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 Straten2,3, 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.
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