Intimate partner violence among HIV-serodiscordant couples in Durban, South Africa

Abstract

Background. South Africa (SA) has a high prevalence rate of intimate partner violence (IPV) and HIV, both of which can be exacerbated further by HIV serodiscordancy in the couple dyad. Further exploration of the discordancy sidedness in known mediating factors, such as alcohol abuse risk and post-traumatic stress (PTS), is required. Objectives. To investigate the extent of and gender differences in IPV, alcohol abuse risk and PTS symptoms among HIV-serodiscordant couples in Durban, SA, and to analyse these further with regard to female HIV serostatus. Methods. A cross-sectional analysis of data on 30 serodiscordant couples was conducted at the point of enrolment into a pilot study of an HIV risk reduction intervention. The statistical procedure for a dependent small sample was applied to examine gender differences in IPV, alcohol use and PTS symptoms among HIV-serodiscordant couples. Results. The woman was HIV-positive in 18 (60.0%) of the 30 serodiscordant couples enrolled. Exposure to IPV differed significantly between men (28.6%) and women (89.3%) (proportional difference −0.61, 95% confidence interval (CI) −0.8–−0.39). The Wilcoxon signed-rank test showed that PTS symptom scores differed significantly between men (median 22, interquartile range (IQR) 23) and women (median 44, IQR 28) (p=0.03). When the above analysis was stratified by female HIV serostatus, significant gender differences were found in IPV and PTS in the couples where the woman was HIV-positive. There were no significant gender differences for alcohol abuse risk. Conclusions. The findings demonstrated high levels of IPV in HIV-serodiscordant couples and a significant gender difference in mental health risk such as PTS in such relationships, particularly where the woman was HIV-positive. HIV intervention programmes should address gender-based violence and inequity among heterosexual couples.

Access to sexual and reproductive health services for women living with HIV in Latin America and the Caribbean: systematic review of the literature

“…This review also reports on structural barriers such as sexual and interfamily violence suffered by WLHIV when disclosing their serostatus to partners and family members, in addition to perceived stigma and discrimination that continues to permeate social and family relations in LAC . Similar results were described in South Africa where authors reported high levels of intimate partner violence in HIV‐serodiscordant couples and by Kennedy et al., who demonstrated how interventions carried out with WLHIV, partners and families to facilitate disclosure of HIV status improve health outcomes, facilitate safe sexual behaviours and empower women to report violence. These highly effective interventions, adapted to their context, should be considered by LAC countries as part of the care provided in public health settings .…”

Adapting a US-Based Evidence-Based HIV Prevention Intervention for the South African Context

“…Firstly, the researchers, through their experience with working with people living with HIV, identified a gap in the services that were available to assist couples with a different HIV status, with most counselling services focussing on voluntary counselling and testing for individuals (Mashaphu & Burns, 2017). Secondly, a systematic literature review was conducted to look at psychosocial interventions that have been used with success within the African context, with a special emphasis on cultural congruency, efficacy and sustainability which can be applied in the real world for the greater benefit of the public (Mashaphu et al, 2018a(Mashaphu et al, , 2018b. Thirdly, Eban II was identified for adaptation through a transdisciplinary collaborative initiative between South Africa and the United States, which allowed the researchers an opportunity to receive training from the Eban II research team.…”

Trapped in a Vicious Cycle of Violence: A Qualitative Inquiry into the Experiences of HIV Serodiscordant Married Couples

“…When partners make aware of their HIV status together in serodiscordant relationships often face major challenges including gender-based violence, lack of sexual desire, divorce and abandonment, self-blaming, the stress of possible transmission, nancial pressures, HIV-related stigma, family breakdown, desertion and isolation; all of which may have a negative in uence on their relationships (11)(12)(13)(14)(15). A study conducted on serodiscordant couples, indicated that exposure to intimacy violence partner differed signi cantly between men (28.6%) and women (89.3%) (16). Mashaphu (2018) argued that there is a high level of intimacy violence partner in HIV serodiscordant couples, therefore, intervention programs should address gender-based violence and inequity among heterosexual couples (16).…”

“…A study conducted on serodiscordant couples, indicated that exposure to intimacy violence partner differed signi cantly between men (28.6%) and women (89.3%) (16). Mashaphu (2018) argued that there is a high level of intimacy violence partner in HIV serodiscordant couples, therefore, intervention programs should address gender-based violence and inequity among heterosexual couples (16). Patel (2016) suggested that counseling programs in relation to intimate partner violence may be important in preventing the risk of HIV transmission to HIVnegative wives (17).…”

“…It seems that conducting research about women's experiences of violence is essential for the reason of identi cation, prevention, control and elimination of violence and also to provide required support services for female victims of violence (22). Several qualitative studies conducted on women's experiences are more focused on intimate partner violence and another person as being the cause of violence against women have not been considered (16,22,23). Additionally, more studies which have been conducted in this context in Iran have focused on HIV positive women and there is no evidence to explain the experiences of violence in Iranian HIV-negative women with HIV-positive husband i.e., HIV serodiscordant couples.…”