Abstract
The relationship between sexual coercion, physical violence, and HIV serostatus was examined at 24 months of follow-up in a cohort of 921 women with steady partners in Kigali, Rwanda. One third of the women reported sexual coercion, and physical violence perpetrated by their male partner was reported by 21%. Sexual coercion was associated with women being HIV-positive, and physical violence was associated with their partner testing HIV-positive. Independent predictors of sexual coercion included the woman being HIV-positive, refusal to have sex, condom negotiation, financial inequality, and male partner's alcohol use. Independent predictors of physical violence were similar to predictors of sexual coercion. Sexual coercion and physical violence are public health issues relevant to HIV prevention, and are associated with financial and sexual gender power differentials. Results suggest the need to expand HIV behavioral interventions to address women's economic and cultural realities.
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REFERENCES
Allen, S., Lindan, C., Chen Rundle, A., Schwalbe, M., and Hulley, S. (1991). Human immunodeficiency virus infection in urban Rwanda. Journal of the American Medical Association, 266, 1657–1663.
Allen, S., Serufilira, A., Bogaerts, J., Van de Perre, P., Nsengumuremyi, F., Lindan, C., Carael, M., Wolf, W., Coates, T. J., and Hulley, S. (1992a). Confidential HIV testing and condom promotion in Africa, impact on HIV and gonorrhea rates. Journal of the American Medical Association, 268, 3338–3343.
Allen, S., Tice, J., and Van de Perre, P. (1992b). Effect of serotesting with counseling on condom use and seroconversion among HIV discordant couples in Africa. British Medical Journal, 304, 1605–1609.
Ankrah, M. E. (1991). AIDS and the social side of health. Social Sciences and Medicine, 32, 967–980.
Bowen, S. P., and Michal-Johnson, P. (1995). HIV/AIDS: A crucible for understanding the dark side of sexual interactions. Thousand Oaks, CA: Sage.
Browne, A. (1993). Violence against women by male partners: Prevalence, outcomes, and policy implications. American Psychologist, 48, 1077–1087.
Counts, D. A., Brown, J. K., and Campbell, J. C. (1992). Sanctions and sanctuary: Cultural perspectives on the beating of wives. Boulder, CO: Westview Press.
De Bruyn, M. (1992). Women and AIDS in developing countries. Social Science and Medicine, 34, 249–262.
Dobash, R. E., and Dobash, R. P. D. (1987). Violence towards wives. In J. Orford (Ed.), Treating the disorder, treating the family (pp. 169–193). Baltimore: The Johns Hopkins University Press.
Goodman, L. A., Koss, M. P., Fitzgerald, L. F., and Russo, N. F. (1993). Male violence against women: Current research and future directions. American Psychologist, 48, 1054–1058.
Gupta, G. R., and Weiss, E. (1993). Women's lives and sex: Implications for AIDS prevention. Culture Medicine and Psychiatry, 17, 399–412.
Hardesty, L. and Greif, G. L. (1994). Common themes in a group for female IV drug users who are HIV positive. Journal of Psychoactive Drugs, 26, 289–293.
Heise, L., Moore, K., and Toubia, N. (1995). Sexual coercion and reproductive health. New York: The Population Council.
Heise, L., Pitanguy, J., and Germain, A. (1994). Violence against women: The hidden health burden. The World Bank Discussion Papers #255. Washington DC.
Heyward, W. L., Batter, V. L., Malulu, M., Mbuyi, N., Mbu, L., St Louis, M. E., Kamenga, M., and Ryder, R. W. (1993). Impact of HIV counseling and testing among child-bearing women in Kinshasa, Zaire. AIDS, 7, 1633–1637.
Ippoliti, G., Del Poggio, P., Arici, C., Gregis, P., Antonelli, G., Riva, E., and Dianzani, F. (1994). Transmission of zidovudine-resistant HIV during a bloody fight. Journal of the American Medical Association, 272, 433–434.
Irwin, K. L., Edlin, B. R., Wong, L., Faruque, S., McCoy, H. V., Word, C., Schilling, R., McCoy, C. B., Evans, P. E., and Holmberg, S. D. (1995). Urban rape survivors: Characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections. Multicenter Crack Cocaine and HIV Infection Study Team. Obstetrics and Gynecology, 85, 330–336.
Jenny, C., Hooton, T. M., Bowers, A., Copass, M. K., Krieger, J. N., Hillier, S. L., Kiviat, N., Corey, L., Stamm, W. E., and Holmes, K. K. (1990). Sexually transmitted diseases in victims of rape. New England Journal of Medicine, 322, 713–716.
Kamenga, M., Ryder, R. W., Jingu, M., Mbuyi, N., Mbu, L., Behets, F., Brown, C. and Heyward W. (1991). Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: Experience at an HIV counseling center in Zaire. AIDS, 5, 61–67.
Karim, Q. A., and Morar, N. (1994). Women and AIDS in Natal/KwaZulu, South Africa: Determinants to the adoption of HIV-protective behavior. International Center for Research on Women Summary Report. Washington, DC.
Keogh, P., Allen, S., Almedal, C., and Tehahagili, B. (1994). The social impact of HIV infection on women in Kigali, Rwanda: A prospective study. Social Science and Medicine, 38, 1047–1053.
Laumann, E. O., Gagnon, J. H., Michael, R. T., and Michaels, S. (1994). Formative sexual experiences. In The social organization of sexuality: Sexual practices in the United States (pp. 321–347). Chicago: University of Chicago Press.
Levinson, D. (1989). Family violence in cross-cultural perspective. Newbury Park, CA: Sage.
Lindan, C., Allen, S., Carael, M., Nsengumuremyi, F., Van de Perre, P., Serufilira, A., Tice, J., Black, D., Coates, T. J., and Hulley, S. (1991). Knowledge, attitudes, and perceived risk of AIDS among urban Rwandan women: Relationship to HIV infection and behavior change. AIDS, 5, 993–1002.
Lippmann, S. B., James, W. A., and Frierson, R.L (1993). AIDS and the family: Implications for counseling. AIDS Care, 5, 71–78.
McFadden, P. (1994). African female sexuality and the heterosexual form. Southern Africa Political and Economic Monthly, 7, 56–58.
Moore, J., Harrison, J. S., Kay, K. L., Deren, S., and Doll, L. S. (1995). Factors associated with Hispanic women's HIV-related communication and condom use with male partners. AIDS Care, 7, 415–427.
Muehlenhard, C. L., Goggins, M. F., Jones, J. M., and Satterfield, A. T. (1991). Sexual violence and coercion in close relationships. In K. McKinney and S. Sprecher (Eds.), Sexuality in close relationships (pp. 155–175). Hillsdale, NJ: Lawrence Erlbaum.
Mutize, C. (1991). Community-linked counseling. In M. A. Mercer and S. J. Scott (Eds.), Tradition and transition: NGOs respond to AIDS (pp. 39–46). Baltimore: The Johns Hopkins University School of Hygiene and Public Health.
O'Farrell, N., Tovey, S. J., and Morgan-Capner, P. (1992). Transmission of HIV-1 infection after a fight. Lancet, 339, 246.
Patten, W., and Ward, A. (1993, June). Empowering women to stop AIDS: Lessons from Cote d'Ivoire and Uganda. In IX International Conference on AIDS, Berlin.
Rothenberg, K. H., and Paskey, S. J. (1995). The risk of domestic violence and women with HIV infection: Implication for partner notification, public policy, and the law. American Journal of Public Health, 85, 1569–1576.
Rozée, P. D. (1993). Forbidden or forgiven? Rape in cross-cultural perspective. Psychology of Women Quarterly, 17, 499–514.
Sanday, P. R. (1981). The socio-cultural context of rape: A cross-cultural study. Journal of Social Issues, 37, 5–27.
Schoepf, B. G. (1993). AIDS action-research with women in Kinshasa, Zaire. Social Science and Medicine, 37, 1401–1413.
Schuler, S. R., and Hashemi, S. M. (1994). Credit programs, women's empowerment, and contraceptive use in rural Bangladesh. Studies in Family Planning, 25, 65–76.
Schwartz, I. L. (1991). Sexual violence against women: prevalence, consequences, societal factors, and prevention. American Journal of Preventive Medicine, 7, 363–373.
Serwadda, D., Gray, R. H., Wawer, M. J., Stalling, R. Y., Sewan Kambo, N. K., Konde-Lule, J. K., Lainjo, B., and Kelly, R. (1995). The social dynamics of HIV transmission as reflected through discordant couples in rural Uganda. AIDS, 9, 745–750.
Somse, P., Chapko, M. K., and Hawkins, R. V. (1993). Multiple sexual partners: Results of a national HIV/AIDS survey in the Central African Republic. AIDS, 7, 579–583.
Stein, Z. A. (1995). Editorial: More on women and the prevention of HIV infection. American Journal of Public Health, 85, 1485–1488.
Sweat, M. D., and Denison, J. A. (1995). Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS, 9(suppl A), s251–257.
Tawil, O., Verster, A., and O'Reilly, K. V. (1995) Enabling approaches for HIV/AIDS prevention: Can we modify the environment and minimize the risk? AIDS, 9, 1299–1306.
Temmerman, M., Ndinya-Achola, J, Ambani, J., and Piot, P. (1995). The right not to know HIV-test results. Lancet, 345, 969–970.
Ulin, P. R. (1992). African women and AIDS: Negotiating behavioral change. Social Science and Medicine, 34, 63–73.
Van der Straten, A., King, R., Grinstead, O., Serufilira. A., and Allen, S. (1995). Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS, 9, 935–944.
Worth, D. (1989). Sexual decision-making and AIDS: Why condom promotion among vulnerable women is likely to fail. Studies in Family Planning, 20, 297–307.
Yoshihama, M., and Sorenson, S. B. (1994). Physical, sexual and emotional abuse by male intimates: Experiences of women in Japan. Violence and Victims, 9, 63–77.
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van der Straten, A., King, R., Grinstead, O. et al. Sexual Coercion, Physical Violence, and HIV Infection Among Women in Steady Relationships in Kigali, Rwanda. AIDS Behav 2, 61–73 (1998). https://doi.org/10.1023/A:1022311424652
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DOI: https://doi.org/10.1023/A:1022311424652