Exploring the Linkages Between Spousal Violence and HIV in Five Sub-Saharan African Countries

Abstract

There has been increasing recognition that spousal violence and HIV are overlapping vulnerabilities for many women. Yet a direct effect of most forms of spousal violence on women’s HIV status is unlikely, as there is no apparent causal pathway leading from one to the other. This study examines the relationship between spousal violence and women’s HIV status using Demographic and Health Surveys from five African countries: Kenya, Malawi, Rwanda, Zambia, and Zimbabwe. It uses couples data and nuanced measures of five separate forms of spousal violence. We adopt a gender-based framework in which a woman’s experience of spousal violence and her HIV status are mediated by her husband’s and her own behavioral and situational HIV risk factors, factors which are also shown to be associated with spousal violence. A series of regression models test for the direct effect of spousal violence, controlling for risk factors. An initial significant relationship with women’s HIV status is found for suspicion and isolation controlling behaviors in Zambia and Zimbabwe; for emotional violence in Kenya, Rwanda, and Zimbabwe; and for physical violence, in Kenya, Rwanda, and Zimbabwe. Sexual violence is not associated with women’s HIV status. Multiple associations between spousal violence and risk factors, and between these risk factors and women’s HIV status, suggest several possible mediators. When they are added to our base model, spousal violence no longer significantly predicts women’s HIV status with one exception: physical violence retains its association with women’s HIV status in Kenya and Zimbabwe.