Violence Toward Women, Men’s Sexual Risk Factors, and HIV Infection Among Women: Findings From a National Household Survey in Rwanda

URESP, Centre de Recherche FRSQ du CHA Universitaire de Québec, Québec, Canada.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 03/2012; 59(3):300-7. DOI: 10.1097/QAI.0b013e31823dc634
Source: PubMed


We used the third Rwanda demographic and health survey data to examine the relationship between violence toward women, men sexual risk factors, and HIV prevalence among women.
The Rwanda demographic and health survey was conducted in 10,272 households in 2005. Analyses were restricted to 2715 women and 2461 men who were legally married or cohabiting. We used logistic regression to analyze associations between HIV and violence toward women. Couple-specific analyses were carried out for assessing the relationship between men sexual risk factors and intimate partner violence (IPV) reported by their wives.
Respectively, 29.2%, 22.2%, and 12.4% of women reported having experienced physical, psychological, and sexual IPV, whereas 52.1% reported control practices by their partners. There was a positive link between IPV reported by women and attitudes justifying wife beating endorsed by their husband. After controlling for sociodemographic variables and women sexual risk factors, the odds of HIV prevalence was 3.23 (confidence interval: 1.30 to 8.03) among women with a score from 3 to 4 on the psychological IPV scale compared with those with a score from 0 to 2. Women who reported having experienced interparental violence (father who beat mother) were more likely to test HIV positive as follows: adjusted odds ratio: 1.95; 95% confidence interval: 1.11 to 3.43. There was also a statistically significant relationship between men risky sexual factors and experience of IPV and HIV prevalence among women.
Violence toward women is associated with HIV in Rwanda. Intervention to reduce gender-based violence should be integrated into HIV/AIDS policy.

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    • "Third, there could be reverse causality, with women's highrisk behavior causing IPV. For example, HIV-infected women could be subject to violence because of their HIV status (Kayibanda et al., 2012; Were et al., 2011). Although HIV testing was not widespread until recently in most of sub-Saharan Africa and most people were unaware of their HIV status, risky behavior itself could trigger violence, either in an attempt to control the woman's behavior or as a consequence of anger and frustration. "
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    ABSTRACT: We investigate the relationship between intimate partner violence (IPV) and HIV among married and cohabiting women in sub-Saharan Africa. We find a strong association, and that it is primarily due to higher HIV risk among violent men; neither women’s decreased ability to protect themselves from HIV within marriage, nor their risky sexual behavior, explains the link. Thus, it is not violence per se that spreads HIV, but that violent men are more likely to become HIV positive and then infect their wives. Programs that aim at reducing HIV by eliminating IPV should therefore also focus on men’s risky sexual behavior.
    Full-text · Article · Aug 2015 · World Development
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    • "However, the 2011 Ugandan Demographic and Health Survey reports a high exposure rate of lifetime spousal physical violence for men and women (26% and 37% respectively) [7]. Important to note is that in studies in which both women and men are included, only women are asked about IPV exposure while men are regarded solely as perpetrators, with their personal characteristics analysed as tentative risk factors [8-10]. One study including both men and women failed to ask the men, but instead inquires women about both exposure and perpetration of IPV [11]. "
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    ABSTRACT: Background Intimate partner violence (IPV) against women is an important, yet often neglected public health issue. The existence of gender norms imbalance expressed by men’s and women’s attitudes in relation to power and decision-making in intimate relationships may influence the magnitude of IPV. The aim of this study was to investigate the prevalence and potential risk factors of physical, sexual and psychological IPV in young men and women in Rwanda. Methods This population-based, cross-sectional study included a representative sample of men and women from the Southern Province of Rwanda. Face-to-face interviews were performed using the World Health Organization (WHO) questionnaire for violence exposure to estimate past year and earlier in life IPV occurrence. Risk factor patterns were analyzed by use of bi- and multivariate logistic regression. Results Women were, to a considerably higher extent, exposed to physical, sexual and psychological IPV than men. Of the women, 18.8% (n = 78) reported physical abuse in the past year, compared to 4.3% (n = 18) of men. The corresponding figures for women and men for sexual abuse were 17.4% (n = 71) and 1.5% (n = 6), respectively, and for psychological abuse, the corresponding figures were 21.4% (n = 92) and 7.3% (n = 32). Findings illustrate that violence against women was recurrent, as the highest frequency (>3 times) dominated in women for the various acts of all forms of violence. Identified risk factors for women’s exposure to physical violence were being low educated, having poor social support, being poor and having many children. For men exposed to physical violence, no statistically significant risk factor was identified. Conclusions In this setting, IPV exposure was more common in women than men in the Southern Province of Rwanda. Promotion of gender equality at the individual level is needed to make a positive difference in a relatively short term perspective. Men’s lower reporting of IPV confirms women’s subordinate position, but men’s denial of incidents could also explain the gender role pattern.
    Full-text · Article · Aug 2014 · BMC Women's Health
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    • "The lack of an association between the experience of sexual violence and women's HIV status in this study is consistent with two other multi-country studies in which no bivariate association between the experience of sexual violence on its own and women's HIV status was found (Harling, Msisha, and Subramanian 2010; Kayibanda, Bitera, and Alary 2012) and with several others in which a bivariate association disappeared in final multivariate models (Andersson and Cockcroft 2012; Silverman et al. 2008). This finding contrasts with several other studies in which a significant association remained in multivariate models including selected HIV risk factors (Dunkle et al. 2004c; Maman et al. 2002; Sareen, Pagura, and Grant 2009). "
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    ABSTRACT: Over the past decade a consensus has been growing that intimate partner violence contributes to women's vulnerability to HIV. The usual interpretation is that spousal violence increases the risk of HIV for women. Yet a direct effect on HIV status is unlikely, since there is no apparent direct causal pathway leading from most forms of spousal violence to the acquisition of HIV. We propose a gender-based conceptual framework in which the association between a woman's experience of spousal violence and her HIV status is mediated by two primary pathways: First, the HIV risk behaviors/factors of her husband and, second, her own behavioral and situational HIV risk factors. The study pools Demographic and Health Survey (DHS) data across five sub-Saharan African countries and uses a sequence of logistic models to explore these pathways among married couples. The study finds a significant association between multiple forms of spousal violence and women's HIV status, after adjusting for wives' and husbands' socio-demographic characteristics but not risk factors. While the association was expected to disappear after adjusting for risky behaviors of both partners and men's status, this was not the case with physical violence. Instead, women's experiences of physical violence within her marriage remains a persistent factor that predicts her HIV status. Thus, contrary to recent reports of no direct association between spousal violence and women's HIV status, this finding points to a direct effect.
    Full-text · Conference Paper · May 2014
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