Women’s recent experience of emotional intimate partner violence is independently associated with HIV-risk behaviours: a cross-sectional study of young women in informal settlements in Durban Andrew Gibbs1, Laura Washington2, Samantha Willan1, Nwabisa Shai1, Rachel Jewkes1 1 Gender and Health Research Unit, SAMRC 2 Project Empower, Durban Good morning and thank you for joining us on this morning’s WW COP on RU. In this morning’s session, I am going to try (through the presentation and discussion) to: Give you an even better understanding of what research uptake is; Provide an increased understanding of why we do research uptake; Show you a snapshot of what research uptake activities have taken place in WW thus far; Share understandings how we “do” research uptake within the WW programme.  Through the examples and discussion, we also hope to start a conversation that will lead to more sharing of experiences between grantees Funded by

Different forms of Intimate Partner Violence (IPV) Emotional IPV conceptualised as: Humiliation, belittling Threats of hurting self, or others Physical IPV: Hitting, punching, slapping Threats or use of weapons Sexual IPV: Sex without consent/coerced Economic IPV: Taking earnings Stopping women from working

Background Women who experience physical/sexual intimate partner violence (IPV) are 25-50% more likely to acquire HIV than those who don’t (Jewkes et al., 2010; Kouyoumdjian et al., 2013) Almost all research on IPV is focused on physical and/or sexual IPV Global burden of disease (GBD) only included physical and/or sexual IPV because of lack of data on health impacts of other forms of IPV (Deveries et al., 2014) Incredibly limited research on emotional IPV

Emotional IPV Common: WHO multi-country study 20% to 75% of women reported emotional abuse in the past year (WHO, 2005) Emotional IPV in pregnancy in Africa estimated at 24.8% to 49% (Shamu et al., 2011) Evidence emotional IPV is important in terms of health outcomes: Brazil emotional violence independently associated with post-natal depression even when controlling physical/sexual IPV (Ludermir et al., 2010) HIV-disease progression, decline CD8+ T-cells associated with emotional IPV, but not physical or sexual IPV (Jewkes et al., 2015) Children’s exposure to emotional violence has larger mental health impacts on them than witnessing physical IPV (Naughton et al., 2017)

Questions Is emotional violence independently associated with HIV-risk behaviour? Does emotional violence remain independently associated with HIV-risk behaviour once physical and/or sexual IPV is included in models?

Methods Baseline study for the Stepping Stones and Creating Futures cluster randomized control trial 680 women recruited in 32 clusters (19-21 people/cluster) Self-completed questionnaire on tablets Three models: Direct relationship between HIV-risk behaviour and emotional violence Adjusted relationship between HIV-risk behaviour and emotional violence (excluding physical/sexual IPV) Adjusted relationship between HIV-risk behaviour and emotional violence, including physical/sexual IPV

What’s your tool box Results mean/% (95%CI) Age 23.7(23.4-23.9) Education Primary 8.1(6.3-10.4) Secondary 61.6(58.0-65.2) Matric 30.3(27.0-33.8) >=R1 earnings past month 30.2(26.8-33.7) Exposures Past 12m emotional IPV 78.1(74.9-81.0) Past 12m physical/sexual IPV 65.2(61.5-68.7) Outcomes Condom use last sex 54.1(50.0-58.1) Transactional sex main partner 55.5(51.7-59.3) Transactional sex casual partner 42.6(38.9-46.5) >2 sex partners past year 38.3(34.6-42.1) Problem alcohol use 23.1(20.1-26.4) Drug use past year 31.8(28.4-35.4) Current contraceptive use 69.3(65.6-72.8) Results What’s your tool box

Results Only emotional IPV Emotional IPV adjusted   Only emotional IPV Emotional IPV adjusted Emotional IPV, adjusted including physical/ sexual IPV N frequency OR p-value aOR Condom use last sex 592 320 0.49 0.001 0.48 0.52 0.005 Transactional sex main partner 645 358 1.71 0.006 1.55 <0.05 1.18 0.456 Transactional sex casual partner 275 2.4 <0.0001 2.12 1.68 0.026 >2 sex partners 247 2.18 1.97 0.002 1.53 0.076 Alcohol use 680 157 3.68 3.55 2.47 Drug use 216 2.37 2.26 1.54 0.089 Current contraceptive use 635 440 1.78 0.004 1.73 0.007 1.84 0.008 Adjusted analysis controlling for: age, education, food security, intervention arm, relationship status

Results Only emotional IPV *Emotional IPV adjusted   Only emotional IPV *Emotional IPV adjusted Emotional IPV, adjusted including physical/ sexual IPV N frequency OR p-value aOR Condom use last sex 592 320 0.49 0.001 0.48 0.52 0.005 Transactional sex main partner 645 358 1.71 0.006 1.55 <0.05 1.18 0.456 Transactional sex casual partner 275 2.4 <0.0001 2.12 1.68 0.026 >2 sex partners 247 2.18 1.97 0.002 1.53 0.076 Alcohol use 680 157 3.68 3.55 2.47 Drug use 216 2.37 2.26 1.54 0.089 Current contraceptive use 635 440 1.78 0.004 1.73 0.007 1.84 0.008 *Adjusted analysis controlling for: age, education, food security, intervention arm, relationship status

Results Only emotional IPV *Emotional IPV adjusted   Only emotional IPV *Emotional IPV adjusted *Emotional IPV, adjusted including physical/ sexual IPV N frequency OR p-value aOR Condom use last sex 592 320 0.49 0.001 0.48 0.52 0.005 Transactional sex main partner 645 358 1.71 0.006 1.55 <0.05 1.18 0.456 Transactional sex casual partner 275 2.4 <0.0001 2.12 1.68 0.026 >2 sex partners 247 2.18 1.97 0.002 1.53 0.076 Alcohol use 680 157 3.68 3.55 2.47 Drug use 216 2.37 2.26 1.54 0.089 Current contraceptive use 635 440 1.78 0.004 1.73 0.007 1.84 0.008 *Adjusted analysis controlling for: age, education, food security, intervention arm, relationship status

Limitations Directionality of the relationships because cross-sectional data High degree of overlap and very few experienced just physical and/or sexual IPV Focused solely on violence from men to women, in heterosexual relationships

Discussion Emotional IPV is important to consider alongside physical and/or sexual IPV in terms of HIV-risk Tendency of HIV-prevention interventions to focus on physical and/or sexual IPV May be that emotional violence is different in patterning and we need to adapt interventions to include this meaningfully Interventions should assess impact on emotional IPV, as well as physical and/or sexual IPV

THANK YOU Acknowledgements Research team Participants Email: Andrew.gibbs@mrc.ac.za