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A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya

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Abstract

We conducted a prospective cohort study to test the hypothesis that intimate partner violence (IPV) is associated with unprotected sex in HIV-positive female sex workers in Mombasa, Kenya. Women completed monthly visits and quarterly examinations. Any IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the current or most recent emotional partner (‘index partner’). Unprotected sex with any partner was measured by self-report and prostate specific antigen (PSA) test. Recent IPV was associated with significantly higher risk of unprotected sex (adjusted relative risk [aRR] 1.91, 95 % CI 1.32, 2.78, p = 0.001) and PSA (aRR 1.54, 95 % CI 1.17, 2.04, p = 0.002) after adjusting for age, alcohol use, and sexual violence by someone besides the index partner. Addressing IPV in comprehensive HIV programs for HIV-positive women in this key population is important to improve wellbeing and reduce risk of sexual transmission of HIV.

Resumen

A partir de un estudio prospectivo de cohorte se probabó la hipótesis de que la violencia en la pareja (VP) está asociada con sexo no protegido con trabajadoras sexuales VIH positivas en Mombasa, Kenia. Las mujeres del estudio realizaron visitas médicas mensuales y trimestrales. Cualquier episodio de VP ocurrida en el año anterior fue definido como uno o más actos de violencia física, sexual o emocional por parte de su pareja actual o de su pareja emocional más reciente (“index partner”). El sexo no protegido con cualquier tipo de pareja fue medido por auto reporte y con la prueba de antígeno prostático (POP). VP reciente estuvo asociada significativamente con un mayor riesgo de tener sexo no protegido (riesgo relativo ajustado (RRa) 1.91, 95 % CI 1.32, 2.78, p = 0.001) y con una POP (RRa 1.54, 95 % CI 1.17, 2.04, p = 0.002), ajustado por edad, uso de alcohol y violencia sexual ejercida por otra persona diferente de su pareja emocional reciente. Abordar la VP en programas amplios de VIH para mujeres VIH positivas en esta población clave, es importante para mejorar el bienestar y reducir el riesgo de transmisión sexual del VIH.

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Acknowledgments

We are grateful to the study participants and our research, clinical, laboratory, outreach, and administrative staff for making this study possible. We thank Mr. Jorge Valencia for translating our abstract into Spanish. This study was funded by a Grant from the National Institutes of Health (R01HD072617). K.S.W. was supported by the University of Washington Center for STD and AIDS (Grant T32 AI07140). Infrastructure and logistics support for the Mombasa research site was provided by the University of Washington’s Center for AIDS Research (CFAR), an NIH funded Program (P30 AI027757) which is supported by the following Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NCCAM. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This study was funded by National Institutes of Health Grants (R01HD072617 and T32 AI07140). Infrastructure and logistics support for the Mombasa research site was provided by an NIH funded Program (P30 AI027757).

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Authors and Affiliations

  1. Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA

    Kate S. Wilson, Ruth Deya, Krista Yuhas, Barbra A. Richardson & R. Scott McClelland

  2. Department of Psychology, University of Washington, Seattle, USA

    Jane Simoni

  3. Department of Epidemiology, University of Washington, Seattle, USA

    Kate S. Wilson, Ann Vander Stoep & R. Scott McClelland

  4. Department of Medicine, University of Washington, Seattle, USA

    R. Scott McClelland

  5. Department of Biostatistics, University of Washington, Seattle, USA

    James P. Hughes & Barbra A. Richardson

  6. University of Nairobi, Nairobi, Kenya

    Juma Shafi, Walter Jaoko & R. Scott McClelland

  7. Coast Province General Hospital, Mombasa, Kenya

    Juma Shafi

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  1. Kate S. Wilson
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Correspondence to Kate S. Wilson.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wilson, K.S., Deya, R., Yuhas, K. et al. A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya. AIDS Behav 20, 2054–2064 (2016). https://doi.org/10.1007/s10461-016-1399-5

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