The role of reproductive coercion in women's risk for HIV: A case-control study of outpatients in Gauteng, South Africa.

Abstract

To investigate how reproductive coercion, or men's attempts to control their partners' use of contraception, may contribute to adverse reproductive health outcomes for women including abortions, sexually transmitted infections, and HIV for young women in South Africa. Findings are based on a case-control interview study of 882 South African women outpatients aged 15-29years, 48.5% (n=427) of whom were HIV seropositive. Covariates include demographics, intimate partner violence, sexually transmitted infections, having an abortion, using long-acting reversible contraception, and unequal sexual relationship power. Most covariates with the exceptions of abortion and unequal relationship power increase the risk of HIV, and all relate to reproductive coercion. Intimate partner violence is strongly associated with reproductive coercion (odds ratio 3.86, 95% confidence interval 2.89-5.15). When intimate partner violence is included in the full model reproductive coercion remains a significant predictor of HIV by 42%, and acts as a partial mediator between IPV and HIV. Findings confirm the significance of reproductive coercion as a risk marker for HIV. Reproductive coercion undermines women's reproductive health and warrants clinical intervention. Recommendations are offered for clinical practice within the South African context to increase training and assessment and provide covert long-acting reversible contraception as one pathway towards promoting women's reproductive autonomy.