Articles tagged as "Domestic violence"

Pregnancy and intimate partner violence among women living with HIV

Intimate partner violence experienced by HIV-infected pregnant women in South Africa: a cross-sectional study.

Bernstein M, Phillips T, Zerbe A, McIntyre JA, Brittain K, Petro G, Abrams EJ, Myer L. BMJ Open. 2016 Aug 16;6(8):e011999. doi: 10.1136/bmjopen-2016-011999.

Objectives: Intimate partner violence (IPV) during pregnancy may be common in settings where HIV is prevalent but there are few data on IPV in populations of HIV-infected pregnant women in Southern Africa. We examined the prevalence and correlates of IPV among HIV-infected pregnant women.

Setting: A primary care antenatal clinic in Cape Town, South Africa.

Participants: 623 consecutive HIV-infected pregnant women initiating lifelong antiretroviral therapy.

Measures: IPV, depression, substance use and psychological distress were assessed using the 13-item WHO Violence Against Women questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), Alcohol and Drug Use Disorders Identification Tests (AUDIT/DUDIT) and the Kessler 10 (K-10) scale, respectively.

Results: The median age in the sample was 28 years, 97% of women reported being in a relationship, and 70% of women reported not discussing and/or agreeing on pregnancy intentions before conception. 21% of women (n=132) reported experiencing ≥1 act of IPV in the past 12 months, including emotional (15%), physical (15%) and sexual violence (2%). Of those reporting any IPV (n=132), 48% reported experiencing 2 or more types. Emotional and physical violence was most prevalent among women aged 18-24 years, while sexual violence was most commonly reported among women aged 25-29 years. Reported IPV was less likely among married women, and women who experienced IPV were more likely to score above threshold for substance use, depression and psychological distress. In addition, women who reported not discussing and/or not agreeing on pregnancy intentions with their partner prior to conception were significantly more likely to experience violence.

Conclusions: HIV-infected pregnant women in the study reported experiencing multiple forms of IPV. While the impact of IPV on maternal and child health outcomes in the context of HIV infection requires further research attention, IPV screening and support services should be considered within the package of routine care for HIV-infected pregnant women.

Trial registration number: NCT01933477.

Abstract  Full-text [free] access 

Editor’s notes: Intimate partner violence among women in sub-Saharan Africa is >30%. There is limited research examining intimate partner violence among women living with HIV. Research is important as intimate partner violence may impact on a woman’s ability to adhere to antiretroviral therapy. Among pregnant women, this includes during pregnancy and post-partum. This study describes the prevalence of recent intimate partner violence, and examines associations between recent intimate partner violence and demographic, relationship and psychological variables.

The study was set in a township in Cape Town, South Africa, where the majority of residents have low socio-economic status and HIV infection among women is approximately 30%. Some 21% percent of 623 participants reported any recent intimate partner violence in the past 12 months.  Fifteen percent reported emotional violence, 15% physical violence (7% severe physical) and two percent sexual violence. Recent violence was associated with hazardous alcohol use, psychological distress and depression. It was more likely among unmarried women, and among women who had not discussed/agreed pregnancy prior to conception. There was no evidence to suggest intimate partner violence was elevated among women newly diagnosed with HIV.

These data suggest significant intimate partner violence experience among pregnant women living with HIV, living in this township. This study adds to the limited literature, examining intimate partner violence in the context of pregnancy and HIV. Longitudinal studies, and studies which examine the impact of intimate partner violence on ART uptake and adherence, including during pregnancy and post-partum, are necessary. 

South Africa
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Keeping adolescent girls in HIV prevention clinical trials: a focus on the effects of domestic violence

Domestic violence among adolescents in HIV prevention research in Tanzania: participant experiences and measurement issues.

Baumgartner JN, Kaaya S, Karungula H, Kaale A, Headley J, Tolley E. Matern Child Health J. 2015 Jan;19(1):33-9. doi: 10.1007/s10995-014-1492-1.

Under-representation of female adolescents in HIV clinical trials may inhibit their access to future prevention technologies. Domestic violence, broadly defined as violence perpetrated by intimate partners and/or family members, may affect trial participation. This study describes violence in the lives of adolescents and young women in Tanzania, explores use of the Women's Experience with Battering (WEB) Scale to measure battering, and examines the associations between battering and socio-demographic and HIV risk factors. Community formative research (CFR) and a mock clinical trial (MCT) were conducted to examine the challenges of recruiting younger (15-17) versus older (18-21) participants into HIV prevention trials. The CFR included qualitative interviews with 23 participants and there were 135 MCT participants. The WEB was administered in both the CFR and MCT. Nineteen CFR participants experienced physical and/or sexual violence and 17 % scored positive for battering. All married participants reported partner-related domestic violence, and half scored positive for battering. Many believed beatings were normal. None of the single participants scored positive on battering, but one-third reported abuse by relatives. Among MCT participants, 15 % scored positive for battering; most perpetrators were relatives. Younger participants were more likely to report battering. Adolescents experienced high rates of domestic violence and the WEB captured battering from both partners and relatives. The level of familial violence was unexpected and has implications for parental roles in study recruitment. Addressing adolescent abuse in HIV prevention trials and in the general population should be a public health priority.

Abstract access

Editor’s notes: Despite their heightened HIV vulnerability, adolescent girls are under-represented in clinical trials on HIV prevention technologies. Domestic violence is a known HIV risk factor for adolescent girls and the authors posit that it may also be a barrier to their participation in clinical trials. This lack of participation may in turn inhibit their access to future prevention technologies. This paper contributes both methodological insights about the measures that can be applied in low-income settings to screen for domestic violence and substantive evidence about the high rates of familial as well as partner associated violence and battering among this group.

The paper draws on data from a larger study conducted in the United Republic of Tanzania which examined recruitment and retention of adolescent girls, aged 15-21 years, in HIV prevention trials. The paper examines the prevalence and type of domestic violence among this group and the capacity of the Women’s Experience with Battering (WEB) scale to measure this. Although the WEB scale has not been used in low income countries before, the authors report that it may have considerable value in identifying exposure to domestic violence and battering among trial participants. Certain adaptations may be necessary, to identify women who are subject to violence and battering but do no report being afraid of the perpetrator. The qualitative study component suggests that this may reflect how beatings are considered a normal aspect of intimate and familial relations. Although this assessment tool is likely to be able to inform trial retention initiatives, the adolescent girls need to be able to participate in these trials. So the use of the scale appears to be limited in its contribution to improving initial recruitment into trials.

The levels of familial battering were higher than expected. This is likely to have implications for parental roles in research and contributes to the ethical concerns of relying on parental consent in HIV prevention trials rather than pursuing the route of autonomy in consenting. This is illustrated by the study itself requiring parental consent for girls aged 15 years.  This paper’s focus was on how to address the under-representation of adolescent girls in HIV prevention trials. Further, it provides valuable evidence on the high rates of exposure of adolescent girls to domestic violence from partners and their relatives. This evidence contributes to the call for greater attention to adolescent domestic violence in global health. 

United Republic of Tanzania
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