Intimate Partner Violence and HIV Sexual Risk Behaviour Among Women Who Inject Drugs in Indonesia: A Respondent-Driven Sampling Study

Claudia Stoicescu,Marisa Casale,Irwanto Irwanto,Anindita Gabriella Sudewo,Thees Spreckelsen,Lucie D Cluver

doi:10.1007/s10461-018-2186-2

Abstract

Women who inject drugs are disproportionately affected by HIV and intimate partner violence (IPV); however, the link between IPV and HIV remains under-researched among substance-using women in low- and middle-income countries. This study examined associations and additive effects of different forms of IPV victimization (psychological, physical and/or injurious, and sexual) on HIV sexual risk behavior among women who inject drugs in Indonesia. Respondent-driven sampling (RDS) was used to recruit 731 women from Greater Jakarta and Bandung, West Java. RDS-II weighted prevalence of any past-year IPV was 68.9% (95% CI 65.0, 72.6) in Jakarta and 55.9% (95% CI 48.0, 63.5) in Bandung. In separate logistic regressions controlling for socio-demographic covariates, all three forms of IPV showed statistically significant associations with sexual risk behavior. After adjusting for all IPV types, psychological (OR 1.87; 95% CI 1.17, 2.99; p = 0.009) and sexual (OR 1.98; 95% CI 1.22, 3.21; p = 0.006) IPV independently predicted women’s sexual risk behavior. Marginal effects models suggested that co-occurrence of multiple forms of IPV had greater adverse consequences: sexual risk behavior was reported by 64.1% of women who did not experience any IPV, but increased to 89.9% among women exposed to all three types. Comprehensive harm reduction services that integrate IPV monitoring and prevention are urgently needed to reduce both HIV and IPV.

Highlights

Asia is home to half of the estimated 3.8 million women who inject drugs globally [1]
This study found that at least 6 in 10 women who inject drugs were exposed to some form of past-year intimate partner violence (IPV), which is up to 24 times higher than IPV prevalence found in the general Indonesian female population [67]
Three quarters of women across the two study cities engaged in HIV sexual risk behavior

Summary

Introduction

Asia is home to half of the estimated 3.8 million women who inject drugs globally [1]. No quantitative studies to date have explored the prevalence and associations of IPV and HIV sexual risk behavior among women who inject drugs in Indonesia. Understanding the relationship between different forms of IPV and sexual risk behavior is essential for elucidating pathways to HIV and for informing effective interventions with women who inject drugs in low-and middle-income countries. This study examines the largest known sample of Indonesian women who inject drugs to date to investigate (1) associations between exposure to psychological, physical and/or injurious, and sexual dimensions of IPV and HIV sexual risk behavior; and (2) potential additive effects of IPV polyvictimization on women’s sexual risk behavior

Study Design and Sampling

Procedures

Ethical Considerations

Results

Discussion