Cross-sectional studies have shown that intimate partner violence and gender inequity
in relationships are associated with increased prevalence of HIV in women. Yet temporal
sequence and causality have been questioned, and few HIV prevention programmes address
these issues. We assessed whether intimate partner violence and relationship power
inequity increase risk of incident HIV infection in South African women.
We did a longitudinal analysis of data from a previously published cluster-randomised
controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06.
1099 women aged 15-26 years who were HIV negative at baseline and had at least one
additional HIV test over 2 years of follow-up were included in the analysis. Gender
power equity and intimate partner violence were measured by a sexual relationship
power scale and the WHO violence against women instrument, respectively. Incidence
rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models,
adjusted for study design and herpes simplex virus type 2 infection, and used to calculate
population attributable fractions.
128 women acquired HIV during 2076 person-years of follow-up (incidence 6.2 per 100
person-years). 51 of 325 women with low relationship power equity at baseline acquired
HIV (8.5 per 100 person-years) compared with 73 of 704 women with medium or high relationship
power equity (5.5 per 100 person-years); adjusted multivariable Poisson model IRR
1.51, 95% CI 1.05-2.17, p=0.027. 45 of 253 women who reported more than one episode
of intimate partner violence at baseline acquired HIV (9.6 per 100 person-years) compared
with 83 of 846 who reported one or no episodes (5.2 per 100 person-years); adjusted
multivariable Poisson model IRR 1.51, 1.04-2.21, p=0.032. The population attributable
fractions were 13.9% (95% CI 2.0-22.2) for relationship power equity and 11.9% (1.4-19.3)
for intimate partner violence.
Relationship power inequity and intimate partner violence increase risk of incident
HIV infection in young South African women. Policy, interventions, and programmes
for HIV prevention must address both of these risk factors and allocate appropriate
National Institute of Mental Health and South African Medical Research Council.
Copyright 2010 Elsevier Ltd. All rights reserved.