Abstract

Intimate partner violence and non-adherence to male condoms and the diaphragm among women in an HIV prevention trial in Sub-Saharan Africa

D. Kacanek¹, A. Bostrom², E. Montgomery³, G. Ramjee⁴, G. de Bruyn⁵, K. Blanchard⁶, A. Rock⁷, S. Mtetwa⁸, A. van der Straten^2,3, MIRA Team

¹Harvard School of Public Health, Center for Biostatistics in AIDS Research, Boston, United States, ²University of California at San Francisco, San Francisco, United States, ³Research Triangle Institute International, Women's Global Health Imperative, San Francisco, United States, ⁴Medical Research Council, South Africa, HIV Prevention Research Unit, Durban, South Africa, ⁵University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa, ⁶Ibis Reproductive Health, Cambridge, United States, ⁷JSI Research & Training Institute, Inc., Boston, United States, ⁸University of Zimbabwe, Harare, Zimbabwe

Background: We longitudinally examined the effect of intimate partner violence (IPV) on condom and diaphragm non-adherence in 2249 women in the intervention (diaphragm/gel, condoms) arm and 2262 women in the control (condoms only) arm of the MIRA study, a phase III trial of the diaphragm for HIV prevention in South Africa and Zimbabwe.
Methods: Recent IPV (defined as fear of violence, experience of emotional abuse, physical violence or forced sex, in the past 3 months), condom non-adherence and diaphragm non-adherence (each defined as not always used in the past 3 months or not at last sex) were assessed at baseline, 12 month and exit visits (12-24 months). The association between IPV and condom non-adherence and diaphragm non-adherence at that visit was modeled using Generalized Estimating Equations (GEE) adjusting for demographic and behavioral characteristics.
Results: Of 4511 participants (n=9566 person-visits where IPV was assessed), 55% reported recent fear or experience of IPV during their trial participation. Women reported fearing violence (41%), experiencing emotional abuse (38%), being physically assaulted (16%), and forced sex (15%) by their primary male partner. Condom non-adherence was reported at 48.8% and 64.0% of visits in the control and intervention arms, respectively, and diaphragm non-adherence at 55.0% of visits. IPV was associated with condom non-adherence in both study arms (AOR=1.42; 95% CI=1.24-1.61 (control arm) and AOR=1.47; 95% CI=1.30-1.69, (intervention arm)) and with diaphragm non-adherence (AOR=1.25; 95% CI=1.07-1.47) adjusting for age, study sites, number of sex partners, and knowledge of male partner infidelity. Modeling effects of each form of IPV separately on condom and diaphragm non-adherence yielded similar results.
Conclusions: Women reported high rates of recent IPV which was associated with condom and diaphragm non-adherence. Product adherence counseling in prevention trials should proactively address IPV. Strategies to encourage men's positive involvement in product use and prevent IPV perpetration should also be considered.