AIDS and Behavior

, Volume 2, Issue 1, pp 61–73 | Cite as

Sexual Coercion, Physical Violence, and HIV Infection Among Women in Steady Relationships in Kigali, Rwanda

  • Ariane van der Straten
  • Rachel King
  • Olga Grinstead
  • Eric Vittinghoff
  • Antoine Serufilira
  • Susan Allen


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.

HIV prevention women sexual coercion physical violence abuse Africa Rwanda gender roles condom negotiation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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.Google Scholar
  2. 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.Google Scholar
  3. 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.Google Scholar
  4. Ankrah, M. E. (1991). AIDS and the social side of health. Social Sciences and Medicine, 32, 967–980.Google Scholar
  5. Bowen, S. P., and Michal-Johnson, P. (1995). HIV/AIDS: A crucible for understanding the dark side of sexual interactions. Thousand Oaks, CA: Sage.Google Scholar
  6. Browne, A. (1993). Violence against women by male partners: Prevalence, outcomes, and policy implications. American Psychologist, 48, 1077–1087.Google Scholar
  7. 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.Google Scholar
  8. De Bruyn, M. (1992). Women and AIDS in developing countries. Social Science and Medicine, 34, 249–262.Google Scholar
  9. 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.Google Scholar
  10. 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.Google Scholar
  11. Gupta, G. R., and Weiss, E. (1993). Women's lives and sex: Implications for AIDS prevention. Culture Medicine and Psychiatry, 17, 399–412.Google Scholar
  12. 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.Google Scholar
  13. Heise, L., Moore, K., and Toubia, N. (1995). Sexual coercion and reproductive health. New York: The Population Council.Google Scholar
  14. Heise, L., Pitanguy, J., and Germain, A. (1994). Violence against women: The hidden health burden. The World Bank Discussion Papers #255. Washington DC.Google Scholar
  15. 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.Google Scholar
  16. 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.Google Scholar
  17. 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.Google Scholar
  18. 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.Google Scholar
  19. 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.Google Scholar
  20. 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.Google Scholar
  21. 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.Google Scholar
  22. 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.Google Scholar
  23. Levinson, D. (1989). Family violence in cross-cultural perspective. Newbury Park, CA: Sage.Google Scholar
  24. 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.Google Scholar
  25. Lippmann, S. B., James, W. A., and Frierson, R.L (1993). AIDS and the family: Implications for counseling. AIDS Care, 5, 71–78.Google Scholar
  26. McFadden, P. (1994). African female sexuality and the heterosexual form. Southern Africa Political and Economic Monthly, 7, 56–58.Google Scholar
  27. 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.Google Scholar
  28. 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.Google Scholar
  29. 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.Google Scholar
  30. O'Farrell, N., Tovey, S. J., and Morgan-Capner, P. (1992). Transmission of HIV-1 infection after a fight. Lancet, 339, 246.Google Scholar
  31. 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.Google Scholar
  32. 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.Google Scholar
  33. Rozée, P. D. (1993). Forbidden or forgiven? Rape in cross-cultural perspective. Psychology of Women Quarterly, 17, 499–514.Google Scholar
  34. Sanday, P. R. (1981). The socio-cultural context of rape: A cross-cultural study. Journal of Social Issues, 37, 5–27.Google Scholar
  35. Schoepf, B. G. (1993). AIDS action-research with women in Kinshasa, Zaire. Social Science and Medicine, 37, 1401–1413.Google Scholar
  36. 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.Google Scholar
  37. Schwartz, I. L. (1991). Sexual violence against women: prevalence, consequences, societal factors, and prevention. American Journal of Preventive Medicine, 7, 363–373.Google Scholar
  38. 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.Google Scholar
  39. 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.Google Scholar
  40. Stein, Z. A. (1995). Editorial: More on women and the prevention of HIV infection. American Journal of Public Health, 85, 1485–1488.Google Scholar
  41. 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.Google Scholar
  42. 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.Google Scholar
  43. Temmerman, M., Ndinya-Achola, J, Ambani, J., and Piot, P. (1995). The right not to know HIV-test results. Lancet, 345, 969–970.Google Scholar
  44. Ulin, P. R. (1992). African women and AIDS: Negotiating behavioral change. Social Science and Medicine, 34, 63–73.Google Scholar
  45. 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.Google Scholar
  46. 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.Google Scholar
  47. 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.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Ariane van der Straten
    • 1
  • Rachel King
    • 2
  • Olga Grinstead
    • 3
  • Eric Vittinghoff
    • 3
  • Antoine Serufilira
    • 4
  • Susan Allen
    • 5
    • 2
    • 6
  1. 1.Center for AIDS Prevention Studies (CAPS)University of CaliforniaSan Francisco
  2. 2.Project San Francisco, Ministry of HealthKigali
  3. 3.Center for AIDS Prevention Studies (CAPS)University of CaliforniaSan Francisco
  4. 4.The National AIDS Control Program, Ministry of HealthKigali
  5. 5.Center for AIDS Prevention Studies (CAPS)University of CaliforniaSan Francisco
  6. 6.Division of Clinical Epidemiology, Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco

Personalised recommendations