Unhealthy alcohol use and intimate partner violence among men and women living with HIV in Uganda

Abstract

Background Intimate partner violence (IPV) and alcohol use are interrelated public health issues. Heavy and frequent alcohol use increase the risk of IPV, but the relationship between alcohol use and IPV (including recent and lifetime IPV victimization and perpetration) has not been well described among persons living with HIV (PWH) in sub-Saharan Africa. Methods We used baseline data from the Drinker’s Intervention to Prevent Tuberculosis study. All participants were PWH co-infected with tuberculosis and had an Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) positive score (hazardous drinking) and positive urine ethyl glucuronide test, indicating recent drinking. High-risk drinking was defined as AUDIT-C > 6 and/or alcohol biomarker phosphatidylethanol (PEth) ≥ 200 ng/mL. We measured IPV using the Conflict Tactics Scale. We estimated the association between alcohol use level and recent (prior six months) IPV victimization (recent perpetration was too low to study) using multivariable logistic regression models adjusted for gender, age, assets, education, spouse HIV status, religiosity, depressive symptoms, and social desirability. We additionally estimated the interaction of alcohol use and gender on IPV victimization and the association between alcohol use and lifetime victimization and perpetration. Results One-third of the 408 participants were women. Recent IPV victimization was reported by 18.9% of women and 9.4% of men; perpetration was reported by 3.1% and 3.6% of women and men. One-fifth (21.6%) of those reporting recent IPV victimization also reported perpetration. In multivariable models, alcohol use level was not significantly associated with recent IPV victimization (p = 0.115), nor was the interaction between alcohol use and gender (p = 0.696). Women had 2.34 times greater odds of recent IPV victimization than men (p = 0.016). Increasing age was significantly associated with decreased odds of recent IPV victimization (p = 0.004). Conclusion Prevalence of IPV victimization was comparable to estimates from a recent national survey, while perpetration among men was lower than expected. Alcohol use level was not associated with IPV victimization. It is possible that alcohol use in this sample was too high to detect differences in IPV. Our results suggest that women and younger PWH are priority populations for IPV prevention.

Bidirectional Violence in Intimate Relationships: A Systematic Review

“…Finally, the prevalence of sexual violence ranged from 0.60% (a study conducted with a community sample; Frankland & Brown, 2014) to 50% (a study conducted with a forensic sample of men who were concurrently undergoing treatment for domestic violence; Crane et al, 2014), with a median of 9.70 ( M = 13.41; SD = 14.03). Miller et al’s (2022) study reported a prevalence of injury of 1.08%.…”

“…Regarding the overall prevalence of bidirectional violence in intimate relationships, it ranged from 2% (study conducted with a mixed clinical sample; Miller et al, 2022) to 98.4% (study conducted with a mixed clinical sample of individuals in treatment for substance dependence that aimed to analyze the prevalence of IPV perpetration; Arteaga et al, 2015). The median of the overall prevalence of bidirectional violence was 20.25 ( M = 31.53; SD = 27.87).…”

“…Regarding the Asian continent, the prevalence of the phenomenon ranged from 3.3% (study conducted in China with a community sample; Hu et al, 2019) to 74.4% (study conducted in Singapore with a forensic sample; Brown & Chew, 2018), with a median of 72.10 ( M = 49.93; SD = 40.40). In Africa, bidirectional violence ranged from 2% (study conducted in Uganda with a mixed clinical sample; Miller et al, 2022) to 35.5% (study conducted in Malawi with a clinical sample; Conroy et al, 2022), with a median of 10.60 ( M = 13.62; SD = 12.54). The prevalence in the European continent ranged between 10% (study conducted in several countries with a community sample; Costa et al, 2016) and 98.4% (study conducted in Spain with a clinical sample; Arteaga et al, 2015), with a median of 56 ( M = 48.52; SD = 34.58).…”

“…Regarding the prevalence of bidirectional violence in intimate relationships in the different sample types, the prevalence rate among community samples ranged from 3.1% (violence reported by men in a study conducted in the USA; Afifi et al, 2012) to 89.1% (a study that aimed to identify directionality patterns of violence and dyadic concordance types in a sample of heterosexual and non-heterosexual male and female individuals; Capinha et al, 2022), with a median of 16.02 ( M = 28.69; SD = 25.84). The prevalence rate in clinical samples ranged from 2% (a study that aimed to examine the associations between alcohol use severity and directionality of physical IPV in a sample of persons with HIV and Tuberculosis; Miller et al, 2022) to 98.4% (people who reported bidirectional violence in a study among participants undergoing treatment programs for substance abuse; Arteaga et al, 2015), with a median of 35.50 ( M = 43.83; SD = 34.06). The prevalence rate in forensic samples ranged from 5.30% (bidirectional violence reported by women residing in a shelter home; Holmes et al, 2016) to 74.40% (violence reported by women in prison; Brown & Chew, 2018), with a median of 45.45 ( M = 42.65; SD = 35.77).…”

“…The prevalence of bidirectional IPV among samples from 18 years to later adulthood ranged between 2% (study conducted with a mixed clinical sample; Miller et al, 2022) and 98.4% (study conducted in Spain with a clinical sample; Arteaga et al, 2015), with a median of 16.02 ( M = 29.42; SD = 28.94). The prevalence of bidirectional violence among individuals from 18 to 25 years range between 66.7% (study conducted in Canada with a community sample; Carranza et al, 2020) and 69% (study conducted in USA with a community sample; Kubicek et al, 2015), with a median of 51.35 ( M = 49.93; SD = 20.98), and among individuals from 18 to 30 years ranged between 23.27% (study conducted in USA with a community sample; Renner & Whitney, 2012) to 65% (study conducted in USA with a community sample; Stults et al, 2020), with a median of 40 ( M = 41.93; SD = 17.62).…”