Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya

Abstract

Introduction Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women. Methods We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. Results The participants’ mean age was 38.6 (range: 18–69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72–80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34–0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31–0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34–0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. Conclusion IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.

Predictors and Factors Associated with Counseling Seeking Behavior Against Intimate Partner Violence Among HIV-Positive Women in Southwestern Uganda

“…18 , 24 Specifically for HIV, these effects include engaging in risky behaviors, 25 incident HIV, 12 , 15 poor acceptance of services to prevent human immunodeficiency virus (HIV) vertical transmission reduced antiretroviral therapy adherence and a lower likelihood of viral load suppression. 10 , 26–28 …”

Intimate partner violence and associated factors among HIV positive women attending antiretroviral therapy clinics in Gondar city, Northwest Ethiopia

“…This finding was significantly higher than in previous studies conducted in Adama town, Ethiopia (32.3%), Baltimore, America (26.5%), Nairobi and Mombasa, Kenya (20% and 14.6%), and India 35.4% [20,27,29,38,39]. This finding was lower than studies done in different parts of the Awi zone, Ethiopia (78%), Nekemet, Ethiopia (72.5%), the WHO multi country study (71%) [37,40,41], and a study done in Kenya 76% [42]. This variation may be due to variation in socio-economic status, reproductive health service coverage, and other gender related health services.…”

The effect of intimate partner violence on women's risk of HIV acquisition and engagement in the HIV treatment and care cascade: an individual-participant data meta-analysis of nationally representative surveys in sub-Saharan Africa

“…20,21 Evidence supports a negative relationship between IPV and ART adherence, though most studies focused on populations such as sex workers 17 , youth 22 , or pregnant/postpartum women. 18,[23][24][25] Quantitative evidence are sparse on ART uptake, but among five studies from high income settings, none showed an association between IPV and current ART use. 13 Studies from Zambia and South Africa point to an association between IPV and unsuppressed viral loads among adolescents/youth 26 and postpartum women.…”