Rates and Covariates of Recent Sexual and Physical Violence Against HIV-Infected Outpatient Drinkers in Western Kenya

Abstract

Victimization from physical and sexual violence presents global health challenges. Partner violence is higher in Kenya than Africa. Violence against drinkers and HIV-infected individuals is typically elevated, so dual vulnerabilities may further augment risk. Understanding violence risks can improve interventions. Participants were 614 HIV-infected outpatient drinkers in western Kenya enrolled in a randomized trial to reduce alcohol use. At baseline, past 90-day partner physical and sexual violence were examined descriptively and in gender-stratified regression models. We hypothesized higher reported violence against women than men, and positive violence association with HIV stigma and alcohol use across gender. Women reported significantly more current sexual (26.3% versus 5.7%) and physical (38.9% versus 24.8%) victimization than men. Rates were generally higher than Kenyan lifetime national averages. In both regression models, HIV stigma and alcohol-related sexual expectations were significantly associated with violence while alcohol use was not. For women, higher violence risk was also conferred by childhood violence, past-year transactional sex, and younger age. HIV-infected Kenyan drinkers, particularly women, endorse high current violence due to multiple risk factors. Findings have implications for HIV interventions. Longitudinal research is needed to understand development of risk.

Forced sexual intercourse and its association with HIV status among people attending HIV Voluntary Counseling and Testing in a healthcare center in Kinshasa (DRC)

“…As described in many other low-income countries [10,38–40], the prevalence of FSI in our study was significantly higher among women. African cultural practices and belief systems provide the social environment for men to consider women as a property [41].…”

“…Among our study participants, 34% reported having ever had FSI (32% and 38% among men and women, respectively). Although our prevalence corresponds to the figures estimated for most SSA countries [10, 37,38] it is higher than the figures described for women in Kinshasa in the 2014 national Demographic and Health Survey (DHS), in which 16% of women reported having suffered sexual violence (the same frequencies described in the previous 2007 DHS) [16,33]. Many of our participants were attending a healthcare center for HIV VCT and therefore, it was a higher risk population, probably more likely to report risk behaviors than the general population.…”

“…According to the 2014 DHS from the DRC, among women reporting sexual violence, 31% said that their partner drank `often´. It has been widely shown that alcohol is a risk factor for sexual violence and viceversa [10,11,37,38,67]. Alcohol may cause aggressive behaviors as a result of a distortion in the perceptions or of a disinhibition [6], it can also make it more difficult for the victims to protect themselves or it can even bring the victims to places where they have a greater risk of meeting a potential offender [3,9,68–70].…”

“…condom use), multiple sexual partners as a result of separation derived from intimate partner violence (IPV), or violent partners more likely to exhibit HIV risk behaviors (i.e. commercial sex, frequent alcohol consumption, multiple sexual partners, unprotected sex or presence of STIs) [1,7,9,10,11,12–14].…”

“…The understanding of the HIV epidemic in the DRC needs to take into account a larger vision including the socio-ecological determinants responsible of these behaviors. For example, transactional sex is an expression of the survival conditions for many people in the country, such as homelessness and financial difficulties to obtain food, clothes, healthcare or to pay student fees [10,18–21]. All of these factors are connected with the fact that the war has paralyzed the development of public policies, including public health.…”