Intimate partner violence against women living with and without HIV: contexts and associated factors in Wolaita Zone, Ethiopia.
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Date
2021
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Abstract
Background: Intimate partner violence (IPV) and Human Immunodeficiency Virus (HIV) are
overlapping or intersecting public health challenges. Intimate partner violence is considered to
be strongly related to HIV infection among women in Africa. However, the evidence is not
conclusive. Women who are abused physically by their partners seek medical treatment in
public institutions, yet, in Ethiopia, the experience of healthcare workers (HCWs) in screening
IPV among HIV-positive and HIV-negative clients is not fully understood
Purpose: This study aimed to map the evidence of IPV in Sub-Saharan Africa, to measure the
factors associated with IPV, to explore the experience of IPV against women living with and
without HIV, and the health care workers' IPV screening experience in Wolaita Zone, southern
Ethiopia.
Objectives
1. To conduct a scoping review of IPV among women living with HIV/AIDS in Sub-
Saharan Africa.
2. To explore the lived experience of IPV against women using antiretroviral therapy
(ART) and other outpatient services in Wolaita Zone.
3. To explore the experiences and challenges in screening for IPV among women who use
ART and other health services in Wolaita Zone.
4. To measure the prevalence and associated factors of IPV among women living with and
without HIV in Wolaita Zone.
Methods: This is a mixed-methods study. I conducted both qualitative and quantitative studies..
Initially, I mapped the evidence of IPV among HIV-positive women in Sub-Saharan Africa
using a scoping review. Then, I conducted an exploratory sequential design of mixed-methods
research. An interpretative (hermeneutic) phenomenological design was used to explore the
lived experiences of women who were living with and without HIV. Additionally, I used a
descriptive phenomenological study design to explore the IPV screening experiences of 16
HCWs. I also used a comparative cross-sectional study comprising 816 women between 18-49
years who were living with and without HIV for the quantitative study. I used the standard
questionnaire of the World Health Organization (WHO) multi-country study on women's health
and domestic violence against women (translated). The scientific rigour, dependability, and
credibility relating to this sensitive subject were maintained. I used STATA software, version 15
for the quantitative data analysis; NVIVO 12 assisted us in developing a framework, and Colaizzi's analysis for the qualitative data. I used the binary and multivariable logistic
regression model for the quantitative analysis.
Results: The scoping review provided a summary of the evidence of IPV experiences among
women with HIV/AIDS. As this review has shown, the HIV-positive women were at
considerable risk of IPV after disclosure of their serostatus to a male partner. Psychological and
emotional abuse was the most common form of violence reported by the review. Subsequently,
in the quantitative study, we found a high lifetime prevalence of IPV among all women in
Wolaita Zone, 487 (59.68%, [95% CI:56.31%-63.05%]. It was slightly higher among women
living with HIV, 250 (61.3%), than among those who were HIV negative, 238 (58.09%).
Factors associated with IPV were the controlling behaviour of husband/partner [AOR=8.13;
95% CI: 4.93-13.42], poor wealth index [AOR=3.97; 95% CI:1.81-8.72], bride price payment to
bride‘s family[AOR=3.46; 95% CI:1.74-6.87], women‘s decision to refuse sex [AOR=2.99;95%
CI:1.39-6.41], age group of women [AOR=2.86; 95% CI:1.67-4.90], partner‘s family choosing
a wife [AOR=2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR=2.36; 95%
CI:1.36-4.10], number of sexual partners [AOR=2.35; 95% CI:1.36-4.09], and if a partner ever
physically fought with another man [AOR=1.83; 95% CI: 1.05-3.19]. Inappropriate legal
punishment of the perpetrator and the lack of a supportive women's network to avert IPV were
perceived as limitations by the women. There were HCW and health system-related challenges
in screening for IPV. These challenges comprised a gap in the medico-legal report provision,
absence of separate record-keeping for IPV cases, lack of client follow-up, and lack of
coordination with an external organisation.
Conclusions and recommendations: There was a high prevalence of IPV among women, both
living with and without HIV. The extent of IPV and its presentation in the different forms
(physical, sexual and psychological), which frequently overlapped, highlights the urgency of
intervention measures. Women reported terrifying experiences of violence, which affected their
health physically, mentally, and psychologically. There are also challenges concerning HCWs,
health systems, and the clients, relating to screening for IPV. Scoping review revealed evidence
of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure
influences IPV, and proof of the association of socio-demographic characteristics with IPV. It
was concluded that marriage arrangements should be by mutual consent of the marriage partners
rather than being made by parents; it is advisable to involve males in all programmes of genderbased
violence prevention to change their violent behaviours; there is a need for the
arrangement of separate record-keeping of IPV cases at the health facilities and for standardising the medico-legal reporting system. Finally, this study emphasises the importance
of executing more gender-equitable policies.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.