affairs. CONCLUSIONS The findings show that the link between extramarital affairs and HIV has a gender dimension in which women are more likely to acquire HIV through extramarital affairs (case of recent extramarital affairs (12 months prior to survey). Future programs seeking to address risk sexual behaviors in Tanzanian marriages can consider context-sensitive interventions which address aspects beyond 'individual risk' and women's financial uncertainties, and include couple's relationship quality, excessive alcohol behaviors, normative masculinity ideology and societal norms, that encourage women's economic dependence and men's engagement in multiple sexual partnerships. Microfinance projects (e.g. VICOBA) could be a platform for gender-transformative approaches, combining economic empowerment and HIV risk protection strategies.
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16
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McGovern T, Fine J, Crisp C, Battistini E. As the HIV Epidemic among Young Women Grows, Can We Look to the SDGs to Reverse the Trend? Health Hum Rights 2017; 19:223-236. [PMID: 29302178 PMCID: PMC5739372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To end the growing HIV epidemic among young women, human rights violations must be addressed. The Sustainable Development Goals have the potential to help, but only if political barriers are overcome and a rights-based approach is integrated.
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Affiliation(s)
- Terry McGovern
- Chair of the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA
| | - Johanna Fine
- Human rights lawyer formerly with the Center for Reproductive Rights, USA
| | - Carolyn Crisp
- Recent graduate of Columbia University’s Mailman School of Public Health and currently works as an independent public health consultant
| | - Emily Battistini
- Recent graduate of Columbia University’s dual-degree program in medicine and public health and currently works as a researcher for the YIELD Project
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Madiba S, Ngwenya N. Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa. Glob Health Action 2017; 10:1341597. [PMID: 28678650 PMCID: PMC5645648 DOI: 10.1080/16549716.2017.1341597] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 06/08/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Women in sub-Saharan Africa bear the brunt of the human immunodeficiency virus (HIV) epidemic, and older married women and those in cohabiting relationships are regarded as the largest HIV risk group. Although preventing HIV infection in married or stable relationships is an international HIV prevention priority, little is known about the influence of sociocultural contexts on safe-sex practice by women, particularly older women in rural communities in South Africa. OBJECTIVES This study aimed to examine how older women in a rural patriarchal society negotiate safer sex within marital and long-term cohabitation relationships, and their perceptions and experiences of barriers that influence condom use. METHODS Focus group discussions were conducted with married and cohabiting women aged 40-60 years recruited from primary health facilities in a rural district in Mpumalanga province, South Africa. A thematic analysis approach was used to analyse the data. RESULTS We found that although women reported negotiating safe sex in their relationships, they dreaded the possible consequences of suggesting condom use with their partners. Many factors made negotiating safe sex complex for these women: living in a patriarchal society where women play no part in sexual decision making, the fear of possible consequences of insisting on condom use, women's inferior social position in marital relationships, cultural practices such as bride price, and gender inequality were the main barriers to practising safer sex. CONCLUSIONS Older married and cohabiting women dreaded negotiating safer sex in this patriarchal society where women's subordination is legitimized. The findings suggest that the women were at high risk of HIV infection because of their inability to negotiate condom use, or to reject forced sex and non-consensual sex. There is a need for interventions targeting older married and cohabiting couples and key stakeholders within communities to create awareness about cultural practices and beliefs that undermine women and HIV prevention efforts.
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Affiliation(s)
- Sphiwe Madiba
- School of Public Health, Department of Environmental and Occupational Heath, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Nomsa Ngwenya
- School of Public Health, Department of Environmental and Occupational Heath, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Kazaura MR, Ezekiel MJ, Chitama D. Magnitude and factors associated with intimate partner violence in mainland Tanzania. BMC Public Health 2016; 16:494. [PMID: 27286859 PMCID: PMC4902958 DOI: 10.1186/s12889-016-3161-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania like in many sub-Saharan countries the data about Intimate Partner Violence (IPV) are scarce and diverse. This study aims to determine the magnitude of IPV and associated factors among ever partnered women in urban mainland Tanzania. METHODS Data for this report were extracted from a big quasi-experimental survey that was used to evaluate MAP (MAP - Men as Partners) project. Data were collected using standard questions as those in big surveys like Demographic and Health Surveys. Data analyses involved descriptive statistics to characterize IPV. Associations between IPV and selected variables were based on Chi-square test and we used binary logistic regression to assess factors associated with women's perpetration to physical IPV and Odds Ratio (OR) as outcome measures with their 95 % confidence intervals (CI). RESULTS The lifetime exposure to IPV was 65 % among ever-married or ever-partnered women with 34, 18 and 21 % reporting current emotional, physical and sexual violence respectively. Seven percent of women reported having ever physically abused partners. The prevalence of women perpetration to physical IPV was above 10 % regardless to their exposure to emotional, physical or sexual IPV. CONCLUSIONS IPV towards women in this study was high. Although rates are low, there is some evidence to suggest that women may also perpetrate IPV against their partners. Based on hypothesis of IPV and HIV co-existence, there should be strategies to address the problem of IPV especially among women.
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Affiliation(s)
- Method R Kazaura
- Department of Epidemiology/Biostatistics, Muhimbili University of Health and Allied Sciences, P. O. Box 65015, Dar es Salaam, Tanzania.
| | - Mangi J Ezekiel
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Dereck Chitama
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mtenga SM, Pfeiffer C, Merten S, Mamdani M, Exavery A, Haafkens J, Tanner M, Geubbels E. Prevalence and social drivers of HIV among married and cohabitating heterosexual adults in south-eastern Tanzania: analysis of adult health community cohort data. Glob Health Action 2015; 8:28941. [PMID: 26432785 PMCID: PMC4592501 DOI: 10.3402/gha.v8.28941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is substantial. Information about the underlying social drivers of HIV transmission in couples is critical for the development of structural approaches to HIV prevention, but not readily available. We explored the association between social drivers, practices, and HIV status among stable couples in Ifakara, Tanzania. Design Using a cross-sectional design, we analyzed data from a sample of 3,988 married or cohabiting individuals, aged 15 years and older from the MZIMA adult health community cohort study of 2013. Sociodemographic factors (sex, income, age, and education), gender norms (perceived acceptability for a wife to ask her partner to use a condom when she knows he is HIV positive), marriage characteristics (being in a monogamous or a polygamous marriage, being remarried), sexual behavior practices (lifetime number of sexual partners and concurrent sexual partners), health system factors (ever used voluntary HIV counseling and testing), and lifestyle patterns (alcohol use) were used to explore the odds of being HIV positive, with 95% confidence intervals. Results Prevalence of HIV/AIDS was 6.7% (5.9% males and 7.1% females). Gender norms, that is, perception that a woman is not justified to ask her husband to use a condom even when she knows he has a disease (adjusted odds ratio AOR=1.51, 95% CI 1.06–2.17), marital characteristics, that is, being remarried (AOR=1.49, 95% CI 1.08–2.04), and sexual behavior characteristics, that is, lifetime number of sexual partners (2–4: AOR=1.47, 95% CI 1.02–2.11; 5+: AOR=1.61, 95% CI 1.05–2.47) were the main independent predictors of HIV prevalence. Conclusions Among married or cohabiting individuals, the key social drivers/practices that appeared to make people more vulnerable for HIV are gender norms, marriage characteristics (being remarried), and sexual behavior practices (lifetime number of sexual partners). Married and cohabiting couples are an important target group for HIV prevention efforts in Tanzania. In addition to individual interventions, structural interventions are needed to address the gender norms, remarriage, and sexual practices that shape differential vulnerability to HIV in stable couples.
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Affiliation(s)
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland
| | | | | | - Joke Haafkens
- Centre for Social Science and Global Health, Amsterdam Institute of Advanced Labour Studies, University of Amsterdam, Amsterdam, The Netherlands.,Department of General Practice AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland
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