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Date: November 22, 2024 Fri
Time: 11:31 am
Time: 11:31 am
Results for spouse abuse (africa)
1 results foundAuthor: MacQuarrie, Kerry L.D. Title: Spousal Violence and HIV: Exploring the Linkages in Five Sub-Saharan African Countries Summary: Over the past decade a consensus has been growing that intimate partner violence contributes to women's vulnerability to HIV. A diverse body of research has explored this association, mostly in the developing world. Studies based on women who present at health clinics often report a significantly higher prevalence of intimate partner violence among HIV-positive women compared with HIV-negative women. Moreover, six of seven studies using nationally representative samples reported a significant association between some form of violence and HIV status. 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. This study contributes to an understanding of the relationship between spousal violence and HIV by taking advantage of data from both members of a couple and using discrete, nuanced measures of spousal violence to better specify the associated pathways through which violence influences 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. Both of these factors have been associated with violence experienced by women and perpetrated by men. This study uses data on married couples from six Demographic and Health Surveys (DHS) in five sub- Saharan countries: Kenya 2008-09, Malawi 2010, Rwanda 2005, Rwanda 2010, Zambia 2007, and Zimbabwe 2010-11. These surveys included HIV testing for both women and men and also the domestic violence module, thus providing a subsample of married or cohabiting couples by their experience of violence and their HIV status. We examine the direct or indirect linkages between spousal violence and women's HIV status. We also explore the association between spousal violence and wives' and husbands' HIV risk factors. Specifically, we include the following factors: lifetime number of sexual partners; STI or STI symptoms in the last 12 months; and for husbands only, non-marital sex in the past 12 months; having paid for sex; alcohol use; and husband's HIV status. We consider several forms of spousal violence (emotional, physical, and sexual violence) and husbands' controlling behaviors. In keeping with the conceptual framework, we develop a series of statistical analyses to test the direct effect of spousal violence on women's HIV status and the role of HIV risk factors as mediators. The results reveal a strikingly common structure of what constitutes violence across the five countries. Five factors emerge in each country: (1) suspicion, (2) isolation, (3) emotional violence, (4) physical violence, and (5) sexual violence. These five factors account for 57 to 66 percent of the variance among the items in each country. Our factor analysis upholds the validity of experts' assignment of the various acts of spousal violence to the categories of emotional, physical, or sexual violence. An important additional insight is that the six items typically categorized as controlling behavior actually represent not one construct, but two separate constructs-suspicion and isolation-which are distinct from emotional, physical, or sexual violence. The study finds a significant association between multiple forms of violence and women's HIV status, after adjusting for wives' and husbands' socio-demographic characteristics but not risk factors. Yet, no single form of spousal violence is consistently associated with women's HIV status in all five countries. A significant relationship is found with women's HIV status for the controlling behaviors suspicion and isolation in Zambia and Zimbabwe; for emotional violence in Kenya, Rwanda and Zimbabwe; for physical violence, in Kenya, Rwanda, and Zimbabwe; and in no country for sexual violence, the least prevalent form of violence among study couples. In Malawi no form of violence is associated with a wife's risk of having HIV. In all five countries both HIV risk factors for women - lifetime number of sexual partners and recent STI or STI symptoms - are significantly associated with their having HIV, after controlling for background characteristics but not for each other. Most of the spousal violence measures are associated with both wives' HIV risk factors in each country. The most prominent predictor of a woman's HIV status is her husband's HIV status, among all the men's factors considered. Numerous husbands' HIV risk factors are associated with their wives' HIV status, but far less consistently than either husbands' HIV status or women's risk factors. The association between the experience of spousal violence and husbands' risk factors, too, is weaker and less consistent than with women's risk factors. Nevertheless, multiple relationships between spousal violence and wives' and their husbands' risk factors on one hand, and between wives' and husbands' risk factors and women's HIV status on the other, suggest that there are several possible mediators between various forms of spousal violence and women's HIV status. Indeed, when either wives' risk factors or husbands' risk factors, or both combined, are added to our models, most spousal violence factors are no longer a significant predictor of women's HIV status. The only form of spousal violence that appears to have a direct net association with HIV is physical violence, which remains significant in all models in Kenya and Zimbabwe. For almost all forms of violence (physical violence being the exception) and in all five countries, any observed significant relationship of spousal violence with a woman's HIV status is explained away by wives' or husband's HIV risk factors. The study provides evidence that there is no direct effect of most forms of spousal violence on women's HIV status, only an indirect effect through selected behavioral and other factors commonly considered to put an individual at high risk of HIV. The finding that sexual violence is not associated with women's HIV status, even before considering any mediating risk factors, deserves further exploration. Similarly, investigation is warranted to ascertain why physical violence continues to be associated with women's HIV status after controlling for these risk factors. Details: Calverton, MD: ICF International, 2013. 71p. Source: Internet Resource: DHS Analytical Studies No. 36: Accessed November 13, 2013 at: http://www.measuredhs.com/pubs/pdf/AS36/AS36.pdf Year: 2013 Country: Africa URL: http://www.measuredhs.com/pubs/pdf/AS36/AS36.pdf Shelf Number: 131654 Keywords: Family ViolenceGender-Based ViolenceHIV (Viruses)Intimate Partner ViolenceSexual ViolenceSpouse Abuse (Africa)Violence Against Women |