The relationship between intimate partner violence and HIV: A model-based evaluation

Background: Many studies have shown that women who have experienced intimate partner violence (IPV) are at a greater risk of HIV, but the factors accounting for this association are unclear, and trials of interventions to reduce IPV have not consistently reduced HIV incidence. Methods: This study uses an agent-based model, calibrated to South African data sources, to evaluate hypotheses about likely causal pathways linking IPV, HIV, and other confounding factors. Assumptions about associations between IPV and HIV risk behaviours were based on reviews of international literature. Findings: There is an association between past IPV experience and HIV incidence even when no causal effects are assumed (IRR 1.28, 95% CI 1.23e1.34), because women with a propensity for multiple partners are more likely to have ever been in a relationship with a violent partner. If, in addition, men with a propensity for concurrent relationships are more likely to perpetrate IPV, the IRR increases to 1.42 (95% CI 1.36e1.48), consistent with empirical IRR estimates. Alternative scenarios in which experience of IPV is assumed to cause changes in women's sexual behaviour have little effect on the IRR. An intervention that reduces IPV by 50% could be expected to reduce HIV incidence by at most 1.3%. Interpretation: Much of the observed association between IPV and HIV is likely to be due to confounding behavioural factors. Although interventions to reduce IPV are important, these interventions alone are unlikely to have a substantial impact on HIV incidence