Prevalence and correlates of intimate partner violence in HIV-positive women engaged in transactional sex in Mombasa, Kenya

Abstract

We evaluated the prevalence and correlates of intimate partner violence in the past year by a regular male partner in HIV-positive female sex workers in Mombasa, Kenya. This cross-sectional study included HIV-positive women ≥ 18 years old who reported engagement in transactional sex at the time of enrolment in the parent cohort. We asked 13 questions adapted from the World Health Organization survey on violence against women about physical, sexual, or emotional violence in the past year by the current or most recent emotional partner (index partner). We used standardised instruments to assess socio-demographic and behavioural characteristics as possible correlates of intimate partner violence. Associations between intimate partner violence and these correlates were evaluated using univariate and multivariate logistic regression. Overall, 286/357 women (80.4%) had an index partner, and 52/357 (14.6%, 95% confidence interval 10.9%–18.2%) reported intimate partner violence by that partner in the past year. In multivariate analysis, women with severe alcohol problems (adjusted odds ratio 4.39, 1.16–16.61) and those experiencing controlling behaviours by the index partner (adjusted odds ratio 4.98, 2.31–10.74) were significantly more likely to report recent intimate partner violence. Recent intimate partner violence was common in HIV-positive female sex workers. Interventions targeting risk factors for intimate partner violence, including alcohol problems and partner controlling behaviours, could help to reduce recurrent violence and negative health outcomes in this key population.

A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

“…Details of these methods are described elsewhere (28). New participants were recruited through community outreach activities at bars and hotels and informational meetings at our clinic.…”

“…Most FSWs in Africa also have long-term boyfriends or husbands (26, 27). Studies from Kenya that focused on IPV (variously defined) against FSWs have reported estimates ranging from 15% (28) to 70% (27). Individual, dyad, and community-based interventions that strengthen women's communication and coping skills have been shown to reduce IPV and negative health consequences in other settings (21, 29-31).…”

Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya

“…At enrollment and annual visits, women who reported a current or most recent regular male sex partner were asked if they had experienced intimate partner violence (IPV) by that partner ever and in the past 12 months. 17 Intimate partner violence was defined as report of 1 or more of 13 items corresponding to acts of psychological, physical, and sexual violence. 18 An additional set of questions assessed whether women had experienced physical or sexual violence from anyone other than a current or most recent regular sex partner since the age of 15.…”

Brief Report: Intimate Partner Violence and Antiretroviral Therapy Initiation Among Female Sex Workers Newly Diagnosed With HIV in Zambia: A Prospective Study

“…To assess the association between baseline IPV and (1) linkage to care and (2) initiation of ART at 4 months, we used logistic regression models adjusted for potential confounding variables, including age, literacy, income, mobile phone ownership, educational status, age at sexual debut, primary partnership status, number of clients, age at initiation of sex work, time since HIV diagnosis, study site, and randomization arm. 16 Covariates were selected based on being theoretical confounders of the relationship between IPV and HIV-care–related outcomes. 16 , 23 – 27 We first modeled any IPV (physical and/or sexual).…”

“… 13 , 14 FSW are at an elevated risk of IPV, both from commercial and noncommercial romantic partners, which may contribute to their increased risk of HIV acquisition as well as HIV-related outcomes. 15 , 16 A substantial proportion of FSW living with HIV are not currently engaged in care or virally suppressed. 17 – 19 The existing evidence of the effect of IPV on HIV care outcomes among FSW is mixed, with 1 study reporting lower risk of detectable viral load among FSW experiencing IPV, 15 and another reporting an association between violence from sexual partners and worse outcomes.…”