Spousal violence and HIV: Exploring the linkages in five sub-Saharan African countries

Spousal violence and HIV- Exploring the linkages in five Sub-Saharan African countries.pdf

Applying nuanced measures to DHS data from both members of married couples, this study identifies pathways between spousal violence and women’s HIV status.

An increasing body of evidence – including six of seven studies using nationally representative samples – underlies the growing consensus that intimate partner violence contributes to women’s vulnerability to HIV. While a direct effect on HIV status is unlikely, the authors propose a gender-based framework defining two primary pathways of association between a woman’s experience of spousal violence and her HIV status:

  1. HIV risk behaviours/factors of her husband
  2. her own behavioural and situational HIV risk factors

Overall, the authors include seven key factors:

  • lifetime number of sexual partners
  • STI or STI symptoms in the last 12 months
  • non-marital sex in the past 12 months (male partner)
  • having paid for sex (male partner)
  • alcohol use (male partner)
  • husbands’ HIV status

The study finds a significant association between multiple forms of violence and women’s HIV status in all five countries (Kenya, Malawi, Rwanda, Zambia and Zimbabwe). A common structure of what constitutes violence emerges:

  • suspicion
  • isolation
  • emotional violence
  • physical violence
  • sexual violence

The analysis finds that “men’s controlling behaviours” represent the first two structures: suspicion and isolation.

The study suggests that there is no direct effect of most forms of spousal violence on women’s HIV status, only an indirect effect through selected behavioural and other factors that put an individual at high risk of HIV. Further investigation is needed, to ascertain why physical violence continues to be associated with women’s HIV status after controlling for risk factors. 

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