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      The Relationship between Intimate Partner Violence, Rape and HIV amongst South African Men: A Cross-Sectional Study

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          Abstract

          Objective

          To investigate the associations between intimate partner violence, rape and HIV among South African men.

          Design

          Cross-sectional study involving a randomly-selected sample of men.

          Methods

          We tested hypotheses that perpetration of physical intimate partner violence and rape were associated with prevalent HIV infections in a cross-sectional household study of 1229 South African men aged 18–49. Violence perpetration was elicited in response to a questionnaire administered using an Audio-enhanced Personal Digital Assistant and blood samples were tested for HIV. A multivariable logistic regression model was built to identify factors associated with HIV.

          Results

          18.3% of men had HIV. 29.6% (358/1211) of men disclosed rape perpetration, 5.2% (63/1208) rape in the past year and 30.7% (362/1180) of had been physically violent towards an intimate partner more than once. Overall rape perpetration was not associated with HIV. The model of factors associated with having HIV showed men under 25 years who had been physically violent towards partners were more likely to have HIV than men under 25 who had not (aOR 2.08 95% CI 1.07–4.06, p = 0.03). We failed to detect any association in older men.

          Conclusions

          Perpetration of physical IPV is associated with HIV sero-prevalence in young men, after adjusting for other risk factors. This contributes to our understanding of why women who experience violence have a higher HIV prevalence. Rape perpetration was not associated, but the HIV prevalence among men who had raped was very high. HIV prevention in young men must seek to change ideals of masculinity in which male partner violence is rooted.

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          Most cited references45

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          Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention

          Rachel Jewkes, Robert Morrell (2010)
          Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted. In South Africa, while gender identities show diversity, the dominant ideal of black African manhood emphasizes toughness, strength and expression of prodigious sexual success. It is a masculinity women desire; yet it is sexually risky and a barrier to men engaging with HIV treatment. Hegemonically masculine men are expected to be in control of women, and violence may be used to establish this control. Instead of resisting this, the dominant ideal of femininity embraces compliance and tolerance of violent and hurtful behaviour, including infidelity. The women partners of hegemonically masculine men are at risk of HIV because they lack control of the circumstances of sex during particularly risky encounters. They often present their acquiescence to their partners' behaviour as a trade off made to secure social or material rewards, for this ideal of femininity is upheld, not by violence per se, by a cultural system of sanctions and rewards. Thus, men and women who adopt these gender identities are following ideals with deep roots in social and cultural processes, and thus, they are models of behaviour that may be hard for individuals to critique and in which to exercise choice. Women who are materially and emotionally vulnerable are least able to risk experiencing sanctions or foregoing these rewards and thus are most vulnerable to their men folk. We argue that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours.
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            HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania.

            Suzanne Maman, Jessie Mbwambo, Nora M. Hogan … (2002)
            Experiences of partner violence were compared between HIV-positive and HIV-negative women. Of 340 women enrolled, 245 (72%) were followed and interviewed 3 months after HIV testing to estimate the prevalence and identify the correlates of violence. The odds of reporting at least 1 violent event was significantly higher among HIV-positive women than among HIV-negative women (physical violence odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.23, 5.63; sexual violence OR = 2.39; 95% CI = 1.21, 4.73). Odds of reporting partner violence was 10 times higher among younger (< 30 years) HIV-positive women than among younger HIV-negative women (OR = 9.99; 95% CI = 2.67, 37.37). Violence is a risk factor for HIV infection that must be addressed through multilevel prevention approaches.
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              Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa.

              N Duvvury, Jonathan Levin, R Jewkes … (2006)
              To examine associations between the perpetration of intimate partner violence and HIV risk behaviour among young men in rural South Africa. An analysis of baseline data from men enrolling in a randomized controlled trial of the behavioural intervention, Stepping Stones. Structured interviews with 1275 sexually experienced men aged 15-26 years from 70 villages in the rural Eastern Cape. Participants were asked about the type, frequency, and timing of violence against female partners, as well as a range of questions about HIV risk behaviours. A total of 31.8% of men reported the perpetration of physical or sexual violence against female main partners. Perpetration was correlated with higher numbers of past year and lifetime sexual partners, more recent intercourse, and a greater likelihood of reporting casual sex partners, problematic substance use, sexual assault of non-partners, and transactional sex. Men who reported both physical and sexual violence against a partner, perpetration both before and within the past 12 months, or more than one episode of perpetration reported significantly higher levels of HIV risk behaviour than men who reported less severe or less frequent perpetration of violence. Young men who perpetrate partner violence engage in significantly higher levels of HIV risk behaviour than non-perpetrators, and more severe violence is associated with higher levels of risky behaviour. HIV prevention interventions must explicitly address the links between the perpetration of intimate partner violence and HIV risk behaviour among men, as well as the underlying gender and power dynamics that contribute to both.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2011
                Publication date (Electronic): 14 September 2011
                Volume: 6
                Issue: 9
                Electronic Location Identifier: e24256
                Affiliations
                [1 ]School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
                [2 ]Gender & Health Research Unit, Medical Research Council, University of the Witwatersrand, Pretoria, South Africa
                [3 ]Research Office, University of Cape Town, Cape Town, South Africa
                [4 ]Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                Vanderbilt University, United States of America
                Author notes

                Conceived and designed the experiments: RJ YS RM KD. Performed the experiments: RJ YS RM KD. Analyzed the data: RJ. Contributed reagents/materials/analysis tools: RJ KD RM. Wrote the paper: RJ YS RM KD. Project manager: YS. Principle investigator: RJ.

                Article
                Publisher ID: PONE-D-11-04522
                DOI: 10.1371/journal.pone.0024256
                PMC ID: 3173408
                PubMed ID: 21935392
                SO-VID: 744ce1c6-0dad-4718-b60f-eb9593b5c327
                Copyright © Jewkes et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 4 March 2011
                Date accepted : 7 August 2011
                Page count
                Pages: 6
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Clinical Research Design
                Subject: Cross-Sectional Studies
                Subject: Epidemiology
                Subject: Infectious Disease Epidemiology
                Subject: Social Epidemiology
                Subject: Infectious Diseases
                Subject: Sexually Transmitted Diseases
                Subject: AIDS
                Subject: Public Health
                Subject: Behavioral and Social Aspects of Health
                Subject: Women's Health
                Subject: Rape and Sexual Assault
                Subject: Social and Behavioral Sciences
                Subject: Sociology
                Subject: Crime and Criminology
                Subject: Domestic Violence
                Subject: Rape
                Subject: Sexual and Gender Issues

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                ScienceOpen disciplines: Uncategorized

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