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

Karim, Quarraisha Abdool; Baxter, Cheryl

doi:10.7196/samj.2016.v106.i12.12126

Cited by 19 publications

(15 citation statements)

References 33 publications

(39 reference statements)

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“…We conceptualized vulnerabilities at first sex based on their known association with HIV risk 16 , 17 , 20 , 24 , 29 , 37 within the following domains: biological [age at first sex (vaginal or anal intercourse) less than 15; first sex before or within 1 year of menarche (calculated using age at first sex and age at menarche)]; behavioral (anal sex at first sex and condomless sex at first sex); partnership characteristics (first sex partner 10 years older, receipt of gifts/money for first sex, first sex arranged by someone other than respondent); and structural GBV (defined as a coerced or forced first sex event). Age at first sex was obtained from current age and duration of sexual activity (yrs/mo since first sex).…”

Section: Methodsmentioning

confidence: 99%

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Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

Becker

Bhattacharjee

Blanchard

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV.Methods:We conducted a cross-sectional biobehavioral survey among AGYW (14–24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N = 408), transactional sex (N = 177), or casual sex (N = 714) and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV).Results:The median age at first sex was 16 years (interquartile range 14–18). A total of 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex, respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 [GBV adjusted odds ratio (AOR) 1.4, 95% confidence interval (CI): 1.0 to 1.9; HIV AOR 1.9, 95% CI: 1.1 to 1.3]; before or within 1 year of menarche (GBV AOR 1.3, 95% CI: 1.0 to 1.7; HIV AOR 2.1, 95% CI: 1.3 to 3.6); and receipt of money (GBV AOR 1.9, 95% CI: 1.4 to 2.5; HIV AOR 2.0, 95% CI: 1.2 to 3.4).Conclusions:HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW's trajectory of risk. HIV prevention programs should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV.

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Section: Methodsmentioning

confidence: 99%

“… 16 – 19 Structural factors including intimate partner violence and other forms of gender-based violence (GBV) are associated with HIV acquisition, 20 – 22 and GBV is common among AGYW. 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

Becker

Bhattacharjee

Blanchard

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…There is global recognition that gender-based violence (GBV) significantly impacts public health and human rights [ 1 ]. Violence against women takes many forms – physical, sexual, economic, and psychological [ 2 ]. Unequal gender power dynamics in relationships, men’s control over women including decision-making, rigid gender roles and low negotiation skills among girls and women, and inequitable gender and social norms are all associated with violence [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and patterns of gender-based violence across adolescent girls and young women in Mombasa, Kenya

Bhattacharjee

Ma²,

Musyoki

et al. 2020

BMC Women's Health

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Background We sought to estimate the prevalence and describe heterogeneity in experiences of gender-based violence (GBV) across subgroups of adolescent girls and young women (AGYW). Methods We used data from a cross-sectional bio-behavioural survey among 1299 AGYW aged 14–24 in Mombasa, Kenya in 2015. Respondents were recruited from hotspots associated with sex work, and self-selected into one of three subgroups: young women engaged in casual sex (YCS), young women engaged in transactional sex (YTS), and young women engaged in sex work (YSW). We compared overall and across subgroups: prevalence of lifetime and recent (within previous year) self-reported experience of physical, sexual, and police violence; patterns and perpetrators of first and most recent episode of physical and sexual violence; and factors associated with physical and sexual violence. Results The prevalences of lifetime and recent physical violence were 18.0 and 10.7% respectively. Lifetime and recent sexual violence respectively were reported by 20.5 and 9.8% of respondents. Prevalence of lifetime and recent experience of police violence were 34.7 and 25.8% respectively. All forms of violence were most frequently reported by YSW, followed by YTS and then YCS. 62%/81% of respondents reported having sex during the first episode of physical/sexual violence, and 48%/62% of those sex acts at first episode of physical/sexual violence were condomless. In the most recent episode of violence when sex took place levels of condom use remained low at 53–61%. The main perpetrators of violence were intimate partners for YCS, and both intimate partners and regular non-client partners for YTS. For YSW, first-time and regular paying clients were the main perpetrators of physical and sexual violence. Alcohol use, ever being pregnant and regular source of income were associated with physical and sexual violence though it differed by subgroup and type of violence. Conclusions AGYW in these settings experience high vulnerability to physical, sexual and police violence. However, AGYW are not a homogeneous group, and there are heterogeneities in prevalence and predictors of violence between subgroups of AGYW that need to be understood to design effective programmes to address violence.

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“…Consequently, it has been suggested that IPV prevention is a worthwhile strategy for reducing HIV ( Abdool Karim and Baxter, 2016 , Mathews et al., 2016 , UNAIDS, 2011 ). Several trials in South Africa ( Jewkes et al., 2008 , Pettifor et al., 2016 , Pronyk et al., 2006 ) and Uganda ( Wagman et al., 2015 ) have significantly reduced IPV, but their findings are inconclusive about the effect on HIV incidence.…”

Section: Introductionmentioning

confidence: 99%

The relationship between intimate partner violence and HIV: A model-based evaluation

Rigby

Johnson

2017

Infectious Disease Modelling

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BackgroundMany studies have shown that women who have experienced intimate partner violence (IPV) are at a greater risk of HIV, but the factors accounting for this association are unclear, and trials of interventions to reduce IPV have not consistently reduced HIV incidence.MethodsThis study uses an agent-based model, calibrated to South African data sources, to evaluate hypotheses about likely causal pathways linking IPV, HIV, and other confounding factors. Assumptions about associations between IPV and HIV risk behaviours were based on reviews of international literature.FindingsThere is an association between past IPV experience and HIV incidence even when no causal effects are assumed (IRR 1.28, 95% CI 1.23–1.34), because women with a propensity for multiple partners are more likely to have ever been in a relationship with a violent partner. If, in addition, men with a propensity for concurrent relationships are more likely to perpetrate IPV, the IRR increases to 1.42 (95% CI 1.36–1.48), consistent with empirical IRR estimates. Alternative scenarios in which experience of IPV is assumed to cause changes in women's sexual behaviour have little effect on the IRR. An intervention that reduces IPV by 50% could be expected to reduce HIV incidence by at most 1.3%.InterpretationMuch of the observed association between IPV and HIV is likely to be due to confounding behavioural factors. Although interventions to reduce IPV are important, these interventions alone are unlikely to have a substantial impact on HIV incidence.

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

Cited by 19 publications

References 33 publications

Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

Prevalence and patterns of gender-based violence across adolescent girls and young women in Mombasa, Kenya

The relationship between intimate partner violence and HIV: A model-based evaluation

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