Special Edition, Spring 2002

Women's Health
Investigating Links Between HIV and Partner Violence

Encouraging clients to inform partners of their test results is an important component of HIV voluntary counseling and testing programs. Yet many clients do not disclose test results to their partners. Studies have found that many women fear their partners will react violently and that indeed HIV-infected women are at increased risk for partner violence. Researchers with Muhimbili University College of Health Sciences and the Population Council’s Horizons program explored the links between HIV infection, the disclosure of test results, and partner violence among women attending the Muhimbili Health Information Center, a voluntary counseling and testing clinic in Dar es Salaam, Tanzania.

The researchers studying HIV and partner violence first collected qualitative data from 62 people—women, men, and couples—who were clients at the Muhimbili Health Information Center. In the second phase, researchers followed 245 women and interviewed them three months after enrollment and HIV testing. Nearly a third of the sample were HIV-positive, almost half were married, and 50 percent were between the ages of 18 and 29 years.

The study, conducted in 1999, found that 64 percent of HIV-positive women shared test results with a partner within three months of testing, compared with nearly 80 percent of HIV-negative women. Overall, the major reason for nondisclosure is fear of their partner’s reaction, principally fear of abuse or abandonment.

The problem of partner violence
Partner violence is a serious problem among many of the clinic’s female clients. More than one-fourth of women interviewed agreed with the statement, “Violence is a major problem in my life.” Study participants, both male and female, 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.

When asked about lifetime violence by an intimate partner, 39 percent of women had had at least one physically abusive partner and 17 percent had had at least one sexually abusive partner. 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 in the three-month period prior to testing.

A small proportion of women who informed their partners of their test results reported a negative reaction. Most women said that partners showed support and understanding when told of the test results. However, the proportion of women who reported this positive reaction was significantly greater among HIV-negative women than among HIV-positive women (82 percent vs. 49 percent).

Twelve women reported one or more negative responses by a partner after disclosing their test results. These included being physically assaulted (one HIV-negative woman and two HIV-positive women) and being told to leave the house or being abandoned (one HIV-negative woman and three HIV-positive women). Given the amount of violence experienced by women in this study, there is considerable and justifiable fear of a partner’s violent reaction. The study revealed little evidence, however, that the act of disclosing HIV test results frequently leads to physical abuse and abandonment.

Being an HIV-positive woman is strongly associated with experiencing partner violence. Young HIV-positive women (18–29 years) were ten times more likely than young HIV-negative women to report partner violence, controlling for socio-demographic variables. As compelling as this evidence is, the study was constrained by the limitations of cross-sectional surveys and cannot thoroughly illuminate the link between partner violence and HIV infection.

Program and policy recommendations
The researchers offered several recommendations based on their findings. Communication between couples about HIV/AIDS and HIV testing should be encouraged when promoting voluntary counseling and testing. Moreover, "counselors need to be trained in how to ask sensitive questions about violence and to use this information to foster but not force disclosure among clients," says Suzanne Maman of Johns Hopkins University, a principal investigator for the study. Counselors must also be made aware of existing services to help women living in violent relationships so that they can make appropriate referrals when necessary.

Policymakers should encourage community-based efforts to address issues related to violence within sexual relationships. Implementing programs that focus on conflict resolution is crucial.

Finally, investigators should conduct further research on HIV and violence; the findings from this study highlight many gaps in knowledge on this topic. Researchers should assess the feasibility of engaging people chosen by women—such as counselors, friends, or religious leaders—to help women disclose their test results. Social scientists need to identify the links between partner violence and HIV infection. And investigators should evaluate community- based interventions that attempt to change harmful attitudes about sexuality and violence. Originally published in Population Briefs 7(2), June 2001.

Source
Maman, Suzanne, Jessie Mbwambo, Margaret Hogan, Gad Kilonzo, Michael Sweat, and Ellen Weiss. 2001. “HIV and partner violence: Implications for HIV voluntary counseling and testing programs in Dar es Salaam, Tanzania,” Horizons Project Report. Washington, DC: Population Council. (PDF)  

Outside funding
United States Agency for International Development

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