1. Results (cont.) Prevalence and Correlates of Intimate Partner Violence among HIV Voluntary Counseling and Testing Clients in Northern Tanzania Methods Cross-sectional study Women ≥18 years were recruited at an HIV VCT center in Moshi, Tanzania (Women Against AIDS in Kilimanjaro) between June 1, 2005, and January 31, 2008 Clients were interviewed using a standardized questionnaire to collect sociodemographics, reasons for testing, sexual behavior IPV questions (answer choices: never, sometimes, frequently): “Has your current husband/partner, or any other partner, ever done something physically to hurt you?” “Has your current husband/partner, or any other partner, ever physically forced you to have sexual intercourse when you did not want to?” Data were entered using Teleform 9.0 (Cardiff, Vista, CA) and analyzed using Stata 11 (StataCorp, College Station, TX) We created a binary variable combining “frequently” and “sometimes” responses to either IPV question to measure lifetime prevalence of IPV Among unique records of clients with ≥1 lifetime sexual partner, we assessed (1) differences in characteristics using Pearson’s chi-square tests and Mantel-Haenszel odds ratios; (2) changes in IPV prevalence by age using nonparametric trend tests We modeled a logistic regression to quantify the effect of selected sociodemographic factors (p<0.10 in bivariate analysis) and HIV serostatus on IPV prevalence Results Lifetime IPV prevalence: 17.7% (432/2,436) Results (cont.) Conclusions In developing nations, VCT sites represent a unique opportunity to screen, counsel, and refer women who experience IPV Physical and sexual intimate partner violence is prevalent among women in northern Tanzania Marriage represents a significant risk factor for IPV Single women with a history of IPV are more likely to be HIV- infected Acknowledgements Malavika Prabhu, BS 1, Bariki Mchome, MD 2, Antipas Mtalo 3, Dafrosa Itemba, BA 3, Anna Mgonja 3, Florida Muro, MD, MPH 2, Jeffrey Wilkinson, MD 4, Jan Ostermann, PhD 5, Nathan Thielman, MD, MPH 1,5 1 Duke University Medical Center, Durham, NC, 2 Kilimanjaro Christian Medical Centre, Moshi, Tanzania, 3 KIWAKKUKI (Women Against AIDS in Kilimanjaro), Moshi, Tanzania, 4 Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 5 Duke Global Health Institute, Duke University, Durham, NC Corresponding Author: Malavika Prabhu, BS, MD candidate, KCMC-Duke University Collaboration, PO Box 3010, Moshi, Tanzania; mprabhu@stanford.edu Abstract Background. HIV infection has been associated with intimate partner violence (IPV), especially in high seroprevalence regions. We investigated IPV among women at an HIV voluntary counseling and testing center in Northern Tanzania. Methods. We assessed clients’ lifetime history of physical or sexual IPV and performed bivariate and logistic regression analyses to identify risk factors for IPV. Results. Of 2,436 women presenting between June 2005 and January 2008, 18% reported IPV during their lifetime. Older, unemployed, less educated women, and those with children were more likely to have experienced IPV (all p<0.05). IPV exposure differed by marital status (p<0.001), with 11% of single, 22% of married, and 30% of divorced women reporting IPV. Married women had 1.51 (95% CI 1.10-2.07) greater odds, and divorced women had 2.25 (95% CI 1.63-3.10) greater odds, of IPV compared to single women, adjusted for other sociodemographic characteristics. Across all women, HIV seropositivity rates did not differ by IPV exposure category; however, 22% of single women with IPV were HIV-infected vs. 15% without IPV (p=0.041). Conclusion. IPV is prevalent among women in northern Tanzania. Given that IPV represents both a risk factor for and a consequence of HIV infection, VCT sites are an appropriate and accessible venue for IPV screening and counseling in resource-poor settings. Background Intimate partner violence (IPV): emotional, physical, or sexual violence, usually perpetrated against women by their intimate male partners, resulting in long-lasting effect on health Prevalence estimates of physical or sexual IPV range from 18% (past year) to 71% (lifetime) WHO Multi-country Study on Violence against Women: 56% of rural and 41% of urban Tanzanian women reported ever experiencing IPV 1 Risk factors: age, lower education, divorce, cohabitation outside of marriage, income inequality between partners, lack of fidelity, more than five children IPV and HIV linked, particularly when seroprevalence is high Dar es Salaam, Tanzania, voluntary counseling and testing (VCT) center: HIV-infected women are 65% more likely to have been in a physically abusive relationship in their lifetime 2 Given the high prevalence of IPV in Tanzania, its impact on women’s health, and the recognition of its relationship with HIV infection, we investigated the correlates associated with IPV among women presenting to an HIV VCT center in the Kilimanjaro Region of Tanzania No History of IPV (n=2,004) Any History of IPV (n=432) Age Category* 18-24605 (30.2%)71 (16.4%) 25-30360 (18.0%)69 (16.0%) 30-39513 (25.6%)145 (33.6%) 40+526 (26.3%)147 (34.0%) Marital Status* Single955 (47.7%)116 (26.9%) Married462 (23.1%)131 (30.3%) Divorced277 (13.8%)118 (27.3%) Widowed310 (15.5%)67 (15.5%) Number of Lifetime Partners 1754 (37.7%)149 (34.7%) 2-41,059 (52.9%)238 (55.4%) 5+186 (9.3%)43 (10.0%) Urban Residence1,001 (50.1%)209 (48.4%) Less than Secondary Education*1,470 (73.4%)351 (81.3%) Any Children*1,468 (73.3%)397 (91.9%) Employed*1,845 (92.1%)375 (86.8%) % HIV Seropositive387 (19.3%)96 (22.2%) Reasons for Testing Illness*372 (18.6%)125 (29.0%) New Sexual Partner180 (14.4%)41 (11.8%) Suspicion of Partner Unfaithfulness*1,008 (50.5%)294 (68.1%) Pre-marriage* 1 297 (19.3%)27 (9.0%) Pre-conception134 (6.7%)19 (4.4%) Received Gifts for Sex*176 (8.8%)22 (5.1%) Sexual Partner Has Other Partners*460 (35.1%)180 (62.9%) Suspect Any Partner Has Ever Had HIV*255 (12.7%)85 (19.7%) TABLE 1. Characteristics of HIV VCT Female Clients with and without a History of Intimate Partner Violence in northern Tanzania, June 2005-January 2008 * p<0.05 1 Data excludes those currently married (n=593) Multivariate results: Married women: OR 1.51 (95% CI 1.10, 2.07) (vs. single) Divorced women: OR 2.25 (95% CI 1.63, 3.10) (vs. single) Unemployed: OR 1.80 (95% CI 1.28, 2.52) ≥1 child: OR 2.81 (95% CI 1.82, 4.33) Predicted probability of IPV: 22.1% among married women vs. 16.2% among otherwise identical single women (p<0.001) No difference in the regression model using IPV severity as the predicted outcome Across all women, HIV seropositivity did not differ by IPV exposure in univariate or multivariate analysis When stratified by marital status, 22.4% of single women with a history of IPV were HIV-infected vs. 15.1% without a history of IPV, p=0.041; OR 1.63, 95%CI 1.01-2.6 FIGURE 1. Mean Prevalence of Intimate Partner Violence by Age and Marital Status among Female VCT Clients in northern Tanzania, June 2005-January 2008 References We would like to thank the study participants and the staff at KIWAKKUKI. This study was supported by the NIH Fogarty International Center through the International Clinical Research Fellows Program at Vanderbilt University (R24 TW007988), the Fogarty International Center AIDS International Training and Research Program (D43 TW006732), the Duke Clinical Trials Unit and Clinical Research Sites (U01 AI06984), the International Studies on AIDS Associated Coinfections award (U01 AI03036), and the Hubert-Yeargan Center for Global Health at Duke University. We report no conflicts of interest. American Public Health Association, 138 th Annual Meeting, 6-10 November, 2010, Denver, CO 1.WHO: WHO multi-country study on women’s health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women’s responses. Geneva, Switzerland. 2005. 2.Maman S, Mbwambo JK, Hogan NM, Kilonzo GP, Campbell JC, Weiss E, et al.: HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. Am J Public Health 2002; 92(8): 1331-7. Sexual Violence NeverSometimesFrequentlyTotal Physical Violenc e Never2,004 (82.3%)76 (3.1%)18 (0.7%)2,098 (86.1%) Sometimes115 (4.7%)79 (3.2%)19 (0.8%)213 (8.7%) Frequently52 (2.1%)29 (1.2%)44 (1.8%)125 (5.1%) Total2,171 (89.1%)184 (7.6%)81 (3.3%)2,436 (100.0%) TABLE 2. Severity of IPV among HIV VCT Clients in northern Tanzania, June 2005-January 2008