HIV This Week

Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA, O'Campo P. HIV/AIDS and intimate partner violence: intersecting women's health issues in the United States. Trauma Violence Abuse 2007;8:178-98.

This article reviews 35 United States studies on the intersection of HIV and adult intimate partner violence (IPV). Most studies describe rates of IPV among women at risk or living with HIV and identify correlates, using multiple types of convenience samples (e.g., women in methadone treatment, women in shelters or clinics), cross-sectional designs, and self-reported risk behaviours. HIV-positive women appear to experience any IPV at rates comparable to HIV-negative women from the same underlying populations; however, their abuse seems to be more frequent and more severe. The authors found only four relevant interventions and none addressed sexually transmitted HIV and partner violence risk reduction simultaneously. There is a critical need for research on (a) causal pathways and cumulative effects of the syndemic issues of violence, HIV, and substance abuse and (b) interventions that target IPV victims at risk for HIV, as well as HIV-positive women who may be experiencing IPV.

Editors’ note: This work highlights important interactions between HIV risk, HIV serostatus and violence. Gender-based violence or intimate partner violence is a human rights violation in all settings which calls for sustained, effective prevention strategies – supporting men and boys to redefine masculinity to exclude it is an essential start. Legislation that is enforced backs up the message.

Research has shown that married women's greatest risk for HIV infection is their husbands' extramarital sexual activities. Using 6 months of ethnographic research in south-eastern Uganda, Parikh examined how the social and economic contexts surrounding men's extramarital sexuality and the dynamics of marriage put men and women at risk for HIV infection. The author found that Uganda's HIV prevention messages may be inadvertently contributing to increased difficulty in acknowledging HIV risk and to newer forms of sexual secrecy and that structural determinants, including persistent poverty, intersect with gender inequalities to shape marital risk. After examining a community effort to regulate men's sexuality, the author suggests that HIV prevention strategies should focus more on endogenous forms of risk reduction while simultaneously addressing structural factors that facilitate opportunities for men's extramarital sex.

Editors’ note: Serodiscordance among stable couples in Uganda can be in either direction with some studies finding the woman as the HIV positive partner in as many as 38% of couples. Marital risk may be more shaped by couples not knowing their serostatus rather than either partner having sexual partners outside the relationship. Secrecy about previous HIV risk can be as dangerous to one’s partner as secrecy about current risk. HIV prevention strategies for stable couples should assist people to acknowledge risk, take an HIV test and break the silence.