Intimate partner violence against women living with and without HIV: contexts and associated factors in Wolaita Zone, Ethiopia.

Abstract

Background: Intimate partner violence (IPV) and Human Immunodeficiency Virus (HIV) are overlapping or intersecting public health challenges. Intimate partner violence is considered to be strongly related to HIV infection among women in Africa. However, the evidence is not conclusive. Women who are abused physically by their partners seek medical treatment in public institutions, yet, in Ethiopia, the experience of healthcare workers (HCWs) in screening IPV among HIV-positive and HIV-negative clients is not fully understood Purpose: This study aimed to map the evidence of IPV in Sub-Saharan Africa, to measure the factors associated with IPV, to explore the experience of IPV against women living with and without HIV, and the health care workers' IPV screening experience in Wolaita Zone, southern Ethiopia. Objectives 1. To conduct a scoping review of IPV among women living with HIV/AIDS in Sub- Saharan Africa. 2. To explore the lived experience of IPV against women using antiretroviral therapy (ART) and other outpatient services in Wolaita Zone. 3. To explore the experiences and challenges in screening for IPV among women who use ART and other health services in Wolaita Zone. 4. To measure the prevalence and associated factors of IPV among women living with and without HIV in Wolaita Zone. Methods: This is a mixed-methods study. I conducted both qualitative and quantitative studies.. Initially, I mapped the evidence of IPV among HIV-positive women in Sub-Saharan Africa using a scoping review. Then, I conducted an exploratory sequential design of mixed-methods research. An interpretative (hermeneutic) phenomenological design was used to explore the lived experiences of women who were living with and without HIV. Additionally, I used a descriptive phenomenological study design to explore the IPV screening experiences of 16 HCWs. I also used a comparative cross-sectional study comprising 816 women between 18-49 years who were living with and without HIV for the quantitative study. I used the standard questionnaire of the World Health Organization (WHO) multi-country study on women's health and domestic violence against women (translated). The scientific rigour, dependability, and credibility relating to this sensitive subject were maintained. I used STATA software, version 15 for the quantitative data analysis; NVIVO 12 assisted us in developing a framework, and Colaizzi's analysis for the qualitative data. I used the binary and multivariable logistic regression model for the quantitative analysis. Results: The scoping review provided a summary of the evidence of IPV experiences among women with HIV/AIDS. As this review has shown, the HIV-positive women were at considerable risk of IPV after disclosure of their serostatus to a male partner. Psychological and emotional abuse was the most common form of violence reported by the review. Subsequently, in the quantitative study, we found a high lifetime prevalence of IPV among all women in Wolaita Zone, 487 (59.68%, [95% CI:56.31%-63.05%]. It was slightly higher among women living with HIV, 250 (61.3%), than among those who were HIV negative, 238 (58.09%). Factors associated with IPV were the controlling behaviour of husband/partner [AOR=8.13; 95% CI: 4.93-13.42], poor wealth index [AOR=3.97; 95% CI:1.81-8.72], bride price payment to bride‘s family[AOR=3.46; 95% CI:1.74-6.87], women‘s decision to refuse sex [AOR=2.99;95% CI:1.39-6.41], age group of women [AOR=2.86; 95% CI:1.67-4.90], partner‘s family choosing a wife [AOR=2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR=2.36; 95% CI:1.36-4.10], number of sexual partners [AOR=2.35; 95% CI:1.36-4.09], and if a partner ever physically fought with another man [AOR=1.83; 95% CI: 1.05-3.19]. Inappropriate legal punishment of the perpetrator and the lack of a supportive women's network to avert IPV were perceived as limitations by the women. There were HCW and health system-related challenges in screening for IPV. These challenges comprised a gap in the medico-legal report provision, absence of separate record-keeping for IPV cases, lack of client follow-up, and lack of coordination with an external organisation. Conclusions and recommendations: There was a high prevalence of IPV among women, both living with and without HIV. The extent of IPV and its presentation in the different forms (physical, sexual and psychological), which frequently overlapped, highlights the urgency of intervention measures. Women reported terrifying experiences of violence, which affected their health physically, mentally, and psychologically. There are also challenges concerning HCWs, health systems, and the clients, relating to screening for IPV. Scoping review revealed evidence of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure influences IPV, and proof of the association of socio-demographic characteristics with IPV. It was concluded that marriage arrangements should be by mutual consent of the marriage partners rather than being made by parents; it is advisable to involve males in all programmes of genderbased violence prevention to change their violent behaviours; there is a need for the arrangement of separate record-keeping of IPV cases at the health facilities and for standardising the medico-legal reporting system. Finally, this study emphasises the importance of executing more gender-equitable policies.