susan m. kiene, phd rhoda wanyenze, moses bateganya, haruna lule ,

Intimate partner physical and sexual violence are associated with

perceived and actual HIV risk among hospital outpatients in rural Uganda

Susan M. Kiene, PhDRhoda Wanyenze, Moses Bateganya, Haruna Lule,

Harriet Nantaba, Michael SteinThe Salawo Research Collaboration

The Warren Alpert Medical School of Brown University, USAMakerere University School of Public Health, Uganda

University of Washington, USAGombe Hospital, Uganda

Background

HIV and intimate partner violence (IPV) are intertwined epidemics in many parts of the world

Violence is a risk factor for HIV In Uganda, where HIV prevalence is 6.5%

(UNAIDS, 2010), 48% of women and 20% of men report IPV, ever (DHS, 2006)

Objectives

Understand the prevalence of the experience of IPV among both women and men in an outpatient population in rural Uganda

Explore the mechanisms by which IPV may increase risk for HIV infection Lack of access to testing Increased risk from unprotected sex

Setting Outpatient clinic in a 100 bed comprehensive

public hospital in rural Butambala District, Uganda

Hospital serves a population > 300,000 Provider-initiated routine HIV-counseling and

testing (PITC) offered to all outpatients regardless of presenting symptoms

Free care and antiretroviral treatment

Procedures and MeasuresProcedures Interviewed before receiving provider-initiated HIV-

counseling and testing

Measures prior HIV testing perceived likelihood of testing HIV positive history of physical (e.g., hitting, slapping) and sexual

(forced sex) violence and emotional abuse (belittling, threats of violence) with current partner

sexual risk behavior

Participants

160 (82 female, 78 male) outpatients receiving provider-initiated routine HIV-counseling and testing

87% married age M=34.0 (range 20-59)

ResultsPrevalence of Violence/Abuse

Women Men

Physical Violence 31.7% 9.0%

Sexual Violence 43.9% 26.9%

Emotional Abuse 36.6% 28.2%

Emotional Abuse: Perceived % chance they would test HIV positive

Difference: Women: Χ2 19.14, p<.001, Men: Χ2 28.8, p<.001

IPV: Tested for HIV in prior year

NS difference

IPV: Perceived % chance they would test HIV positive

Difference: Women: Χ2 11.14, p<.001 , Men: Χ2 9.00, p<.01

IPV: Percent who tested HIV-positive

Difference: Women: Χ2 3.81, p<.05 , Men: Χ2 3.95, p<.05

IPV: Number of unprotected sex acts in prior 3 months

Difference: Women: OR 1.06, CI (1.04-1.09) , Men: OR 1.13, CI (1.02-1.24)

Summary IPV is prevalent in this community

Women and men who experienced IPV were more likely to: Think they would test HIV positive Test HIV positive Engage in more unprotected sex

No difference in prior access to HIV testing

Conclusions

The effect of IPV on increasing HIV risk is likely explained by the risk posed from unprotected sex not from lack of access to HIV testing

Interventions are needed to reduce the risk from unprotected sex among both women and men who experience IPV

Acknowledgements

Participants

Gombe Hospital Staff

Research AssistantsRuth NamulemeNalongo KijjeHajara Kagulire Farouk Kimbowa

FundingNIH K01 MH083536

Contact: susankiene@gmail.com