Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort

Anna M Leddy,Rhian Twine,Xavier Gómez-Olivé,Linda J Kimaru,Sheri A Lippman,Amanda Selin,Audrey Pettifor,Kathleen Kahn

doi:10.1007/s10461-021-03535-y

Abstract

Limited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.

Highlights

Adolescent girls and young women (AGYW) ages 15–24 years in sub-Saharan Africa are disproportionately affected by HIV and intimate partner violence (IPV) [1, 2], defined as physical, sexual and/or emotional violenceResearch Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa 4 Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 5 Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden perpetrated by a current or former partner [3]
Such research is needed given the disproportionate burden of IPV and HIV among this population, as well as their unique developmental stage which may differentially influence their response to experiences of emotional IPV, with potentially negative implications for HIV prevention. To address this knowledge gap, we examined the relationship between emotional IPV and HIV risk behaviors among AGYW participating in the HIV Prevention Trials Network (HPTN) 068 trial in rural South Africa [19]
We found that verbal IPV, defined as being insulted, belittled, or humiliated by a partner, was associated with all three HIV risk behaviors, while threats were only associated with transactional sex

Summary

Introduction

Adolescent girls and young women (AGYW) ages 15–24 years in sub-Saharan Africa are disproportionately affected by HIV and intimate partner violence (IPV) [1, 2], defined as physical, sexual and/or emotional violence. AGYW in sub-Saharan Africa account for 25% of all new HIV infections globally [1], with the highest burden of new infections occurring among AGYW in South Africa [4]. Sub-Saharan Africa is the region with the highest prevalence of lifetime physical and sexual IPV among AGYW (34.4%) in the world [2]. The prevalence of IPV increases substantially during the period of transition from adolescence to young adulthood. A recent study from rural South Africa found that the prevalence of lifetime IPV rose from 17.7 to 32.1% among AGYW ages 15–16 and 17–20 years, respectively [6]

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