Intimate partner violence is associated with incident HIV infection in women in Uganda

Objectives:To quantify the association between intimate partner violence (IPV) and incident HIV infection in women in the Rakai Community Cohort Study between 2000 and 2009. Design and methods:Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Longitudinal data analysis was used to estimate the adjusted incidence rate ratio (IRR) of incident HIV associated with IPV in sexually active women aged 15–49 years, using a multivariable Poisson regression model with random effects. The population attributable fraction was calculated. Putative mediators were assessed using Baron and Kenny's criteria and the Sobel–Goodman test. Results:Women who had ever experienced IPV had an adjusted IRR of incident HIV infection of 1.55 (95% CI 1.25–1.94, P = 0.000), compared with women who had never experienced IPV. Risk of HIV infection tended to be greater for longer duration of IPV exposure and for women exposed to more severe and more frequent IPV. The adjusted population attributable fraction of incident HIV attributable to IPV was 22.2% (95% CI 12.5–30.4). There was no evidence that either condom use or number of sex partners in the past year mediated the relationship between IPV and HIV. Conclusion:IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the adjusted population attributable fraction is modest. The prevention of IPV should be a public health priority, and could contribute to HIV prevention.

[1]  M. Alary,et al.  Violence Toward Women, Men's Sexual Risk Factors, and HIV Infection Among Women: Findings From a National Household Survey in Rwanda , 2012, Journal of acquired immune deficiency syndromes.

[2]  J. Baeten,et al.  A prospective study of frequency and correlates of intimate partner violence among African heterosexual HIV serodiscordant couples , 2011, AIDS.

[3]  R. Morrell,et al.  The Relationship between Intimate Partner Violence, Rape and HIV amongst South African Men: A Cross-Sectional Study , 2011, PloS one.

[4]  N. Thielman,et al.  Prevalence and correlates of intimate partner violence among women attending HIV voluntary counseling and testing in northern Tanzania, 2005–2008 , 2011, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[5]  N. Abrahams,et al.  A Systematic Review of African Studies on Intimate Partner Violence against Pregnant Women: Prevalence and Risk Factors , 2011, PloS one.

[6]  S. Subramanian,et al.  No Association between HIV and Intimate Partner Violence among Women in 10 Developing Countries , 2010, PloS one.

[7]  C. Mikton.  Preventing intimate partner and sexual violence against women: taking action and generating evidence , 2010, Injury Prevention.

[8]  R. Jewkes,et al.  Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study , 2010, The Lancet.

[9]  A. Muula,et al.  Intimate partner violence among pregnant women in Rwanda , 2008, BMC women's health.

[10]  Charlotte Watts,et al.  WHO Multi-country Study on Women's Health and Domestic Violence against Women: Initial Results on Prevalence, Health Outcomes and Women's Responses , 2008 .

[11]  J. Silverman,et al.  Intimate partner violence and HIV infection among married Indian women. , 2008, JAMA.

[12]  C. Watts,et al.  Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study , 2008, The Lancet.

[13]  V. Chandrasekaran,et al.  Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India. , 2007, Indian journal of medical sciences.

[14]  R. Jewkes,et al.  Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. , 2006, International journal of epidemiology.

[15]  Richard Goldstein,et al.  Regression Methods in Biostatistics: Linear, Logistic, Survival and Repeated Measures Models , 2006, Technometrics.

[16]  M. Temmerman,et al.  Increased Risk of HIV in Women Experiencing Physical Partner Violence in Nairobi, Kenya , 2005, AIDS and Behavior.

[17]  R. Jewkes,et al.  Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa , 2004, The Lancet.

[18]  P. Shrout,et al.  Mediation in experimental and nonexperimental studies: new procedures and recommendations. , 2002, Psychological methods.

[19]  Jacquelyn C. Campbell,et al.  HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. , 2002, American journal of public health.

[20]  A C Gielen,et al.  The intersections of HIV and violence: directions for future research and interventions. , 2000, Social science & medicine.

[21]  G. Ironson,et al.  Stress and coping: the psychoneuroimmunology of HIV/AIDS. , 1999, Bailliere's best practice & research. Clinical endocrinology & metabolism.

[22]  M. Szklo,et al.  Epidemiology: Beyond the Basics , 1999 .

[23]  Ronald H Gray,et al.  Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial , 1999, The Lancet.

[24]  Thomas C. Quinn,et al.  A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda , 1998, AIDS.

[25]  R. DiClemente,et al.  The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. , 1997, American journal of public health.

[26]  S. Zierler,et al.  Sexual violence against women living with or at risk for HIV infection. , 1996, American journal of preventive medicine.

[27]  A. van der Straten,et al.  Couple communication, sexual coercion, and HIV risk reduction in Kigali, Rwanda , 1995, AIDS.

[28]  S. Zierler,et al.  Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. , 1991, American journal of public health.

[29]  Murray A. Straus,et al.  Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scales. , 1979 .

[30]  A. Dude.  Spousal Intimate Partner Violence is Associated with HIV and Other STIs Among Married Rwandan Women , 2009, AIDS and Behavior.

[31]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[32]  M. Graffar.  [Modern epidemiology]. , 1971, Bruxelles medical.