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Intimate partner violence among women with HIV infection in rural Uganda: critical implications for policy and practice

BMC Women's Health volume 11, Article number: 50 (2011) Cite this article

Abstract

Background

Intimate partner violence (IPV) is a major public health problem in Africa and worldwide. HIV infected women face increased IPV risk. We assessed the prevalence and factors associated with IPV among HIV infected women attending HIV care in Kabale hospital, Uganda.

Methods

This cross-sectional study was conducted among 317 HIV infected women attending Kabale regional hospital HIV treatment centre, from March to December 2010. Participants were interviewed using an interviewer-administered questionnaire. Data was collected on socio-demographic variables, social habits, and IPV (using the abuse assessment screen and the Severity of Violence against Women Scale to identify physical, sexual and psychological violence). Characteristics of the participants who reported IPV were compared with those who did not. Multivariate logistic-regression analysis was conducted to analyze factors that were independently associated with IPV.

Results

The mean age of 317 respondents was 29.7 years. Twenty two (6.9%) were adolescents and 233 (73.5%) were married or cohabiting. The mean age of the spouse was 33.0 years.

One hundred and eleven (35.0%) were currently on antiretroviral therapy. Lifetime prevalence of IPV (physical or sexual) was 36.6%. In the preceding 12 months, IPV (any type) was reported by 93 respondents (29.3%). This was physical for 55 (17.6%), and sexual /psychological for 38 (12.1%). On multivariate multinomial logistic regression analysis, there was a significant but inverse association between education level and physical partner violence (adjusted relative risk (ARR) 0.50, confidence limits (95% CI) 0.31-0.82, p-value = 0.007). There was a significant but inverse association between education level of respondent and sexual/psychological violence (ARR 0.47 95%CI (0.25-0.87), p-value = 0.017) Likewise, there was a significant inverse association between the education level of the spouse and psychological/sexual violence (ARR 0.57, 95% CI 0.25-0.90, p-value = 0.018). Use of antiretroviral therapy was associated with increased prevalence of any type of violence (physical, sexual or psychological) with ARR 3.04 (95%CI 1.15-8.45, p-value = 0.032).

Conclusion

Almost one in three women living with HIV had suffered intimate partner violence in the preceding 12 months. Nearly one in five HIV patients reported physical violence, and about one in every seven HIV patients reported sexual/psychological violence. Likewise, women who were taking antiretroviral drugs for HIV treatment were more likely to report any type of intimate partner violence (physical, sexual or psychological). The implication of these findings is that women living with HIV especially those on antiretroviral drugs should be routinely screened for intimate partner violence.

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Background

Intimate partner violence (IPV) is a major public health problem in Africa and worldwide [1–7]. For women, its consequences include low birth weight [6], unwanted pregnancy and induced abortion [7] and death from homicide [8]. Other effects include physical injury or disability, depression [9], post-traumatic stress syndrome [9] and preterm birth [10]. In addition, other sequelae include poor acceptance of services to prevent human immunodeficiency virus (HIV) vertical transmission [11]. IPV has been associated with several risk factors, which include (for the male) having multiple sexual partners [4] and perpetrator alcohol use [2, 3, 12, 13]. For the woman, risk factors for IPV include HIV positive status [3, 6, 11], low education or low socioeconomic status [2, 6], pregnancy [7] and being in a cohabitating relationship [7].

Numerous studies in heterosexual relationships [14–19] found an association between IPV and high rates of risk behaviors (such as multiple sex partners, non-use or inconsistent use of condoms and sexual coercion) and sexually transmitted infections (STIs) such as HIV. There are several explanations for this relationship. Firstly, gender differences in socialization of men and women (in socially defined and socially constructed ways) influence who, where and in what context men and women form sexual partnerships, as well as the overt and covert power relationships involved [14]. Secondly, in some patriarchal societies, men's socialization idolizes traits of strengths and toughness, phenomenal sexual success and clustering of violent, anti-social and risky sexual practices [14], as well as women's submissiveness. In such societies, women's sexuality might pose a threat to the socially accepted norms and behavior, as it challenges men's control over women, and provokes jealousy in the women's spouses [14, 15]. Women who follow such socially prescribed norms are at high risk of acquiring HIV infection subsequent to their partners' high-risk behavior puts them at risk of acquiring HIV infection.

Substance abuse is often associated with risky sexual behavior [14–16]. IPV increases women's risk of acquisition of HIV as a result of coercive sex (in case of sexual violence), non-use of condoms and increased risk of exposure to HIV [17–19]. Abusive partners have other risk behaviors such as drinking alcohol, drug abuse, STIs, multiple sexual partners and concurrent sexual partnerships. Abused women face increased HIV risk based both on the greater likelihood of HIV infection among abusive husbands and elevated HIV transmission within abusive relationships [17–19]. IPV affects the psychological and mental health of women survivors, in part through increasing other risk behaviors such as drug and substance abuse [16]. Indeed, alcohol use before sex and related disinihibition were found to increase therisk of HIV infection in young women aged 15-24 years in Uganda [17].

In addition, IPV may be a consequence of HIV care. Where as voluntary counseling and testing (VCT) and routine counseling (RCT) are cornerstones of HIV prevention interventions and are entry points into care for those who test HIV positive, the behaviors promoted after testing positive increase risk of IPV. Such behaviors include negotiating condom use with sexual partners, abstaining from sex and disclosure of HIV status to sexual partners [20]. To overcome this problem, couple counseling has been advanced as a measure to promote HIV prevention and reduce IPV risks. IPV functions as both a risk marker and a risk factor for HIV among women [21]. Indeed, among women attending antenatal clinic in South Africa and Nigeria, a strong association was found between gender-based violence and HIV infection [22–25], suggesting the need for routine HIV and IPV screening for Prevention of Mother to Child HIV transmission (PMTCT) programs. Given that IPV increases women's risk of acquiring HIV and that disclosure of HIV status or negotiating safer sex could be catalysts for gender-based violence [20], integrating gender-based violence screening and management could be a critical component of HIV prevention and care programs. The objective of this cross-sectional study was to assess the prevalence and factors associated with IPV among HIV infected women attending HIV care in Kabale Hospital, Uganda.

Methods

Study design, participants and data collection procedure

This cross-sectional study was conducted at Kabale regional hospital, from March to December 2010. During this period, 317 women were recruited into the study from among women who received medical care and counseling services at the HIV treatment centre. Participants were interviewed using an interviewer-administered questionnaire adapted from the demographic and health survey [12]. Data was collected on socio-demographic variables such as age, level of education, marital status, employment status, age of spouse, occupation of spouse and social habits (drinking alcohol or smoking) as well as the education level of spouse. For assessment of IPV, we used the Abuse Assessment Screen by McFarlane et al [26] and the Severity of Violence against Women Scale [27]. We inquired whether the respondents had experienced violence from their spouses over their lifetime or in the preceding 12 months (separating physical, sexual and psychological violence. We obtained ethical approval from Kabale Hospital and Mbarara University Ethics committees. Counseling about IPV was provided to all the participants, and all eligible participants were provided with appropriate counseling, support and antiretroviral therapy.

Data analysis

Data was analyzed by computing frequencies and percentages for categorical variables as well as means and standard deviations for numerical variables, stratified for presence or absence of IPV. On bivariate analysis, factors associated with IPV were analyzed, using chi-square test for categorical variables and Student's t-test for numerical variables, at the 95% significance level. Multivariate multinomial logistic-regression analysis was conducted to analyze factors that were independently associated with IPV, computing relative risks for IPV. During the stepwise multinomial logistic regression modeling, IPV in the preceding 12 months was coded at three levels: any type of violence, physical violence only and sexual/psychological violence. Absence of IPV was the reference category.

Results

Regarding socio-demographic characteristics, the mean age of the 317 women was 29.7 years (standard deviation 9.9 years). Twenty two (6.9%) were adolescents while 233 (73.5%) were married or cohabiting. The mean age of the spouse was 33.0 years (standard deviation 8.6 years). The respondents were of high parity with 164 women (51.7%) being of parity 5 or higher. Regarding education level, 184 women (58.5%) had just primary level or no formal education. Lifetime prevalence of IPV (physical or sexual) was reported by 116 (36.6%) respondents. In the preceding 12 months, IPV (any type) was reported by 93 respondents (29.3%). This was physical for 55 (17.6%), and sexual/psychological for 38 (12.1%). Table 1 shows the socio-demographic characteristics of the respondents stratified by presence of IPV in the preceding 12 months. The respondents who reported history of IPV were comparable to those who did not (p > 0.05) with respect to all socio-demographic variables except level of education (of the respondents) (p-value = 0.002) and level of education of their spouses (p-value = 0.037).

Table 1 Socio-demographic characteristics of the respondents stratified for presence or absence of intimate partner violence in the preceding 12 months
Full size table

Table 2 shows the respondents' treatment with antiretroviral therapy (ART) in relation to the prevalence of intimate partner violence in the preceding12 months. One hundred and eleven women (35.0%) were currently on ART. The mean duration of ART was 3.3 months (± 3.2 months). Thirty four women (30.6%) had changed their treatment regimen to second line regimen, with side effects of the drugs being the main reasons for treatment regimen change. (The commonest ART first line regimen was Triomune, a fixed dose combination of Stavudine, Lamivudine and Nevirapine, which frequently caused side effects and was eventually phased out from the available treatment regimes). Women who were currently on ART were nearly twice as likely to be report IPV in the preceding 12 months (Odds ratio 1.9, 95% CI 0.93-3.93), p-value = 0.078).

Table 2 Drug therapy and Intimate partner violence in the preceding 12 months
Full size table

Table 3 shows the results of multivariate multinomial logistic regression analysis showing factors associated with IPV in the preceding 12 months. Factors associated with lower prevalence of physical violence were education level of respondent (adjusted relative risk (ARR) 0.50, confidence limits (95%CI) 0.31-0.82), education level of spouse (ARR 0.5, 95%CI 0.31-0.82, p = 007) and use of antiretroviral therapy (ARR 2.56, 95%CI 0.98-7.32, p-value = 0.054). There was an inverse association between age of respondent (ARR 0.93, 95%CI 0.87-1.08, p-value = 0.054), education level of respondent (ARR 0.47, 95%CI 0.25-0.87, p-value = 0.017) and education level the spouse of respondent (ARR 0.47, 95%CI 0.25-0.90, p-value = 0.018) and presence of sexual/psychological violence. Only use of ART was significantly associated with prevalence of any type of violence (physical, sexual or psychological) with ARR 3.04 (95%CI 1.15-8.45, p-value = 0.032), after adjusting for age, parity, education level and employment status of the respondent.

Table 3 Multinomial multivariate logistic regression of factors associated with Intimate partner violence in the preceding 12 months
Full size table

Discussion

Violence against women has been identified as a major risk factor for HIV infection among women [28–31]. Observational studies have shown that a woman's exposure to IPV is associated with an increased risk for HIV infection in southern and eastern Africa [3, 4, 13–15, 21, 22, 32]. There are several mechanisms through which IPV is related to increased risk for HIV infection among women. These include direct effects through higher levels of violent sexual intercourse among abused women. This is in addition to the likelihood that men who enact IPV will have more high-risk sexual behaviors [33, 34] and may be more likely to be HIV infected [23]. Furthermore, there are indirect effects through reduced likelihood that women who have suffered past abuse are likely to have more sexual partners and more transactional sex, as well as being less likely to test/disclose sero-status or less receptive to HIV awareness programs [35, 36]. These reflect an underlying power imbalance. Indeed, two cohort studies in South Africa have found reduced HIV risk behaviors [37] and reduced HIV incidence [38] following interventions to empower women.

In our study, there was an inverse association between education level of spouse with sexual/psychological violence. The explanation for this is unclear. Where as a woman's education level may reduce gender inequality and gender-power imbalance in some contexts, it may increase insecurity in the male partners and become one of the contextual factors for increased IPV in other contexts [14–16]. In addition, gender inequality and polygamy have been associated with increased risk of IPV. Likewise, there is no evidence that the more educated the woman is, the less likely they will be in polygamous marital relationships. There is no evidence that marital conflict, drug abuse or excessive alcoholic consumption occur with lower frequency in sexual relationships of more educated women. However, women in such relationships may have more bargaining power and potential to leave such abusive relationships. In the latter case, such leaving or threats of leaving may trigger intimate partner violence.

In this study, we acknowledge several limitations: this was a cross-sectional study in women attending a health facility with a regional HIV care centre, where we evaluated only 317 respondents, all of whom were HIV positive. Our findings are not representative of all HIV patients or all survivors of IPV. Since the respondents were women already accessing HIV care, it is possible that they experienced lower levels of violence that the HIV infected women in the general population. Secondly, we can not establish a temporal relationship between HIV and IPV. Thirdly, since we have no reference group that was HIV negative, we can not evaluate a causal relationship between IPV and HIV. Our findings, however, suggest that IPV is associated with HIV infection, as almost every third woman living with HIV had suffered IPV, and about one in seven HIV patients reported both sexual and psychological violence in the preceding 12 months.

Our findings are in agreement with studies from Tanzania [4], Rwanda [39] and South Africa [40, 41] which found an association between HIV and IPV. The high prevalence of IPV (both physical and sexual violence) in women with HIV infection has critical implications for policy and practice in programs and interventions for HIV or IPV. Such programs/interventions should incorporate strategies to address the problem on several fronts. Firstly, the strategies should change the underlying social construction of masculinity and gender power imbalances that underlie risk for IPV and HIV. The experience of violence reinforces gendered power inequalities that impact on women's HIV risk, such that women who have less power in their sexual relationship (measured on the Sexual Relationship Power Scale) are at higher risk of having HIV [13] and women with less power have a lower likelihood of condom use [14, 41]. In addition, health education should be provided to women receiving care for HIV or IPV regarding the nature of the associated risk, as well as reduction of risk factors (that increase risk of both HIV and IPV).

Secondly, policy guidelines should incorporate routine screening for IPV and HIV in healthcare settings. Thirdly, clinicians should incorporate inquiries about IPV to women accessing care for STIs or HIV. Similarly, STIs should be recognized as potential epidemiological markers for IPV. Lastly, our findings have implications for future research: A larger study comprised of both HIV positive and HIV negative participants would confirm whether a true association exists between HIV infection and IPV. Furthermore, though their findings tend to be context-specific and their generalisability is limited, qualitative studies should be conducted in this population and setting to develop more nuanced understanding of the complex interaction between gender norms, IPV and HIV. In addition, association between use of antiretroviral therapy and IPV requires further investigation in longitudinal community based studies, given its grave possible repercussions at the personal and public health levels, resulting from viral resistance that could develop in case of poor adherence to medication.

Conclusion

Nearly one in five women living with HIV had suffered IPV in the preceding 12 months, and one in every six HIV patients with sexual violence reported psychological violence. The higher the education level attained by the respondent (or their spouse), the less likely they were to report sexual or psychological violence. Likewise, women who were taking antiretroviral drugs for HIV treatment were more likely to report any type of IPV. The implication of these findings is that women living with HIV especially those on antiretroviral drugs should be routinely screened for intimate partner violence

References

  1. Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C, WHO Multi-country Study on Women's Health and Domestic Violence against Women Study Team: 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. 1. Lancet. 2008, 371 (9619): 1165-1172. 10.1016/S0140-6736(08)60522-X.

    Article  PubMed  Google Scholar 

  2. Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH, WHO Multi-country Study on Women's Health and Domestic Violence against Women Study Team: Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet. 2006, 368 (9543): 1260-1269. 10.1016/S0140-6736(06)69523-8.

    Article  PubMed  Google Scholar 

  3. Koenig MA, Lutalo T, Zhao F, Nalugoda F, Wabwire-Mangen F, Kiwanuka N, et al: Domestic violence in rural Uganda: evidence from a community-based study. Bulletin of the World Health Organisation. 2003, 81: 53-60.

    Google Scholar 

  4. Maman S, Mbwambo JK, Hogan NM, Kilonzo GP, Campbell JC, Weiss E, et al: HIV positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar Es Salaam, Tanzania. American Journal of Public Health. 2002, 92: 1331-1337. 10.2105/AJPH.92.8.1331.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Andersson N, Ho-Foster A, Mitchell S, Scheepers E, Goldstein S: Risk factors for domestic physical violence: a national cross-sectional household survey in eight southern African countries. BMC Women's Health. 2007, 16: 11.

    Article  Google Scholar 

  6. Kaye DK, Mirembe FM, Bantebya G, Johansson A, Ekstrom AM: Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda. Tropical Medicine and International Health. 2006, 11 (10): 1576-1584. 10.1111/j.1365-3156.2006.01711.x.

    Article  PubMed  Google Scholar 

  7. Kaye DK, Mirembe FM, Bantebya G, Johansson A, Ekstrom AM: Domestic violence as risk factor for unwanted pregnancy and induced abortion in Mulago Hospital, Kampala, Uganda. Tropical Medicine and International Health. 2006, 11 (1): 90-101. 10.1111/j.1365-3156.2005.01531.x.

    Article  PubMed  Google Scholar 

  8. Campbell JC, Glass N, Sharps PW, Laughon K, Bloom T: Intimate partner homicide: review and implications of research and policy. Trauma Violence and Abuse. 2007, 8: 246-269. 10.1177/1524838007303505.

    Article  Google Scholar 

  9. Rosen D, Seng JS, Tolman RM, Mallinger G: Intimate partner violence, depression, and posttraumatic stress disorder as additional predictor of low birth weight infants among low-income mothers. Journal of Interpersonal Violence. 2007, 22: 1305-1314. 10.1177/0886260507304551.

    Article  PubMed  Google Scholar 

  10. Neggers Y, Goldenberg R, Cliver S, Hauth J: Effects of domestic violence on preterm birth and low birth weight. Acta Obstetricia et Gynecologia Scandinavica. 2004, 83 (5): 455-460.

    Article  Google Scholar 

  11. Karamagi CA, Tumwine JK, Tylleskar T, Heggenhougen K: Intimate partner violence against women in eastern Uganda: implications for HIV prevention. BMC Public Health. 2006, 6: 284-10.1186/1471-2458-6-284.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Uganda Bureau of Statistics (UBOS): Uganda Demographic and Health Survey. 2006, Entebbe, Uganda; Uganda Bureau of Statistics and ORC Macro

    Google Scholar 

  13. Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, et al: Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. American Journal of Epidemiology. 2004, 160: 230-239. 10.1093/aje/kwh194.

    Article  PubMed  Google Scholar 

  14. Jewkes R, Morrell R: Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society. 2010, 13: 6.

    PubMed  PubMed Central  Google Scholar 

  15. Dunkle K, Jewkes R, Nduna M, Levin J, Jama N, Khuzwayo N, et al: Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape. AIDS. 2006, 20: 2107-2114. 10.1097/01.aids.0000247582.00826.52.

    Article  PubMed  Google Scholar 

  16. el-Bassel N, Fontdevila J, Gilbert L, Voisin D, Richman BL, Pitchell P: HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue. Journal of Substance Abuse. 2001, 13 (1-2): 29-43. 10.1016/S0899-3289(01)00068-2.

    Article  CAS  PubMed  Google Scholar 

  17. Zablotska IB, Gray RH, Koenig MA, Serwadda D, Nalugoda F, Kigozi G, et al: Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda. AIDS and Behavior. 2009, 13 (2): 225-33. 10.1007/s10461-007-9333-5.

    Article  PubMed  Google Scholar 

  18. Martin SL, Kilgallen B, Tsui AO, Maitra K, Singh KK, Kupper LL: Sexual behaviors and reproductive health outcomes: associations with wife abuse in India. JAMA. 1999, 282 (20): 1967-1972. 10.1001/jama.282.20.1967.

    Article  CAS  PubMed  Google Scholar 

  19. Silverman JG, Decker MR, Kapur NA, Gupta J, Raj A: Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men. Sexually Transmitted Infections. 2007, 83 (3): 211-215.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gaillard P, Melis R, Mwanyumba F, Claeys P, Muigai E, Mandaliya K, et al: Vulnerability of women in an African setting: lessons for mother-to-child HIV transmission prevention programmes. AIDS. 2002, 16 (6): 937-9. 10.1097/00002030-200204120-00019.

    Article  PubMed  Google Scholar 

  21. Decker MR, Seage GR, Hemenway D, Raj A, Saggurti N, Balaiah D, et al: Intimate partner violence functions as both a risk marker and risk factor for women's HIV infection: findings from Indian husband-wife dyads. Journal of the Acquired Immune Deficiency Syndrome. 2009, 51 (5): 593-600. 10.1097/QAI.0b013e3181a255d6.

    Article  Google Scholar 

  22. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntyre JA, Harlow SD: Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004, 363 (9419): 1415-1421. 10.1016/S0140-6736(04)16098-4.

    Article  PubMed  Google Scholar 

  23. Myer L, Rebe K, Morroni C: Missed opportunities to address reproductive health care needs among HIV-infected women in antiretroviral therapy programmes. Tropical Medicine and International Health. 2007, 12 (12): 1484-1489. 10.1111/j.1365-3156.2007.01955.x.

    Article  PubMed  Google Scholar 

  24. Ezeanochie MC, Olagbuji BN, Ande AB, Kubeyinje WE, Okonofua FE: Prevalence and correlates of intimate partner violence against HIV sero-positive pregnant women in a Nigerian population. Acta Obstetricia et Gynecologia Scandinavica. 2011, 90 (5): 535-539. 10.1111/j.1600-0412.2011.01083.x.

    Article  Google Scholar 

  25. Christofides N, Jewkes R: Acceptability of universal screening for intimate partner violence in voluntary HIV testing and counseling services in South Africa and service implications. AIDS Care. 2010, 22 (3): 279-285. 10.1080/09540120903193617.

    Article  PubMed  Google Scholar 

  26. McFarlane J, Parker B, Soeken K, Bullock LF: Brief report. Assessing for abuse during pregnancy. JAMA. 1992, 267: 3176-3178. 10.1001/jama.267.23.3176.

    Article  CAS  PubMed  Google Scholar 

  27. World Health Organization: WHO Multi-Country Study on Women's Health and Domestic Violence: Core Questionnaire and WHO Instrument-Version 9. 2000, Geneva: World Health Organization

    Google Scholar 

  28. Andersson N, Cockcroft A, Shea B: Gender-based violence and HIV: relevance for HIV prevention n hyperendemic countries of southern Africa. AIDS. 2008, 22 (Suppl 4): S73-86. 10.1097/01.aids.0000341778.73038.86.

    Article  PubMed  Google Scholar 

  29. Garcia-Moreno C, Watts C: Violence against women: its importance for HIV/AIDS. AIDS. 14 (Suppl 3): S253-265.

  30. Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A: Intimate partner violence and HIV infection among married Indian women. JAMA. 2008, 300: 703-710. 10.1001/jama.300.6.703.

    Article  CAS  PubMed  Google Scholar 

  31. Jewkes RK, Levin JB, Penn-Kekana LA: Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Social Science and Medicine. 2003, 56: 125-134. 10.1016/S0277-9536(02)00012-6.

    Article  PubMed  Google Scholar 

  32. Fonck K, Els L, Kidula N, Ndinya-Achola J, Temmerman M: Increased risk of HIV in women experiencing physical partner violence in Nairobi, Kenya. AIDS and Behavior. 2005, 9: 335-339. 10.1007/s10461-005-9007-0.

    Article  PubMed  Google Scholar 

  33. Jewkes R, Dunkle K, Koss MP, Levin JB, Nduna M, Sikweyiya Y: Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors. Social Science and Medicine. 2006, 63: 2949-2961. 10.1016/j.socscimed.2006.07.027.

    Article  PubMed  Google Scholar 

  34. Silverman JG, Decker MR, Kapur NA, Gupta J, Raj A: Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men. Sexually Transmitted Infections. 2007, 83: 211-215.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Townsend L, Jewkes R, Mathews C, Johnston LG, Flisher AJ, Zembe Y, et al: HIV risk behaviors and their relationship to intimate partner violence (IPV) among men who have female sexual partners in Cape Town, South Africa. AIDS Behav. 2011, 15: 132-141. 10.1007/s10461-010-9680-5.

    Article  PubMed  Google Scholar 

  36. Dunkle KL, Jewkes RK, Nduna M, Levin J, Jama N, Khuzwayo N, et al: Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. AIDS. 2006, 20: 2107-2114. 10.1097/01.aids.0000247582.00826.52.

    Article  PubMed  Google Scholar 

  37. Pronyk PM, Kim JC, Abramsky T, Phetla G, Hargreaves JR, Morison LA, et al: A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS. 2008, 22: 1659-1665. 10.1097/QAD.0b013e328307a040.

    Article  PubMed  Google Scholar 

  38. Jewkes RK, Dunkle K, Nduna M, Shai N: Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010, 376 (9734): 41-48. 10.1016/S0140-6736(10)60548-X.

    Article  PubMed  Google Scholar 

  39. van der Straten A, King R, Grimstead O, Vittinghoff E, Serufilira A, Allen S: Sexual coercion, physical violence and HIV infection among women in steady relationships in Kigali, Rwanda. AIDS and Behavior. 1998, 2: 61-73. 10.1023/A:1022311424652.

    Article  Google Scholar 

  40. Harling G, Msisha W, Subramanian SV: No association between HIV and intimate partner violence among women in 10 developing countries. PLoS One. 2010, 5 (12): e14257-10.1371/journal.pone.0014257.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, et al: Factors associated with HIV sero-status in young rural South African women: Connections between intimate partner violence and HIV. International Journal of Epidemiology. 2006, 35: 1461-1468. 10.1093/ije/dyl218.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to colleagues of the Kabale hospital, the research assistants who did the data collection and all the research participants.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Kabale Regional Hospital, P.O.B ox 7, Kabale, Uganda

    Michael O Osinde

  2. Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

    Dan K Kaye & Othman Kakaire

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  1. Michael O Osinde
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Correspondence to Dan K Kaye.

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The authors declare that they have no competing interests.

Authors' contributions

DKK and OK conceptualized the study. DKK, OK and MOO designed the study instrument. MOO piloted the study instruments and collected the data. DKK and OK conducted the data analysis. DKK wrote the first draft of the manuscript. All co-authors contributed to revision of the subsequent drafts and approved the final version of the manuscript.

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Osinde, M.O., Kaye, D.K. & Kakaire, O. Intimate partner violence among women with HIV infection in rural Uganda: critical implications for policy and practice. BMC Women's Health 11, 50 (2011). https://doi.org/10.1186/1472-6874-11-50

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