Impact of exposure to intimate partner violence on CD4+ and CD8+ T Cell decay in HIV infected women: Longitudinal study

Jewkes, R; Dunkle, K; Jama-Shai, N; Gray, G PLoS One, 2015;

Emotional abuse has generally received little attention from programmes, but a growing body of evidence shows it to be a risk factor for ill health. This analysis highlights the importance of attending to emotional abuse when studying the physiological impact of intimate partner violence (IPV) experience and the mechanisms of its impact on women’s health.

The analysis presents two hypotheses:

  1. that exposure to gender-based violence is associated with change in CD4 and CD8 indicating progression to HIV disease in young ART-naïve* women
  2. that hunger, depression and substance abuse are associated with change in CD4 and CD8 as indicators of progression of HIV disease in young ART naïve women


A total of 103 HIV infected young women, aged 15-26, enrolled in this cluster randomised controlled trial (RCT). They were part of the Stepping Stones study. 

"ART-naïve" means they were not eligible for anti-retroviral treatment because of their CD4 count and the slow roll out of ART in the public sector in the study area. The analysis only focuses on the period after HIV infection was established.

Other social and biological factors, such as non-partner rape and pregnancy, have an impact on CD4. These may confound any relationship between CD4 and CD8 and IPV. 


Two rapid tests were performed in the site laboratory where participants gave blood samples. All were offered their HIV test results and offered psychological support from a study nurse.

Questionnaires measured the derived variables that also included age, completed years of schooling and adverse childhood experiences.


  • In young ART-naïve HIV positive women gender-based violence exposure in the form of emotional abuse is associated with a faster rate of decline in markers of cellular immunity
  • When examining purely CD4 decline, 40.8% women had no CD4 T-cell decline, 7.8% had a small decline and 51.4% had larger declines
  • For CD8, 36.9% of women had no decline and 59.2% had larger declines
  • Alcohol problems and having ever experience emotional abuse and emotional abuse by a current partner at baseline was associated with a larger CD4 decline


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