Background: The HPTN 071(PopART) study is a community-randomised trial in Zambia and South Africa, examining the impact of combination-prevention including universal test and treat (UTT), on HIV-incidence (Figure-1). Intimate partner violence (IPV) is known to adversely affect women''s health. We evaluated factors associated with IPV (physical and/or sexual) in PopART intervention communities.
Methods: During 2015-16, a random subset of adults who participated in the first year of the PopART intervention were recruited. Data on 300 HIV-negative women from Arm-A and Arm-B communities being offered HB-HTC, and 422 HIV-positive women from Arm-A communities who had been referred for ART were included (Figure-1). Demographic, socio-economic, behavioural factors and perceptions/opinions about HIV/HIV service factors were surveyed using standardised questionnaires and associations with IPV were examined. Logistic regression was performed to estimate odds ratios.
Results: Among >700 women studied, ~20% of both HIV-negative and HIV-positive women reported experiencing physical and/or sexual violence in the last 12-months (Table-1). The proportion of women reporting sexual violence was similar by HIV status, but HIV-positive women were more likely to report physical violence and both sexual and physical violence. Among HIV-negative women, transactional sex (aOR:4.30, 95%CI:1.20-15.44, p=0.03) and not knowing partner''s HIV status (aOR:3.01, 95%CI:1.24-7.29, p=0.02) were associated with increased odds of IPV. Having control of household finances was associated with reduced odds, and women with AUDIT scores ≥8 (increased risk of alcohol dependence) were at increased odds of IPV in both groups in crude analyses, but statistical evidence of association only remained in the multivariable model for HIV-positive women (aOR:0.39, 95%CI:0.21-0.74, p=0.004 and aOR:1.96, 95%CI:1.02-3.77, p=0.02, respectively). For HIV-positive women, IPV was associated with disclosure of HIV status to their sexual partner in the crude analysis but not after adjusting for confounding factors (aOR:1.54, 95%CI:0.87-2.72, p=0.14). IPV was not associated with declining HB-HTC or failure to initiate ART within 6-months of referral (aOR:1.47, 95%CI:0.71-3.06, p=0.30 and aOR:0.92, 95%CI:0.53-1.62, p=0.78, respectively).
Conclusions: We identified factors associated with IPV which differed by HIV status. Our findings could help the development of interventions against IPV. Promisingly, our evidence suggests that acceptance of PopART UTT interventions was not affected by IPV.