Intimate Partner Violence as a Risk Factor for Incident HIV Infection in Women in Rakai, Uganda

Background: Intimate partner violence (IPV) is a significant public health problem, which has been associated with HIV infection. Previous studies that assessed IPV and HIV have been limited. Objectives: The primary objective of this study was to quantify the association between IPV and incident HIV infection in women in Rakai, Uganda. Secondary objectives were to explore whether condom use and number of partners in the past year mediate this association, and to identify risk factors for IPV. Methods: Data were collected over seven rounds of the Rakai Community Cohort Study between 2000 and 2009. Sexually active women aged 15 to 49 were included in analyses. Longitudinal data analysis was used to quantify the association between IPV and incident HIV infection, modelling participants as random effects. The adjusted population attributable risk fraction was calculated using an adjusted relative risk from a Poisson model. Putative mediators were assessed using Baron and Kenny’s criteria and the Sobel-Goodman test. Longitudinal and non-longitudinal analyses were used to assess predictors of IPV. Results: Women who experienced IPV ever had an odds ratio of incident HIV infection of 1.54 (95% CI 1.14, 2.09, p value 0.01), compared with women who had never experienced IPV. The adjusted population attributable risk fraction of incident HIV during the study period attributable to IPV ever was 14.3% (95% CI 2.8, 23.6). There was no evidence that condom use or partner violence in the past year mediated the relationship between IPV and HIV. Risk factors for IPV included sexual abuse, younger age at first sex, lower levels of education, forced first sex, younger age, being married, relationship of shorter duration, alcohol use by women and by their partners, and thinking that violence is acceptable. Discussion: This study demonstrates that IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the population attributable risk fraction was modest. The prevention of IPV both in early sexual experiences and in adulthood should be a public health priority, and could contribute to HIV prevention. Further research is needed to understand the pathway from IPV to HIV infection.Ph