Diagnosis and Disclosure of HIV Status: Implications for Women's Risk of Physical Partner Violence in the Postpartum Period

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Abstract

Introduction:

This study prospectively examined whether HIV leads to elevated risk for intimate partner violence (IPV) for women and how this risk varies depending on HIV status disclosure to a partner.

Methods:

We ran a series of logistic regression models using data from 1092 pregnant and postpartum women enrolled in an RCT in Durban, South Africa. Model 1 assessed whether baseline HIV status predicted 14-week postpartum physical IPV, controlling for baseline physical IPV, disclosure to partner, and demographic and study covariates. Model 2 added the interaction between HIV status and disclosure.

Results:

HIV was not associated with 14-week physical IPV in the main effects model [adjusted odds ratio: 1.34, 95% confidence interval (CI): 0.88 to 2.05]. However, there was a statistically significant positive interaction between HIV and disclosure (adjusted odds ratio: 0.22, 95% CI: 0.05 to 0.96). Among women who disclosed their HIV status, HIV was not significantly associated with 14-week IPV (adjusted odds ratio: 1.12, 95% CI: 0.71 to 1.89). However, among women who had not disclosed, the odds of reporting IPV at 14 weeks was 5.15 times higher for HIV-positive women as compared with HIV-negative women (95% CI: 1.25 to 21.00).

Discussion:

Although we established that HIV does not increase incidence of IPV for all HIV-positive women, we found an elevated risk of IPV among the HIV-positive women who chose not to disclose their status to their partner. Nondisclosure is likely a marker for other problematic aspects of the relationship, and counselors should either find alternative safe options for disclosure or support women's decisions not to disclose.

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