Abstract
BackgroundGlobally, studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. Despite the criminalisation of IPSV and deliberate sexual HIV infection in Zimbabwe, IPSV remains common. This study explored women's and health workers' perspectives and experiences of sexuality and sexual violence in pregnancy, including in relation to HIV testing.MethodsThis qualitative study was part of a larger study of the dynamics of intimate partner violence and HIV in pregnancy in Zimbabwe. Key informant interviews were conducted with health workers and focus group discussions were held with 64 pregnant or nursing mothers attending antenatal and postnatal care clinics in low-income neighbourhoods of Harare, covering the major thematic areas of validated sexual violence research instruments. Thematic content analysis of audio-recorded and transcribed data was conducted.ResultsWhile women reported some positive experiences of sex in pregnancy, most participants commonly experienced coercive sexual practices. They reported that men failed to understand, or refused to accept, pregnancy and its associated emotional changes, and often forced painful and degrading sexual acts on them, usually while the men were under the influence of alcohol or illicit drugs. Men often refused or delayed HIV testing, and participants reported accounts of HIV-positive men not disclosing their status to their partners and deliberately infecting or attempting to infect them. Women's passive acceptance of sexual violence was influenced by advice they received from other females to subordinate to their partners and to not deprive men of their conjugal sexual rights.ConclusionsCultural and societal factors, unequal gender norms and practices, women's economic vulnerability, and men's failure to understand pregnancy and emotional changes, influence men to perpetrate IPSV, leading to high risk of HIV infection.
Highlights
Gender-based violence in general, including coercive sexual practices, is widely understood as an expression of male control and domination over women [1,2,3]
The first significant finding was that all participants discussed the issues openly and both health workers and participants reported coercive or violent sex during pregnancy as commonplace yet complex
We report how respondents discussed the issue of sexual relations around the time of HIV testing and disclosure
Summary
Gender-based violence in general, including coercive sexual practices, is widely understood as an expression of male control and domination over women [1,2,3]. Research conducted to understand unsafe and inequitable sexual relationships in the light of the high rate of HIV shows that coercive sexual practices, from more subtle forms to physical rape, are endemic in heterosexual intimate relationships in southern Africa [5,6,7]. One of the challenges in studying intimate partner violence is the definition of sexual violence, which includes a spectrum of actions that vary from non-physical persuasive language to the use of physical force [9]. Studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. This study explored women’s and health workers’ perspectives and experiences of sexuality and sexual violence in pregnancy, including in relation to HIV testing
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