Nearly one in seven new HIV infections could be prevented if women were not subjected to physical or sexual abuse, and a similar number prevented if relationship inequalities were eliminated, the study authors note.
“This is the first longitudinal study to show that women in Africa who experience violence from male partners are more likely to become HIV positive, something we have suspected, but never before proven,” says study co-author Kristin Dunkle, MPH, PhD, assistant professor of behavioral science and health education, Rollins School of Public Health, Emory University.
Although most new HIV infections in high prevalence areas occur in women, most HIV prevention programs target male condom use, testing, treatment of sexually transmitted infections, male circumcision and antiretroviral treatment.
Previous studies have suggested a potential link between male partner violence, relationship inequalities and increased risk of HIV infection in women. However, this study is the first to evaluate new infections over time among women who have experienced violence, and provides the strongest evidence to date of a causal link. Lack of such evidence has limited the resources allocated to HIV prevention programs and interventions that focus on gender issues, Dunkle says.
To further examine the effects of male partner violence and power inequity in sexual relationships on new HIV infections, Dunkle and colleagues from the Medical Research Council in South Africa examined data from an HIV prevention trial in South Africa. They studied 1,099 young African women who were HIV negative at the start of the study and who had at least one subsequent HIV test over two years of follow-up. Women were given face-to-face interviews to assess exposure to violence and gender equality in their relationships.
Women in relationships with low equality at the start of the study had a much higher incidence of HIV compared to women with medium or high relationship power (51 of 325 women versus 73 of 704 women). Additionally, women who reported more than one episode of abuse from a male partner at the start of the study were more likely to acquire HIV than those who experienced one or no episodes of abuse (45 of 253 women versus 83 of 846 women).
Dunkle and team found that if gender inequalities were improved so that no women were in relationships with low power, 13.9 percent of new HIV infections could be prevented. In addition, 11.9 percent of new HIV infections could be avoided if women weren’t subjected to multiple episodes of physical or sexual abuse by their partner.
“Organizations driving HIV prevention agendas for women, particularly UNAIDS, USAID and PEPFAR, need to ensure that policies, programs, and interventions to build gender equity and prevent partner violence are developed and widely implemented as part of the HIV prevention agenda,” the authors note. “Donors and researchers must invest in efforts and resources in developing and testing new interventions.”
The study, “Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study,” was published in the June 16, 2010, online issue of The Lancet.
A study abstract is available at:
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital. The Woodruff Health Sciences Center has a $2.5 billion budget, 17,600 employees, 2,500 full-time and 1,500 affiliated faculty, 4,700 students and trainees, and a $5.7 billion economic impact on metro Atlanta.