Four in ten people living with HIV have ever experienced intimate partner violence, with two in ten people experiencing it in the previous year. This is according to the results of a systematic review and meta-analysis published in Trauma, Violence, & Abuse. Emotional abuse was the most prevalent type of intimate partner violence experienced.
Forty-four per cent of people living with HIV in South America and Asia had experienced at least one type of intimate partner violence, 39% in Europe and North America, and 36% in Africa. The analysis also found that 42% of women and pregnant women had experienced intimate partner violence, 38% of men and men who have sex with men, and in heterosexual couples where one partner was HIV positive and another negative, 31% had experienced it.
Intimate partner violence (IPV) is one of the most common forms of violence against vulnerable populations by current and former spouses and dating partners. Types of IPV include physical abuse (slapping, punching, shoving, or otherwise physically hurting on purpose), sexual abuse (physical coercion into sexual intercourse or demeaning sexual acts), emotional abuse (belittling, humiliating, intimidating, and threatening to harm a person or someone they care about), and psychological abuse (verbal abuse, threats, withholding allowance, fear of spouse, and refusal of food for a person).
Efforts to address intimate partner violence have largely neglected people living with HIV even though experiencing both HIV and IPV may create a situation of double stigma and result in adverse effects on one’s physical, mental, and behavioural health.
The few reviews that discuss the prevalence of intimate partner violence among people with HIV are out of date and mostly focused on specific sub-groups. Given these shortcomings, Ling Jie Cheng of the National University of Singapore and colleagues conducted a systematic review and meta-analysis of published research to estimate the prevalence of different types of intimate partner violence among people living with HIV.
“To our knowledge, this is the first systematic global-level synthesis, disaggregating prevalence rates across multiple factors among people living with HIV, including distinct types of IPV and recall period,” the authors say.
Cheng and colleagues searched databases and journals to identify studies where all participants were living with HIV and the prevalence of intimate partner violence was measured. A total of 49 eligible published studies that enrolled 33,133 participants from 13 countries were identified. Almost half of the included studies (25) were conducted in Africa, nine in North America, eight in Asia, three in Europe, three in South America, and one study was undertaken across all regions.
The average age of participants across the studies ranged from 18.4 to 48. The study population included studies of women only (25), pregnant women (6), men who have sex with men (6), men only (4), heterosexual couples where one partner was HIV negative and the other positive (3) and general people with HIV (5).
Prevalence of intimate partner violence
The meta-analysis found that among people living with HIV:
- 39% (95% confidence interval 32-47) had experienced at least one type of IPV, and the prevalence for the last year was 19%.
- 26% (95% CI 18-35) had experienced physical IPV with a prevalence of 14% in the last year.
- 17% (95% CI 10-25) had experienced sexual IPV and last year’s prevalence was 11%.
- 28% (95% CI 12-49) had experienced emotional IPV. During the last year, there was an 18% prevalence.
- 23% (95% CI 10-40) had experienced psychological IPV with a prevalence of 12% in the last year.
The authors urge caution in interpreting the results of their meta-analysis because of the high variation between study populations. Most of the studies were also rated as having a high risk of bias, and some estimates were based on a small pool of studies.
Altogether, these findings underline the urgent need to integrate intimate partner violence screening and interventions in HIV care programmes. Health care providers should be trained and given resources for supporting people who experience IPV, e.g., toolkits on tips for starting a conversation about violence. Brochures and posters in clinics can also help educate clients.
People living with HIV should be routinely screened for violence in both current and past relationships. If IPV is disclosed, health workers should assess patients’ safety and refer to mental health and support services. Complaint and redress mechanisms for IPV should also be accessible within HIV services.
To reach the UNAIDS goal of ending the AIDS epidemic as a public health threat by 2030, proactive leadership is necessary to ensure that the human rights of people living with HIV, including freedom from violence, are implemented.
Ling Jie C et al. Global Prevalence and Factors Related to Intimate Partner Violence Amongst People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression. Trauma, Violence, & Abuse, online ahead of print, 6 May 2022.