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HIV-Positive Women Report More Lifetime Partner Violence: Findings from a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania

August 27, 2002

There is growing evidence linking the epidemics of HIV and violence against women. Women are the fastest-growing population to become infected with HIV in most regions of the world. In 1999, it was estimated that there were 15,000 new infections per day, 95 percent of which occurred in developing countries and more than 40 percent of which occurred in women. The most common form of violence against women globally is abuse by intimate male partners. In general, from 10 percent to 50 percent of women worldwide have been physically assaulted by a male partner in their lifetime.

There are different ways in which the epidemics of HIV and violence overlap in the context of women's lives. Violence may increase a woman's risk for HIV infection through forced or coercive sexual intercourse and by limiting her ability to negotiate HIV-preventive behaviors. This report describes the meaning of partner violence in the Tanzanian context, and the forms this violence assumes, and it identifies the prevalence and correlates of violence against women who use HIV voluntary counseling and testing (VCT) services in Dar es Salaam, Tanzania.

The study was conducted in 1999 at the Muhimbili Health Information Center, 1 of 6 free-standing voluntary HIV counseling and testing clinics in Dar es Salaam. The goal of the first phase of research was to define violence in the local context; to describe the HIV testing and serostatus disclosure decision-making process among men, women and couples; and to develop the survey instruments for use in the second phase. The first phase consisted of in-depth interviews with 15 women (13 HIV-positive, 2 HIV-negative), 17 men (6 HIV-positive, 11 HIV-negative), and 15 couples who had been through the HIV counseling and testing process at the Muhimbili Health Information Center. The second phase of research measured the prevalence and identified the correlates of violence among 340 women enrolled immediately after their HIV pretest counseling session and before receiving test results in the post-test counseling session. To be enrolled in the study, women had to be at least 18 years of age, have a primary sexual partner for at least the past 3 months, and plan to reside in Dar es Salaam for at least the next 3 months. On average, women were 32 years old and had 9.23 years of education; 29.8 percent were infected with HIV, 48.3 percent were married, and the average duration of relationships was 7.5 years. A total of 245 of these women (72 percent) were followed and interviewed 3 months after enrollment and testing.

Forty-one percent of women surveyed identified at least 1 situation in which partner violence was justified, including disobedience, infidelity, and noncompletion of household work. Forty-four percent of women also felt that a woman was not justified in denying her partner sex after he had beaten her, and 16.8 percent felt that fear of HIV infection was not adequate justification for refusing sex. Violence that is considered mild or moderate and does not leave a physical mark on a woman may also be justified. The odds of reporting at least one violent event were significantly higher among HIV-positive women than among HIV-negative women. The odds of reporting partner violence were 10 times higher among younger (<30 years) HIV-positive women than among younger HIV-negative women.

The major finding highlighted in this study is the strong association between prior history of violence and women's HIV status. Women infected with HIV were significantly more likely to have had a physically violent partner in their lifetime and to have experienced physical violence, sexual violence, or both with their current partner. The results from this study have important implications for the prevention of HIV and violence against women. Women in settings like Tanzania are at risk for both HIV infection and violence largely because of the behavior of their male partners. The authors recommend structural changes, including legal and policy changes, that may reduce violence by empowering women to maintain more control over their own lives, ultimately enabling women in violent relationships to extricate themselves without suffering major economic and social losses.

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Adapted from:
American Journal of Public Health
08.02; Vol. 92; No. 8: P. 1331-1337; Suzanne Maman, Ph.D.; Jessie K. Mbwambo, M.D.; Nora M. Hogan, Psy.D.; Gad P. Kilonzo, M.B.Ch.B., M.Med., F.R.C.P.(C.); Jacquelyn C. Campbell, Ph.D., R.N., F.A.A.N.; Ellen Weiss, M.Sc.; Michael D. Sweat, Ph.D.

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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