EXPOSURES TO INTIMATE PARTNER VIOLENCE AND NON-PARTNER SEXUAL VIOLENCE ARE ASSOCIATED WITH HYPERTENSION IN SOUTH AFRICAN WOMEN

Abstract

Objective: South African women suffer from a dual burden of gender-based violence and hypertension. Studies suggest abuse exposures may increase the risk of hypertension by contributing to psychological stress, but this association has not been clearly described. This study described the associations of intimate partner violence (IPV), non-partner sexual violence (NPSV) and sexual harassment (SH) exposures with hypertension, and potential mediators of those associations in South African women aged 18 to 40 years. Design and method: Baseline data from the Rape Impact Cohort Evaluation study, including history of sexual, physical, emotional and economic IPV, NPSV and SH were examined using validated questionnaires. Hypertension was based on measured blood pressure (equal or higher than 140/90 mmHg) or a previous diagnosis. Logistic regression models examining the associations between various types of IPV, NPSV and hypertension adjusted for traditional hypertension risk factors and other traumatic exposures including recent rape incident. Mediation effects of body mass index, HIV infection, current smoking, alcohol binge drinking, depressive symptom scores and post-traumatic stress symptom (PTSS) scores on the associations using multiple mediation models adjusted for age and recent rape exposure. Results: Among 1742 women, 218 (12.5%) had hypertension. Hypertension prevalence was higher in women with, compared to without, a history of all four types of IPV (15% vs. 9%), sexual (19% vs. 11%), physical (16% vs. 9%), emotional (17% vs. 9%) and economic IPV (19% vs. 11%); NPSV (18% vs. 11%) and SH (29% vs. 11%), (p-values were equal or above 0.001). More than one episode of NPSV (adjusted odds ratio (aOR): 1.63; 95%CI: 1.27–2.67), any SH (aOR: 2.56; 95%CI: 1.60–4.03), frequent physical (aOR: 1.44; 95%CI: 1.06–1.95) and emotional IPV (aOR: 1.45; 95%CI: 1.06–1.98), and greater severity score of emotional IPV (aOR: 1.05; 95%CI: 1.02–1.08) were associated with hypertension. Current depression, PTSS and/or alcohol binge drinking completely or partially mediated these associations. Conclusions: The modifiable associations of IPV, NPSV and SH with hypertension highlight that, while gender-based violence must be prevented, public health interventions should incorporate monitoring blood pressure of violence victims, determining a history of violence in hypertension patients, and providing counselling.