Gender-based violence and HIV sexual risk behavior: Alcohol use and mental health problems as mediators among women in drinking venues, Cape Town

Abstract

Gender-based violence is a key determinant of HIV infection among women in South Africa as elsewhere. However, research has not examined potential mediating processes to explain the link between experiencing abuse and engaging in HIV sexual risk behavior. Previous studies suggest that alcohol use and mental health problems may explain how gender-based violence predicts sexual risk. In a prospective study, we examined whether lifetime history of gender-based violence indirectly affects future sexual risk behavior through alcohol use, depression and post-traumatic stress disorder (PTSD) in a high-risk socio-environmental context. We recruited a cohort of 560 women from alcohol drinking venues in a Cape Town, South African township. Participants completed computerized interviews at baseline and 4 months later. We tested prospective mediating associations between gender-based violence, alcohol use, depression, PTSD, and sexual risk behavior. There was a significant indirect effect of gender-based violence on sexual risk behavior through alcohol use, but not mental health problems. Women who were physically and sexually abused drank more, which in turn predicted more unprotected sex. We did not find a mediated relationship between alcohol use and sexual risk behavior through the experience of recent abuse or mental health problems. Alcohol use explains the link between gender-based violence and sexual risk behavior among women attending drinking venues in Cape Town, South Africa. Efforts to reduce HIV risk in South Africa by addressing gender-based violence must also address alcohol use.

Intimate Partner Violence Victimization and Associated Factors among Male and Female University Students in 22 Countries in Africa, Asia and the Americas

“…In addition, sexual risk behaviour (having had two or more sexual partners in the past year) and having a history of an STI in bivariate analysis was found to be associated with IPV. Similar results were found in previous studies [32][33][34] . Alcohol use in the context of sexual activity may reduce the ability to avoid violence 17,51 .…”

“…Sociodemographic factors for IPV among university students may include, female gender (although some report similar proportions of IPV between females and males) 16,20,24,25 earlier year of study 18 being single 17,19 and residing in a campus residence 19 . Individual risk factors for IPV may include childhood physical or sexual abuse or other prior victimization as well as history of interparental violence 17,18,25,26 substance use (alcohol and tobacco use) 17,[27][28][29] posttraumatic stress disorder (PTSD), depression, and suicidal behaviour 14,16,24,30,31 and sexual risk behaviour, including sexually transmitted infections (STI) and HIV [32][33][34] . Protective factors may include lack of peer and parental social support 22 lack of life satisfaction 20,24 high religiosity 35 low perceived control 36 lower Gross national income but not family income 37 .…”

Mental health, intimate partner violence and HIV

“…[8] Conversely, research indicates that women with mental health problems, particularly comorbid drinking and substance use problems, are at heightened risk for HIV, primarily as a result of high sexual risk-taking behaviour. [9] Common mental disorders compromise quality of life and functional outcomes in HIV-positive individuals. [5] Furthermore, traumatic stress, or exposure to traumatic events/situations, whereby individuals are overwhelmed by an inability to cope with the experience, accelerates disease progression in HIV-infected individuals by suppressing immune functioning.…”

The dual burden of gender-based violence and HIV in adolescent girls and young women in South Africa

“…Studies have shown that women who have been subjected to GBV often adopt risky behaviors such as alcohol abuse, which in turn can lead to more unprotected sex and an increased risk of acquiring HIV. [23][24][25] The fear of IPV can also discourage women from getting tested for HIV, [26] discourage disclosure of their HIV-positive status [27] and serve as a barrier to treatment uptake and adherence, [27,28] and may disrupt HIV prevention services [29] and result in poorer HIV outcomes. [28,30] The relationship between IPV and HIV is also bidirectional.…”