Preventing intimate partner violence for HIV positive women

Relationship power and sexual violence among HIV-positive women in rural Uganda.

Conroy AA, Tsai AC, Clark GM, Boum Y, Hatcher AM, Kawuma A, Hunt PW, Martin JN, Bangsberg DR, Weiser SD. AIDS Behav. 2016 Sep;20(9):2045-53. doi: 10.1007/s10461-016-1385-y.

Gender-based power imbalances place women at significant risk for sexual violence, however, little research has examined this association among women living with HIV/AIDS. We performed a cross-sectional analysis of relationship power and sexual violence among HIV-positive women on antiretroviral therapy in rural Uganda. Relationship power was measured using the Sexual Relationship Power Scale (SRPS), a validated measure consisting of two subscales: relationship control (RC) and decision-making dominance. We used multivariable logistic regression to test for associations between the SRPS and two dependent variables: recent forced sex and transactional sex. Higher relationship power (full SRPS) was associated with reduced odds of forced sex (AOR = 0.24; 95 % CI 0.07-0.80; p = 0.020). The association between higher relationship power and transactional sex was strong and in the expected direction, but not statistically significant (AOR = 0.47; 95 % CI 0.18-1.22; p = 0.119). Higher RC was associated with reduced odds of both forced sex (AOR = 0.18; 95 % CI 0.06-0.59; p < 0.01) and transactional sex (AOR = 0.38; 95 % CI 0.15-0.99; p = 0.048). Violence prevention interventions with HIV-positive women should consider approaches that increase women's power in their relationships.

Abstract access  [1]

Editor’s notes: This paper addresses the lack of research into relationship power and sexual violence among women living with HIV. The authors report on analysis of data, collected as part of an ongoing prospective cohort study on HIV medication adherence (Uganda AIDS Rural Treatment Outcomes (UARTO) study). The authors examined the association between relationship power and forced and transactional sex, based on their hypothesis that higher relationship power would be protective against both.

Participants for the main study were recruited from the Mbarara Regional Referral Hospital Immune Suppression Syndrome (ISS) Clinic, and in August 2007, the survey was modified for this sub-study to include measures on relationship power, intimate partner violence, stigma, social support, health behaviours, and food security. For the survey, relationship power was measured using the Sexual Relationship Power Scale (SRPS), which contains two subscales: relationship control (RC) and decision-making dominance (DMD).

The authors found a strong protective effect of relationship power on recent experience of forced sex and transactional sex among the participants. They also found that the association between RC and transactional sex was consistent with the association between RC and forced sex, which they suggest reveals that transactional sex, for these women, is associated with male dominance and control. That is, HIV-positive women with low relationship power may be more likely to engage in transactional sex due to poverty and food insecurity rather than for empowering reasons associated with agency.

The authors conclude with a call to consider the multiplicity of issues that need to be addressed for women living with HIV, including access to HIV care and treatment, social support, stigma and discrimination, disclosure, poverty and food security, and skills to negotiate safer sex and resolve conflict. In relationship to violence prevention they argue that anti-violence programmes should be integrated within HIV healthcare services as well as addressing structural factors through economic empowerment and gender transformative programmes.

Africa [4]
Uganda [5]
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