A systematic review of the effects of intimate partner violence on HIV-positive pregnant women in sub-Saharan Africa

Abstract

Background Intimate partner violence (IPV) affects more than one in three women in sub-Saharan Africa (SSA). It is associated with both pregnancy and HIV, adversely affecting women in this region. This is the first systematic examination of the effects of IPV on HIV-positive (HIV+) pregnant women in SSA. Methods A systematic review of the literature on HIV+ pregnant women experiencing IPV in SSA was carried out. Searches were carried out in PubMed, Web of Science and African Journals Online databases. Articles published between January 2010 and June 2020, in English, were included. Data extraction included details on study locations, study design, study participants and the study outcome variables (depression, IPV, medication adherence, postpartum unsafe sex, and HIV disclosure). Results Fourteen studies (ten cross-sectional studies, four cohort studies) were included. Results indicate a high prevalence of IPV amongst pregnant women with HIV in SSA (18.0 to 63.1%). The results suggest an association between HIV-positive status and consequences of IPV during pregnancy, particularly mental health effects, such as depression symptoms and suicidal ideation. HIV-related stigma has a key role within the relationship between HIV and IPV during pregnancy. One study described that the presence of IPV reduces adherence to Prevention of Mother-To-Child Transmission (PMTCT) medication. Three studies reported no association between HIV positive status or HIV status disclosure and IPV during pregnancy. Discussion/conclusions The systematic review confirms interconnections between IPV and HIV seropositivity amongst pregnant women in SSA. Importantly, stigma, social isolation and poor mental health hinder help-seeking, disclosure, and treatment adherence among HIV+ pregnant women exposed to IPV in SSA. As a result, the potential of community interventions to tackle issues associated with IPV in HIV-positive pregnant women in this area should be explored in research, policy, and practice.

The prevalence, incidence, and recurrence of intimate partner violence and its association with adverse childhood experiences among pregnant and breastfeeding women living with HIV in Malawi

“…Notwithstanding this limitation, almost all prior research on ACEs or IPV has relied on self-reports. 40,79 Importantly, widely validated instruments were used to estimate ACEs and IPV, strengthening the validity of the study results. 52,80 A third limitation is that we might be missing insights from women living with HIV as they were not involved at every step of this particular research.…”

Intimate Partner Violence and Health Outcomes Among Women Living With HIV/AIDS in Ghana: A Cross-Sectional Study

“…Previous studies have established theoretical and empirical pathways between IPV and health outcomes among HIV-positive persons (Fiorentino et al, 2019; Schafer et al, 2012; Wetzel et al, 2021). However, in determining the health consequences of IPV, the majority of these studies have examined HIV infection as the outcome (Durevall & Lindskog, 2014; Nyamayemombe et al, 2010; Rigby & Johnson, 2017), focused on HIV-related outcomes of selected samples, mostly pregnant women (Hatcher et al, 2014; Lin et al, 2022; Wetzel et al, 2021; Yonga et al, 2022), or explored the health-related consequences of IPV in the general population (Campbell, 2002; McKelvie et al, 2021; Potter et al, 2021; Tenkorang, 2019).…”

“…Researchers have examined HIV-positive women’s psychosocial/mental health, but paid limited attention to their physical and sexual reproductive health outcomes (see Mitchell et al, 2016; Woollett & Hatcher, 2016). Moreover, most studies have focused on pregnant women (see Lin et al, 2022; Yonga et al, 2022) and HIV-related health outcomes, including medication adherence and CD4 count (Schafer et al, 2012). This study is one of very few to comprehensively investigate the health consequences of IPV on HIV-positive women by focusing on their physical, sexual, and psychosocial health outcomes.…”

A Comparative Analysis of Gender Discrepancy Stress, Attitudes toward Intimate Partner Violence, and Perpetration among Young Adults in the USA and Uganda

“…In the U.S., more than 43.6 million, or 36.4% of women, reported having experienced physical violence, sexual violence, stalking, or some combination of the three perpetrated by their intimate partner at some point in their lives [ 5 ]. In SSA, data indicate that the prevalence of violence is similarly high [ 4 ], with tremendous burden to health and well-being, particularly among vulnerable women [ 6 , 7 ]. This is also the case in Uganda, where IPV and gender-based violence are common among vulnerable youth who reside in urban slums [ 8 ] and where violence is often exacerbated by the link to both alcohol use and human immunodeficiency virus (HIV) [ 9 ].…”