Abstract
Non-consensual sex is associated with HIV infection in Africa, but there is little longitudinal data on this association. We describe reported non-consensual sex among women over two decades in southwest Uganda, including associations with incident HIV infection. Between 1990 and 2008, individuals in a population cohort who recently seroconverted to HIV were enrolled into a clinical cohort, along with randomly selected HIV-negative controls. Participants were invited to the study clinic every 3 months, and females asked about recent experiences of sex against their will. Associations of non-consensual sex with HIV status were analyzed prospectively using conditional logistic regression, adjusting for age and year of interview, allowing for within-woman correlation. 476 women aged 14–81 enrolled and attended 10,475 visits over 19 years. The results show high levels of repeated non-consensual sex, often long after HIV infection. There was more reporting among women living with HIV compared to HIV-negative women (22 vs 9 %; OR = 2.29, 95 %CI 1.03–5.09), with the strongest associations among married participants. HIV programmes should address repeated sexual coercion before and subsequent to HIV infection.
Highlights
High prevalence of HIV among 15–24 year old women has been a persistent feature of HIV epidemics in sub-Saharan Africa [1,2,3,4,5] and has eluded most HIV prevention efforts [6]
In the Ugandan Demographic and Health Survey (DHS) in 2006, 21 % of young women and 7 % of men aged 15–19 years reported having ever been ‘‘forced to have sexual intercourse or perform other sexual acts against [their] will.’’[9] The prevalence rose to 41 % among 20–24 year-old women, and 49 % among 30–39 year olds
We considered whether the risk of non-consensual sex is higher among women living with HIV compared to HIVnegative women
Summary
High prevalence of HIV among 15–24 year old women has been a persistent feature of HIV epidemics in sub-Saharan Africa [1,2,3,4,5] and has eluded most HIV prevention efforts [6]. A cohort study in South Africa documented an association between intimate partner violence and incidence of HIV infection, after 2 years of follow up with young women aged 15–26 years [17]. Details of enrolment and follow-up procedures within the RCC have been described previously [18] During these booked appointments, consenting participants were seen by clinicians who administered a detailed socio-demographic, behavioural and medical questionnaire and conducted a physical examination. At their enrolment visit, all female participants were asked: ‘‘In the last 12 months, have you ever had sex against your will?’’ In all subsequent visits, they were asked: ‘‘Since your last visit, have you ever had sex against your will?’’. Clinic staff were blinded to participants’ HIV status up to the introduction of ART in January 2004
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