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Partner violence may undermine use of female-controlled forms of HIV prevention
Michael Carter, 2013-08-27 09:50:00
experience violence from their male partner are less likely to use condoms or
diaphragms, an international team of investigators report in the online edition
of the Journal of Acquired Immune
Deficiency Syndromes. Intimate partner violence (IPV) increased the risk of
condom non-use by up to 47% and non-use of diaphragms by a quarter.
believe the association between partner violence and not using a diaphragm
could have implications for research into microbicides and other forms of HIV prevention
under female control: “IPV is likely to impede adherence to HIV prevention
interventions, even those that are specially designed to give women greater
control over protecting their sexual health.”
HIV and intimate
partner violence are highly prevalent in southern Africa. Previous research has
shown that women who experience violence from a male partner are more likely to
report inconsistent condom use, multiple sexual partners and to have higher
rates of sexually transmitted infections and HIV.
experience IPV may be unsuccessful in their efforts to negotiate condoms, or be
less likely to refuse sex or to suggest the use of condoms because they fear
violence,” write the authors.
methods of HIV prevention can potentially give women more control over sexual
decision-making. However, investigators were concerned that the real-world
effectiveness of these interventions may be reduced for women experiencing
intimate partner violence.
To see if this was
the case they designed a 24-month longitudinal study involving 4505 women
recruited to the Methods for Improving Reproductive Health in Africa (MIRA)
study. Recruitment took place between 2003 and 2006 in South Africa and
Zimbabwe. Participants were randomised to receive diaphragms, lubricant and
condoms or condoms alone.
The women were
interviewed about their experiences of intimate partner violence at baseline
and again twelve and 24 months after randomisation. Data were gathered on
adherence to diaphragm and condom use and the investigators explored the
association between intimate partner violence and non-adherence.
Overall, 55% of
women reported intimate partner violence during at least one follow-up visit.
reported fearing violence from their male partner, 34% reported that their male
partner had emotionally abused them, 16% said their male partner had physically
assaulted them and 15% reported that their male partner had forced them to have
for potential confounders, there was a significant relationship between
intimate partner violence and condom non-adherence (intervention arm = AOR, 1.47; 95% CI, 1.28-1.69; control arm
= AOR, 1.41; 95% CI, 1.24-1.61).
intimate partner violence also associated with diaphragm non-adherence
(AOR,1.24; 95% CI, 1.06-1.45).
At all study
points, there was a significant relationship between partner violence and
non-adherence to condom or diaphragm use.
Women in the
control arm who experienced persisting (AOR, 2.02; 95% CI, 1.54-3.1) and
incident partner violence (AOR, 1.69; 95% CI, 1.08-2.6) had higher odds of
reporting condom non-adherence compared to women who did not report violence at
baseline or at the twelve month follow-up visit.
Women in the
intervention arm who reported persisting violence were significantly more
likely than women who did not report intimate partner violence to report condom
non-adherence (AOR, 1.53; 95% CI, 1.06-2.2) and diaphragm non-adherence (AOR,
2.0; 95% CI, 1.39-2.9).
policies that explicitly address IPV and the links to HIV infection risk are
urgently needed,” comment the authors. “Research that identifies multilevel
determinants of men’s perpetration of IPV and evaluates targeting young men and
women should be a high priority.”