Intimate partner violence by men living with HIV in Cameroon: Prevalence, associated factors and implications for HIV transmission risk (ANRS-12288 EVOLCAM).

Marion Fiorentino,Laura March,Christopher Kuaban,Sylvie Boyer,Abdourahmane Sow,Marie-Thérèse Mengue,Luis Sagaon-Teyssier,For The Evolcam Study Group ,Laurent Vidal,Bruno Spire,Christian Laurent,Marion Mora

doi:10.1371/journal.pone.0246192

Abstract

Intimate partner violence (IPV) against women is frequent in Central Africa and may be a HIV infection risk factor. More data on HIV-positive men (MLHIV) committing IPV are needed to develop perpetrator-focused IPV and HIV prevention interventions. We investigated the relationship between IPV and HIV transmission risk and IPV-associated factors. We used data from the cross-sectional survey EVOLCam which was conducted in Cameroonian outpatient HIV structures in 2014. The study population comprised MLHIV declaring at least one sexual partner in the previous year. Using principal component analysis, we built three variables measuring, respectively, self-reported MLHIV-perpetrated psychological and physical IPV (PPV), severe physical IPV (SPV), and sexual IPV (SV). Ordinal logistic regressions helped investigate: i) the relationship between HIV transmission risk (defined as unstable aviremia and inconsistent condom use) and IPV variables, ii) factors associated with each IPV variable. PPV, SPV and SV were self-reported by 28, 15 and 11% of the 406 study participants, respectively. IPV perpetrators had a significantly higher risk of transmitting HIV than non-IPV perpetrators. Factors independently associated with IPV variables were: i) socio-demographic, economic and dyadic factors, including younger age (PPV and SPV), lower income (PPV), not being the household head (SPV and SV), living with a main partner (SPV), and having a younger main partner (SPV); ii) sexual behaviors, including ≥2 partners in the previous year (PPV and SPV), lifetime sex with another man (SPV), inconsistent condom use (SV), and >20 partners during lifetime (SV); iii) HIV-related stigma (PPV and SV). IPV perpetrators had a higher risk of transmitting HIV and having lifetime and recent risky sexual behaviors. Perpetrating IPV was more frequent in those with socioeconomic vulnerability and self-perceived HIV-related stigma. These findings highlight the need for interventions to prevent IPV by MLHIV and related HIV transmission to their(s) partner(s).

Highlights

Intimate partner violence (IPV) affects two thirds of the population in Central Africa [1]
IPV perpetrators had a higher risk of transmitting HIV and having lifetime and recent risky sexual behaviors
Perpetrating IPV was more frequent in those with socioeconomic vulnerability and self-perceived HIV-related stigma. These findings highlight the need for interventions to prevent IPV by men living with HIV (MLHIV) and related HIV transmission to their(s) partner(s)

Summary

Introduction

Intimate partner violence (IPV) affects two thirds of the population in Central Africa [1]. In certain contexts, IPV—including non-sexual IPV— increases the risk of HIV acquisition in women in heterosexual relationships through three main mechanisms [2,3,4]. Men who are violent with female partners are more likely to acquire HIV from other partners, because of more frequent risky behaviors, including unprotected sex, transactional sex, and higher sexually transmitted infection (STI) incidences [5,6,7,8,9]. Coerced or undesired sex may lead to more frequent anal intercourse [10] and anatomic lesions of the vaginal or rectal mucosa which increase the risk of HIV acquisition [7]. The psychological consequences of IPV on a victim may deteriorate immunity [5, 11], which is a higher risk factor for HIV acquisition

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