Post on 22-Feb-2016
description
Intimate partner physical and sexual violence are associated with
perceived and actual HIV risk among hospital outpatients in rural Uganda
Susan M. Kiene, PhDRhoda Wanyenze, Moses Bateganya, Haruna Lule,
Harriet Nantaba, Michael SteinThe Salawo Research Collaboration
The Warren Alpert Medical School of Brown University, USAMakerere University School of Public Health, Uganda
University of Washington, USAGombe Hospital, Uganda
Background
HIV and intimate partner violence (IPV) are intertwined epidemics in many parts of the world
Violence is a risk factor for HIV In Uganda, where HIV prevalence is 6.5%
(UNAIDS, 2010), 48% of women and 20% of men report IPV, ever (DHS, 2006)
Objectives
Understand the prevalence of the experience of IPV among both women and men in an outpatient population in rural Uganda
Explore the mechanisms by which IPV may increase risk for HIV infection Lack of access to testing Increased risk from unprotected sex
Setting Outpatient clinic in a 100 bed comprehensive
public hospital in rural Butambala District, Uganda
Hospital serves a population > 300,000 Provider-initiated routine HIV-counseling and
testing (PITC) offered to all outpatients regardless of presenting symptoms
Free care and antiretroviral treatment
Procedures and MeasuresProcedures Interviewed before receiving provider-initiated HIV-
counseling and testing
Measures prior HIV testing perceived likelihood of testing HIV positive history of physical (e.g., hitting, slapping) and sexual
(forced sex) violence and emotional abuse (belittling, threats of violence) with current partner
sexual risk behavior
Participants
160 (82 female, 78 male) outpatients receiving provider-initiated routine HIV-counseling and testing
87% married age M=34.0 (range 20-59)
ResultsPrevalence of Violence/Abuse
Women Men
Physical Violence 31.7% 9.0%
Sexual Violence 43.9% 26.9%
Emotional Abuse 36.6% 28.2%
Emotional Abuse: Perceived % chance they would test HIV positive
Difference: Women: Χ2 19.14, p<.001, Men: Χ2 28.8, p<.001
IPV: Tested for HIV in prior year
NS difference
IPV: Perceived % chance they would test HIV positive
Difference: Women: Χ2 11.14, p<.001 , Men: Χ2 9.00, p<.01
IPV: Percent who tested HIV-positive
Difference: Women: Χ2 3.81, p<.05 , Men: Χ2 3.95, p<.05
IPV: Number of unprotected sex acts in prior 3 months
Difference: Women: OR 1.06, CI (1.04-1.09) , Men: OR 1.13, CI (1.02-1.24)
Summary IPV is prevalent in this community
Women and men who experienced IPV were more likely to: Think they would test HIV positive Test HIV positive Engage in more unprotected sex
No difference in prior access to HIV testing
Conclusions
The effect of IPV on increasing HIV risk is likely explained by the risk posed from unprotected sex not from lack of access to HIV testing
Interventions are needed to reduce the risk from unprotected sex among both women and men who experience IPV
Acknowledgements
Participants
Gombe Hospital Staff
Research AssistantsRuth NamulemeNalongo KijjeHajara Kagulire Farouk Kimbowa
FundingNIH K01 MH083536
Contact: susankiene@gmail.com