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A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

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Abstract

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05–0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

Resumen

Se realizó un estudio de cohorte prospectivo para evaluar la violencia en la pareja (VP) como un factor de riesgo para la carga viral detectable en plasma en las trabajadoras sexuales (TS) con VIH-positivo en el tratamiento antirretroviral (TAR) en Kenia. La violencia de pareja en el último año se definió como ≥1 acto de violencia física, sexual o emocional por parte de la pareja (novio/marido). El resultado principal fue la carga viral detectable (≥180 copias/ml). Entrevistas de profundidad y grupos de enfoque fueron realizados para contextualizar los resultados. Los análisis incluyeron 195 mujeres (570 visitas). Inesperadamente, la violencia de pareja se asoció con un riesgo significativamente menor en la carga viral detectable (riesgo relativo ajustado: 0.21; IC del 95 %: 0.05 a 0.84; p-value = 0.02). Los resultados cualitativos revelaron que las mujeres valoran el apoyo emocional y financiero de sus parejas, a pesar de la violencia de pareja. La violencia de pareja no era un obstáculo importante para el cumplimiento del TAR. La asociación observada entre la violencia de pareja y un más bajo riesgo en la carga viral detectable en las trabajadoras sexuales puede ser debido a factores personales y de relación que no fueron medidos, y que merecen ser investigados en profundidad.

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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 would like to thank Ms. Tahilin Sanchez for translating our abstract into Spanish. This study was funded by a Grant from the National Institutes of Health (R01HD072617 PI: McClelland). 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, Seattle, 98104, USA

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

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

    Jane M. Simoni

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

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

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

    James P. Hughes & Barbra A. Richardson

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

    Linnet Masese & R. Scott McClelland

  6. Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya

    George Wanje, Walter Jaoko & R. Scott McClelland

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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., Wanje, G., Yuhas, K. et al. A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya. AIDS Behav 20, 2065–2077 (2016). https://doi.org/10.1007/s10461-016-1420-z

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