Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders

Hatcher, Abigail M.; Turan, Janet M.; Stöckl, Heidi; Woollett, Nataly; García‐Moreno, Claudia; Christofides, Nicola

doi:10.1016/j.ssmmh.2022.100112

Cited by 5 publications

(8 citation statements)

References 90 publications

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“…Our findings build on existing quantitative evidence from sub‐Saharan Africa that also established that VAW has a negative impact on ART adherence for WLH. Multiple studies have found that WLH who have experienced intimate partner violence, or VAW more broadly, are more likely to have challenges with ART adherence and viral suppression [ 11 , 12 , 14 , 16 ]. Though the evidence on pathways linking VAW and ART adherence in pregnant and breastfeeding women is limited, a few qualitative studies from Johannesburg, South Africa ( n = 32 and n = 38) and Lusaka, Zambia ( n = 32) found that intimate partner violence worsens HIV‐related health in pregnant and postpartum women through leading to women's increased poor mental health, such as depression and anxiety [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…A 2019 scoping review improved representation from African clinical samples and found that WLH who experienced VAW (as defined by the primary articles included in the review, including intimate partner violence or violence regardless of the perpetrator) were less likely to engage in HIV care and treatment, including ART uptake and adherence [ 14 ]. Clinical samples have confirmed these associations in African settings [ 15 , 16 , 17 ] but these are methodologically limited as participants are often actively engaged in healthcare.…”

Section: Introductionmentioning

confidence: 99%

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Sexual violence and antiretroviral adherence among women of reproductive age in African population‐based surveys: the moderating role of the perinatal phase

et al. 2023

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Introduction Women face challenges in antiretroviral therapy (ART) adherence and achieving viral suppression despite progress in the expansion of HIV treatment. Evidence suggests that violence against women (VAW) is an important determinant of poor ART adherence in women living with HIV (WLH). In our study, we examine the association of sexual VAW and ART adherence among WLH and assess whether this association varies by whether women are pregnant/breastfeeding or not. Methods A pooled analysis was conducted among WLH from Population‐Based HIV Impact Assessment cross‐sectional surveys (2015−2018) from nine sub‐Saharan African countries. Logistic regression was used to examine the association between lifetime sexual violence and suboptimal ART adherence (≥1 missed day in the past 30 days) among reproductive age WLH on ART, and to assess whether there was any evidence for interaction by pregnancy/breastfeeding status, after adjusting for key confounders. Results A total of 5038 WLH on ART were included. Among all included women, the prevalence of sexual violence was 15.2% (95% confidence interval [CI]: 13.3%−17.1%) and the prevalence of suboptimal ART adherence was 19.8% (95% CI: 18.1%−21.5%). Among only pregnant and breastfeeding women, the prevalence of sexual violence was 13.1% (95% CI: 9.5%−16.8%) and the prevalence of suboptimal ART adherence was 20.1% (95% CI: 15.7%−24.5%). Among all included women, there was evidence for an association between sexual violence and suboptimal ART adherence (adjusted odds ratio [aOR]: 1.69, 95% CI: 1.25−2.28). There was evidence that the association between sexual violence and ART adherence varied by pregnant/breastfeeding status (p = 0.004). Pregnant and breastfeeding women with a history of sexual violence had higher odds of suboptimal ART adherence (aOR: 4.11, 95% CI: 2.13−7.92) compared to pregnant and breastfeeding women without a history of sexual violence, while among non‐pregnant and non‐breastfeeding women, this association was attenuated (aOR: 1.39, 95% CI: 1.00−1.93). Conclusions Sexual violence is associated with women's suboptimal ART adherence in sub‐Saharan Africa, with a greater effect among pregnant and breastfeeding WLH. To improve women's HIV outcomes and to achieve the elimination of vertical transmission of HIV, violence prevention efforts within maternity services and HIV care and treatment should be a policy priority.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sexual violence and antiretroviral adherence among women of reproductive age in African population‐based surveys: the moderating role of the perinatal phase

et al. 2023

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“…Viral suppression was defined based on a viral load test of 50 copies of HIV-RNA/ml or less Predictors IPV was measured using items adapted from the IPV instrument of the WHO Multi-Country Study questionnaire [29]. This questionnaire has been used in several countries, including in South Africa [23,30]. Participants were asked questions for the past 12 months such as, 'How often did your boyfriend/girlfriend insult, swore or say something to spite (hurt) you?…”

Section: Discussionmentioning

confidence: 99%

“…IPV was measured using items adapted from the IPV instrument of the WHO Multi-Country Study questionnaire [ 29 ]. This questionnaire has been used in several countries, including in South Africa [ 23 , 30 ]. Participants were asked questions for the past 12 months such as, ‘How often did your boyfriend/girlfriend insult, swore or say something to spite (hurt) you?’, with responses to the questions scored on a five-point Likert scale.…”

Section: Methodsmentioning

confidence: 99%

“…There is more evidence amongst adult women: a 2015 meta-analysis of 13 cross-sectional studies found that IPV was associated with lower self-reported ART adherence and viral load suppression [ 18 ], with this finding supported by a scoping review in 2019 [ 19 ]. Since these reviews, associations between IPV and nonadherence have been found in cross-sectional studies of adult women in Kenya [ 20 , 21 ], Uganda [ 22 ], and longitudinally in South Africa [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa

Cluver

Zhou

Orkin

et al. 2022

Aids

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Objective: We are failing to reach 95-95-95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally.Design: A prospective cohort of ALHIV (sample N ¼ 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36month follow-up (2015)(2016)(2017)(2018).Methods: A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex.Results: Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21-0.72, P ¼ 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P ¼ 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70-74%) compared with 38% (95% CI 20-56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex. Conclusion:Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.

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Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review

Hunt,

Peay,

Henderson

2024

AIDS Behav

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Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders

Cited by 5 publications

References 90 publications

Sexual violence and antiretroviral adherence among women of reproductive age in African population‐based surveys: the moderating role of the perinatal phase

Sexual violence and antiretroviral adherence among women of reproductive age in African population‐based surveys: the moderating role of the perinatal phase

Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa

Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review

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