Addressing Intimate Partner Violence and Power in Intimate Relationships in HIV Testing Services in Nairobi, Kenya.
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ABSTRACT:
SUBMITTER: Haberland N
PROVIDER: S-EPMC7395047 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
Addressing Intimate Partner Violence and Power in Intimate Relationships in HIV Testing Services in Nairobi, Kenya.
Haberland Nicole N Ndwiga Charity C McCarthy Katharine K Pulerwitz Julie J Kosgei Rose R Mak'anyengo Margaret M Peltz Amelia A Wong Vincent J VJ Kalibala Sam S
AIDS and behavior 20200801 8
Intimate partner violence (IPV) undermines women's uptake of HIV services and violates their human rights. In a two-arm randomized controlled trial we evaluated a short intervention that went a step beyond IPV screening to discuss violence and power with women receiving HIV testing services during antenatal care (ANC). The intervention included training and support for HIV counselors, a take-home card for clients, and an on-site IPV counselor. One third (35%) of women (N = 688) reported experien ...[more]
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Project description:People in informal urban settlements in Kenya face multiple inequalities, yet researchers investigate issues such as HIV or intimate partner violence (IPV) in isolation, targeting single populations and focusing on individual behaviour, without involving informal settlement dwellers. We formed a study team of researchers (n = 4) and lay investigators (n = 11) from an informal settlement in Nairobi, Kenya to understand the power dynamics in the informal urban settlement that influence vulnerability to IPV and HIV among women and men from key populations in this context. We facilitated participatory workshops with 56 women and 32 men from different marginalised groups and interviewed 10 key informants. We used a participatory data analysis approach. Our findings suggest the IPV and HIV nexus is rooted in the daily struggle for cash and survival in the informal urban settlement where lucrative livelihoods are scarce and a few gatekeepers regulate access to opportunities. Power is gendered and used to exercise control over people and resources. Common coping strategies applied to mitigate against the effects of poverty and powerlessness amplify vulnerabilities to HIV and IPV. These complex power relations create and sustain an environment conducive to IPV and HIV. Prevention interventions thus need to address underlying structural drivers, uphold human rights, create safe environments, and promote participation to maximise and sustain the positive effects of biomedical, behavioural, and empowerment strategies.
| S-EPMC10622644 | biostudies-literature
Project description:Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.
| S-EPMC7117691 | biostudies-literature
Project description:Background: Intimate Partner Violence (IPV) is an important public health challenge. In recent years, there has been a greater awareness concerning this phenomenon, its causes and consequences. Due to the relational nature of IPV, attachment theory (Bowlby, 1988) appears a useful framework to read the phenomenon and to better understand its components and its dynamics to provide more precise and tailored interventions in the future. Purpose: To summarize our knowledge of the research concerning IPV and attachment with an aim to better design and implement future research. Methods: Computer database researches were conducted using the following databases: Psychinfo, Psycharticle, Medline, Scopus, Web of Science, and PubMed (all years to the 01/02/2018). Search terms were compiled into two concepts for all database namely Attachment and IPV. Results: After removing the duplicates, a total of 3,598 records was screened, resulting in the identification of 319 full-text articles to be further scrutinized. Upon closer examination, there was consensus that 113 of those studies met the study inclusion criteria. Data was organized considering specifically studies concerning (1) IPV victimization and attachment, (2) IPV perpetration and attachment (both these sections were articulated in Physical, Psychological, and Sexual IPV), and (3) New research (comprising same-sex couples, IPV and attachment in couple contexts and IPV profiles and attachment among perpetrators). Conclusion: A number of studies failed to find significant associations between insecure attachment and IPV victimization or perpetration. Additional research is needed to provide a greater understanding of different IPV forms and to aid in the development of prevention and treatment interventions.
| S-EPMC6042056 | biostudies-literature
Project description:Intimate partner violence (IPV) is a common and devastating problem affecting the health of women, men, and children. Most health-care research focuses on the effects of IPV on women and children and addressing IPV with women in the health-care setting. Less is known about addressing IPV with men in the health-care setting. This article reviews the challenges in interpreting research on IPV in men, its prevalence and health effects in men, and the arguments for addressing IPV with men in the health-care setting. It introduces pilot guidelines that are based on the existing literature and expert opinion.
| S-EPMC2596504 | biostudies-literature
Project description:IntroductionIntimate partner violence and food insecurity are both structural drivers of HIV acquisition, care, and treatment, but little is known about how the 2 conditions intersect in the lives of those already living with HIV.MethodsThis study examined cross-sectional baseline data (collected in January 2016-December 2017) from an ongoing trial in southwestern Kenya. Trained interviewers asked enrolled participants living with HIV aged 18-60 years about household food insecurity (using the Household Food Insecurity Access Scale), intimate partner violence (using an adapted WHO multicountry study instrument), and sociodemographics. Negative binomial regression was used to examine the association between food insecurity and partner violence victimization (among women) or perpetration (among men). Secondary data were analyzed in August 2019-March 2020.ResultsOf 720 participants, more than half of women reported experiencing intimate partner violence (57.6%) and most men reported perpetrating it (58.4%). Participants reporting any partner violence had higher Household Food Insecurity Access Scale scores (21.8) compared with those reporting no violence (21.3, p=0.02). Each categorical change in food insecurity (mild, moderate, severe) was associated with a 41% increased risk of an additional partner violence episode. In models controlling for relationship status, wealth, season of interview (lean versus not lean), and baseline physical health, each 1-point increase in food insecurity was associated with a 6% higher risk of violence victimization among women and 4% greater risk of men perpetrating partner violence.ConclusionsThis study highlights the interconnected nature of intimate partner violence and food insecurity among women and men living with HIV. This relationship suggests that enhancing food security may be a useful intervention strategy to prevent intimate partner violence and improve HIV-related health outcomes.
| S-EPMC7987870 | biostudies-literature
Project description:At least half a million women are victims of intimate partner violence in the United States annually, resulting in substantial harm. However, the etiology of violence to intimate partners is not well understood. Witnessing such violence in childhood has been proposed as a principal cause of adulthood perpetration, yet it remains unknown whether the association between witnessing intimate partner violence and adulthood perpetration is causal.We conducted a propensity-score analysis of intimate partner violence perpetration to determine whether childhood witnessing is associated with perpetration in adulthood, independent of a wide range of potential confounding variables, and therefore might be a causal factor. We used data from 14,564 U.S. men ages 20 and older from the 2004-2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions.Nearly 4% of men reported violent behavior toward an intimate partner in the past year. In unadjusted models, we found a strong association between childhood witnessing of intimate partner violence and adulthood perpetration (for witnessing any intimate partner violence, risk ratio [RR] = 2.6 [95% confidence interval = 2.1-3.2]; for witnessing frequent or serious violence, 3.0 [2.3-3.9]). In propensity-score models, the association was substantially attenuated (for witnessing any intimate partner violence, adjusted RR = 1.6 [1.2-2.0]; for witnessing frequent or serious violence, 1.6 [1.2-2.3]).Men who witness intimate partner violence in childhood are more likely to commit such acts in adulthood, compared with men who are otherwise similar with respect to a large range of potential confounders. Etiological models of intimate partner violence perpetration should consider a constellation of childhood factors.
| S-EPMC3108188 | biostudies-literature
Project description:BackgroundIntimate partner violence remains a global problem and is of particular concern in Latina diasporas.AimTo identify effective elements of interventions to address intimate partner violence in Latina women.MethodThe systematic review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We focused the search on intervention studies assessing intimate partner violence as an outcome measure and on publications in English and Spanish from the last 11 years (2004-2015).ResultsDespite the scope of the problem, from the 1,274 studies screened only four met the search criteria and only a single study included an exclusive Latino population. Of the four interventions, one was only as effective as the control treatment. Heterogeneity of study populations and designs prohibited meta-analytic methods.ConclusionsTheoretically derived interventions that are gender specific, culturally appropriate, target mutual aid through group dynamics, and that are developed collaboratively with the target population are likely to be most effective.
| S-EPMC4978383 | biostudies-literature
Project description:BackgroundThirty per cent of all women experience intimate partner violence (IPV) in their lifetime. The aim of this study was to examine the association between the WHO's novel R.E.S.P.E.C.T framework and IPV among women in Kenya.MethodsWe used the 2014 Kenya Demographic and Health Survey (KDHS). Only women selected for the domestic violence module and who were married/living with their partner were eligible for this study (n=3737). We created a summary score for the strategies denoted by R.E.S.P.T based on availability of questions addressing these strategies in the KDHS, and a total score that summed responses across all strategies. Each letter was assessed with Cronbach's alpha. Multiple logistic regression models were used to investigate the relationship between R.E.S.P.T scores and IPV.ResultsAll strategies except for E lowered the odds of IPV. Decision-making (R) was negatively associated with experiencing IPV (OR=0.62 (0.53 to 0.72)). Land and property ownership (E) were positively associated with experiencing IPV (OR=1.25 (1.08 to 1.43)). Access to healthcare (S) was negatively associated with experiencing IPV (OR=0.55 (0.48 to 0.63)). Higher levels of wealth (P) were negatively associated with experiencing IPV (OR=0.47 (0.37 to 0.62)). Not justifying wife-beating in any scenario (T) was negatively associated with experiencing IPV (OR=0.39 (0.29 to 0.53)). After adjusting for demographics, a 1-unit increase in total R.E.S.P.T score was negatively associated with experiencing IPV (AOR=0.63 (0.57 to 0.70)) with a similar finding for IPV in the past 12 months (AOR=0.59 (0.53 to 0.66)). Younger women, higher education and Muslim religion were associated with decreased odds of experiencing IPV while living in a rural location and working were associated with increased odds of experiencing IPV.ConclusionsOur study provides initial evidence that by using the multistrategy R.E.S.P.E.C.T framework, countries can dramatically lower the odds of women experiencing IPV. IPV prevention strategies must have a wide approach. The DHS can be used as a tool to monitor implementation and efficacy of this novel strategy.
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Project description:BackgroundIntimate partner violence (IPV) is a significant health problem that has been associated with HIV infection in numerous studies. We aimed to systematically review the literature on relationships between IPV and HIV in order to describe the prevalence of IPV in people with HIV, the prevalence of HIV in people experiencing IPV, the association between IPV and HIV, and evidence regarding mechanisms of risk and interventions.MethodsData sources were 10 electronic databases and reference lists. Studies were included if they reported data on the relationship between IPV and HIV. All records were independently reviewed by two authors at the stages of title and abstract review and full text review. Any abstract considered eligible by either reviewer was reviewed in full, and any disagreement regarding eligibility of full texts or data extracted was resolved by discussion.Results101 articles were included. Experiencing IPV and HIV infection were associated in unadjusted analyses in most studies, as well as in adjusted analyses in many studies. The findings of qualitative and quantitative studies assessing potential mechanisms linking IPV and HIV were variable. Few interventions have been assessed, but two identified in this review were promising in terms of preventing IPV, though not HIV infection.ConclusionsExperiencing IPV and HIV infection tend to be associated in unadjusted analyses, suggesting that IPV screening and linkage with relevant programs and services may be valuable. It is unclear whether there is a causal association between experiencing IPV and HIV infection. Research should focus on defining parameters of IPV which are relevant to HIV infection, including type of IPV and period of exposure and risk, on assessing potential mechanisms, and on developing and assessing interventions which build on the strengths of existing studies.
| S-EPMC3840028 | biostudies-literature
Project description:BackgroundIntimate partner violence (IPV) perpetrated by males is the most prevalent form of violence against women across the globe. A systematic review was carried out to identify published randomized controlled trials of interventions aiming to prevent or reduce IPV in Sub-Saharan Africa. Details were sought on the interventions, outcomes, and risk of bias in evaluations.MethodsArticles were identified by searching MEDLINE, Embase, Web of Science, and PsycInfo. The search included terms pertaining to IPV, the research design, and the target geographical region. To be included, studies needed to have assessed the impact of an intervention on reported incidence, prevalence of IPV, or measures of related attitudes and behaviors. Fifteen papers were included in the final review. Risk of bias was evaluated using the Cochrane Library "Risk of Bias" tool.ResultsFindings suggest that interventions have the potential to reduce IPV-related behaviors and attitudes. Certain types of IPV were more amenable to change than others. Higher levels of efficacy were identified in interventions that had longer follow-up, addressed IPV as a main aim, and occurred at the community level or multiple levels of the social ecology.ConclusionsFindings should be interpreted in light of varying risks of bias. Suggestions are made for future research and practice.
| S-EPMC7197024 | biostudies-literature