August 2001

HIV and Partner Violence: Implications for HIV Voluntary Counseling and Testing Programs

Key Findings

Many women lack autonomy to make decisions about HIV testing. Male and female informants frequently referred to the need for women to “seek permission” from partners prior to testing. Men, on the contrary, generally made the decision to test on their own without soliciting prior consent. According to a married, 36-year-old, HIV-negative male:

Let’s take an example. She passes, she finds there is a centre of testing like here…. Now she can’t test for just good intention. When she goes home she can’t say she went to that certain place. Now if it is a man having mind to test it is not a problem.

Most women in the study thought about testing for at least a month prior to actually seeking services.

Disclosure to partners by HIV-positive women has increased over time but is still significantly less than that for HIV-negative women. During a VCT study conducted at MHIC in the mid-1990s, only 27 percent of HIV-positive women who were tested as individuals disclosed their test results to a partner within six months after being tested (Grinstead 2000). In this study 64 percent of HIV-positive women who enrolled as individuals shared test results with a partner within three months of testing. The researchers hypothesize that this increase in disclosure rates may be due to increased awareness and acceptability of HIV in the community, increased communication between couples about HIV and HIV testing, and greater emphasis on disclosure by counselors during pre- and post-test counseling.

While the figure for disclosure among HIV-positive women is high (Figure 1), it is significantly lower than the 79.5 percent of HIV-negative women in the study sample who disclosed their test results to a partner (p < .03). Overall the major reason for non-disclosure (52 percent) among all women, regardless of HIV serostatus, is fear of the partner’s reaction, principally fear of abuse or abandonment.

Partner violence is a serious problem among many female VCT clients. More than a fourth of women interviewed agreed with the statement, “Violence is a major problem in my life.” Male and female informants described violence as a way to “correct” or “educate” women, and said that violence that does not leave a physical mark on a woman is justifiable. According to a 45-year-old male:

I punished by beating with a cane and like three or four slaps. What I know is small, small punishments like these are normal. It is a must that I remain firm as father of the family. I am head of the household.

When asked about lifetime violence by an intimate partner, 38.5 percent of women had had at least one partner who had been physically abusive and 16.7 percent had had at least one partner who had been sexually abusive.² Physical violence by a current partner was also commonly reported. Nearly a third of women had experienced at least one physically violent episode perpetrated by a current partner, such as slapping, twisting an arm, grabbing, punching, and kicking, in the three-month period prior to testing.

A small proportion of women who disclosed their serostatus to partners reported a negative reaction. Most women said that partners showed support and understanding when told the test results. However, as shown in the figure, the proportion of women who reported this positive reaction is significantly greater among HIV-negative women compared to HIV-positive women. Regardless of the women’s serostatus, only a small percentage of women’s male partners said they would come for HIV testing. (Figure 2)

Twelve women (6.4 percent) reported one or more negative responses by a partner after disclosing their test results. This included being blamed for the results or for getting tested (two HIV-negative women and eight HIV-positive women), physically assaulted (one HIV-negative woman and two HIV-positive women), and/or told to leave the house or abandoned (three HIV-positive women and one HIV-negative woman). Given the prevalence of violence among women in this study, there is considerable and justifiable fear of a partner’s violent reaction, but little evidence that serostatus disclosure frequently leads to physical abuse and abandonment.

Women’s HIV status is strongly associated with partner violence. Without adjusting for other variables, HIV-positive women were 2.68 times more likely than HIV-negative women to have experienced a violent episode by a current partner. Examining the interaction between women’s age and HIV status and controlling for other sociodemographic variables, young HIV-positive women (18-29 years) were ten times more likely to report partner violence than young HIV-negative women. Given the limitations of cross-sectional surveys, this study cannot describe the causal pathways between violence and HIV infection. However, the strong association between prior history of violence and HIV infection does support the theory that violence plays a role in women’s risk for HIV infection in this population.

² Women were asked about number of partners who have hit, slapped, kicked, pushed, shoved, or otherwise physically hurt them, and physically forced them into sexual activity against their will.

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This page updated
19 Oct 2007