A mountain stream flows through the jungle in Bhutan.

Exploring the Link Between Intimate Partner Violence and HIV Infection

This week I’ve been listening to lectures from Confronting Gender Based Violence: Global Lessons with Case Studies from India on coursera.org

It’s a MOOC (Massive Online Open Course) through John Hopkins University Center for Clinical Global Health Education. Some MOOC’s are meh. Not this one. It’s like a podcast series on rocket fuel! Plus they provide lots of links to free articles (at the bottom).

The #4 lecture of week one is all about the link between intimate partner violence (IPV) and HIV. Fascinating.

Here’s some stuff I learned:

  • According to the India Demographic Health Survey, women experiencing IPV are at 3 times greater risk of HIV infection.
  • IPV is linked to risky sexual behavior, often out of the woman’s control.
  • There appears to be a link between IPV and the incidence of HIV. In other words, if you experience IPV you’re more likely to contract HIV.
  • IPV tends to be more frequent and severe among women with HIV.
  • Women experiencing IPV report more frequent nonconsensual condom nonuse, fear of asking to use a condom, and fear of refusing sex.
  • Women experiencing IPV report more frequent nonconsensual sex, unprotected sex, and anal sex (sometimes nonconsensual unprotected anal sex). These sexual events often result in abrasions and lacerations which facilitate virus transmission. Further, anal sex increases virus transmission by 16 times.
  • Perpetrators of IPV tend to engage in more risky behavior such as nonfidelity, condom nonuse, coercive sex, and intravenous drug use. Perpetrators have a higher infection rate compared with nonperpetrators.
  • Diagnosis of HIV and partner notification is a frightening experience for women and may lead to increased abuse.
  • HIV status may put a woman at more risk of abuse if her partner threatens to disclose her status, threatens to use her status for gain (for example in a custody dispute), uses her status to humiliate and degrade, or uses her status as an excuse for violence.
  • The fear associated with diagnosis and partner notification may discourage women from seeking care including testing and treatment.
  • Women experiencing IPV may have less effective treatment if her partner interferes with her medication, if she has competing priorities, or if she is experiencing mental health symptoms. Depression and PTSD are associated with poor medication compliance.
  • There is new research suggesting that stress and trauma are linked with a decreased viral response to medication.

And that’s just week one! Later lectures will address clinical care and programmatic implications and recommendations. They will also discuss some programs that have been successful in Africa.

Here are the resources from this week’s lectures:

Stöckl H, Devries K, Rotstein A, Abrahams N, Campbell J, Watts C, Moreno CG (2013). The global prevalence of intimate partner homicide: a systematic review. Available online: http://www.sciencedirect.com/science/article/pii/S0140673613610302

Moore AM, Awusabo-Asare K, Madise N, John-Langba J, Kumi-Kyereme A (2007). Coerced First Sex among Adolescent Girls in Sub-Saharan Africa: Prevalence and Context. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367148/

Population Council, Sida, Norwegian Ministry of Foreign Affairs (2010). Comprehensive Responses to Gender Based Violence in Low-Resource Settings: Lessons learned from Implementation. Available online: http://www.popcouncil.org/uploads/pdfs/2010RH_CompRespGBV.pdf

United Nations Fund for Population Activities (2010). Addressing violence against women and girls in sexual and reproductive health services: A review of knowledge assets. Available online: http://www.unfpa.org/sites/default/files/pub-pdf/addressing_violence.pdf

Li Y, Marshall CM, Rees HC, Nunez A, Ezeanolue E, Ehiri JE (2014). Intimate partner violence and HIV infection among women: systematic review and meta-analysis. Available online: http://www.jiasociety.org/index.php/jias/article/view/18845/3496

Jewkes RK, Dunkle K, Nduna M, Shai N (2010). Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Available online: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60548-X/abstract

World Health Organization (2013). 16 Ideas for addressing violence against women in the context of the HIV epidemic: A programming tool. Available online: http://apps.who.int/iris/bitstream/10665/95156/1/9789241506533_eng.pdf?ua=1

Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N (2008). Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. Available online: http://www.bmj.com/content/337/bmj.a506

Kishor, S. (2015). Intimate partner violence and HIV: clearing up confusion. Available online:  http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2814%2970372-9/fulltext?rss=yes

Measure DHS+ (2004). Profiling Domestic Violence: A Multi-Country Study. Available online:  http://dhsprogram.com/pubs/pdf/od31/od31.pdf

Maxwell L, Devries K, Zionts D, Alhusen JL, Campbell J (2015). Estimating the effect of intimate partner violence on women’s use of contraception: a systematic review and meta-analysis. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334227/

Miller E,  Jordan B, Levenson R, Silverman JG (2010). Reproductive coercion: connecting the dots between partner violence and unintended pregnancy. Available online: http://www.arhp.org/uploadDocs/journaleditorialjune2010.pdf

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