Abstract
BackgroundWomen remain disproportionally affected by the HIV/ AIDS epidemic because of sociocultural factors including violence perpetrated by intimate partners. Among HIVpositive (HIV+) women, intimate partner violence (IPV) affects engagement in care and reproductive health outcomes. We analyzed data from a national survey to estimate the prevalence of IPV among HIV+ women in care and associated factors.MethodsThe study was conducted among 5198 HIV+ women in care. Data were collected on socio-demographic characteristics, self-reported couple HIV status, mutual HIV status disclosure and IPV. IPV was assessed by asking participants whether their current husband or partner ever hit, slapped, kicked or did anything to hurt them physically, and whether their current husband or partner ever physically forced them to have intercourse or perform any sexual acts against their will. Women who responded “yes” were classified as having ever experienced IPV. Modified Poisson regression was used to identify factors associated with experiencing IPV.ResultsOf 5198 HIV+ women, 1664 (32.1%) had ever experienced physical violence, 1466 (28.3%) had ever experienced sexual violence and 2290 (44.2%) had ever experienced any IPV. Compared with women in relationships where the woman and their male partner were of the same age, women in relationships where the partner was ≥1 year younger were more likely to ever experience IPV (Prevalence risk ratio [PRR] = 1.43, 95% Confidence Interval [95%CI]: 1.10–1.71), as were women in relationships where the partner was < 10 years older (PRR = 1.20, 95%CI: 1.00–1.43) or ≥ 10 years older (PRR = 1.31, 95%CI: 1.05–1.64). Compared with women who did not have biological children, women with 3–4 biological children were more likely to have ever experienced IPV (PRR = 1.27 95%CI: 1.00–1.59) as were those with ≥5 biological children (PRR = 1.34, 95%CI: 1.06–1.71). Compared with women in sero-concordant relationships, women in sero-discordant relationships were less likely to ever experience IPV (PRR = 0.87 95%CI: 0.78–0.98).ConclusionsIn Uganda, a high proportion of HIV+ women have ever experienced IPV. Experiencing IPV was associated with circumstances related to the intimate relationship between the woman and her male partner. Health care workers should screen HIV+ women in care for IPV and offer appropriate psychosocial assistance.
Highlights
Women remain disproportionally affected by the Human Immunodeficiency Virus (HIV)/ AIDS epidemic because of sociocultural factors including violence perpetrated by intimate partners
Data from Demographic Health Surveys of 18 countries across Sub-Saharan Africa have shown that women are disproportionally affected by the HIV/ AIDS epidemic compared with their male counterparts [1]
Since the assessment of intimate partner violence was a secondary objective from the survey, considering a total population of about 600, 000 HIV positive women in Uganda [14] and a background prevalence of spousal violence of 44% [5], a minimum sample size of 5185 would provide sufficient power to establish the national prevalence of intimate partner violence among HIV positive women
Summary
Women remain disproportionally affected by the HIV/ AIDS epidemic because of sociocultural factors including violence perpetrated by intimate partners. Intimate partner violence has been associated with a loss of reproductive health control that may involve coercion by the male partner for the female partner to become pregnant and birth control sabotage or male partner interference with contraception [12]. This could lead to a woman becoming pregnant against their will, increase risk of sexually transmitted infections or among women who are HIV positive in a sero-discordant relationship increase the risk of HIV transmission to their partner
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