Intimate Partner Violence and Condom and Diaphragm Nonadherence Among Women in an HIV Prevention Trial in Southern Africa
Intimate Partner Violence and Condom and Diaphragm Nonadherence Among Women in an HIV Prevention Trial in Southern Africa
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DOI：
10.1097/qai.0b013e3182a6b0be
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发表时间：
2013-12-01
影响因子：
3.6
通讯作者：
van der Straten, Ariane
中科院分区：
文献类型：
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作者：
Kacanek, Deborah;Bostrom, Alan;van der Straten, Ariane
背景：我们在非洲改善生殖健康方法研究中纵向研究了亲密伴侣暴力 (IPV) 对女性不遵守安全套和隔膜的影响，该研究是南部非洲的一项 III 期艾滋病毒预防试验。方法：在基线、12 个月和出院就诊（最多 24 个月）时评估近期 IPV（过去 3 个月内对暴力、情感虐待、身体暴力或强迫性行为的恐惧）、安全套不依从性和隔膜不依从性。 IPV 与 (1) 安全套不依从或 (2) 隔膜不依从之间的关联通过调整潜在混杂因素的广义估计方程进行建模。结果：在 4505 名参与者中，55% 的人在参与试验期间报告了最近的 IPV。女性表示害怕固定男性伴侣的暴力（41%）、情感虐待（38%）、身体攻击（16%）和强迫性行为（15%）。在两个研究组中，IPV 均与安全套不依从相关[调整比值比 (AOR)：1.41，95% 置信区间 (CI)：1.24 至 1.61（对照组）和 AOR：1.47，95% CI：1.28 至 1.69，（干预组）] 以及隔膜不依从（AOR 1.24，95% CI： 1.06 至 1.45）根据年龄、研究地点、性伴侣数量以及对男性伴侣不忠的了解进行调整。分别对每种形式的 IPV 对不依从性结果的影响进行建模，得出了相似的结果。结论：近期 IPV 的患病率很高，并且与试验期间安全套和隔膜不依从性相关。预防试验中的咨询应主动解决 IPV 问题，在产品和风险降低咨询中也是如此。应考虑制定鼓励男性积极参与产品使用并防止 IPV 发生的策略。
Background: We longitudinally examined the effect of intimate partner violence (IPV) on condom and diaphragm nonadherence among women in theMethods for Improving Reproductive Health in Africa study, a phase III HIV prevention trial in southern Africa. Methods: Recent IPV (fear of violence, emotional abuse, physical violence, or forced sex, in past 3 months), condom nonadherence, and diaphragm nonadherence were assessed at baseline, 12 month, and exit visits (up to 24 months). The association between IPV and (1) condom nonadherence or (2) diaphragm nonadherence across visits was modeled using Generalized Estimating Equations adjusting for potential confounders.Results: Of 4505 participants, 55% reported recent IPV during their trial participation. Women reported fearing violence (41%), emotional abuse (38%), being physically assaulted (16%), and forced sex (15%) by their regular male partner. IPV was associated with condom nonadherence in both study arms [adjusted odds ratio (AOR): 1.41, 95% confidence interval (CI): 1.24 to 1.61 (control arm) and AOR: 1.47, 95% CI: 1.28 to 1.69, (intervention arm)] and with diaphragm nonadherence (AOR 1.24, 95% CI: 1.06 to 1.45) adjusting for age, study sites, number of sex partners, and knowledge of male partner infidelity. Modeling effects of each form of IPV separately on nonadherence outcomes yielded similar results.Conclusions: Prevalence of recent IPV was high and associated with condom and diaphragm nonadherence during the trial. Counseling in prevention trials should proactively address IPV, for its own sake, and in product and risk-reduction counseling. Strategies to encourage men's positive involvement in product use and prevent IPV perpetration should be considered.