1. 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
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2. 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

3. 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

4. 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)

5. 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?

6. 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

7. What’s your tool box Results mean/% (95%CI) Age 23.7(23.4-23.9)
Education
Primary
8.1( )
Secondary
61.6( )
Matric
30.3( )
>=R1 earnings past month
30.2( )
Exposures
Past 12m emotional IPV
78.1( )
Past 12m physical/sexual IPV
65.2( )
Outcomes
Condom use last sex
54.1( )
Transactional sex main partner
55.5( )
Transactional sex casual partner
42.6( )
>2 sex partners past year
38.3( )
Problem alcohol use
23.1( )
Drug use past year
31.8( )
Current contraceptive use
69.3( )
Results
What’s your tool box

8. 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

9. 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

10. 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

11. 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

12. 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

13. THANK YOU Acknowledgements Research team Participants