The Impact of a Combined Intimate Partner Violence and HIV Prevention Intervention on Recent Abuse, Sexual Risk Behaviors and HIV Incidence in Rakai, Uganda

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Johns Hopkins University
Background: Intimate partner violence (IPV) is a precursor to and consequence of HIV infection. Few interventions combining HIV and IPV prevention have been evaluated and none has significantly decreased both outcomes. Design: A cluster-randomized trial was conducted in Rakai, Uganda. Intervention arm clusters (n=4) received an IPV prevention intervention (the Safe Homes and Respect for Everyone (SHARE) Project), enhanced HIV testing and treatment and routine HIV services. Control arm clusters (n=7) received standard of care HIV services alone. Methods: Baseline and two follow-up visits were conducted via the Rakai Community Cohort Study between 2005 and 2009. Primary outcomes were past year emotional, physical and sexual IPV and HIV incidence. Analysis was by intention-to-treat. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) to detect the impact of the intervention on IPV and secondary outcomes. Poisson regression was used to estimate incidence rate ratios (IRR) of HIV acquisition per 100 PY. Results: Among women, SHARE was associated with reduced physical IPV (aPRR=0.80; 95% CI: 0.68-0.93), sexual IPV (aPRR= 0.82; 95% CI: 0.69-0.99), emotional IPV (aPRR= 0.90; 95% CI: 0.79-1.03), and rape (aPRR=0.80; 95% CI: 0.66-0.97). SHARE did not significantly reduce reported perpetration of any type of IPV by men. There was a marginal reduction in women’s reports of multiple sex partners in the past year (aPRR=0.98; 95% CI: 0.97-1.00). The intervention did not reduce the number of sex/non-marital partners, alcohol use surrounding sex, condom use, or discussion about using condoms. Disclosure of HIV results was associated with reduced HIV acquisition, particularly among women but these estimates were not statistically significant. The intervention was associated with a reduction of HIV incidence in the total population (aIRR=0.64; 95% CI: 0.43-0.95, P=0.028). Conclusion: SHARE reduced IPV among women and HIV incidence in the population. While we cannot conclusively explain the differential in HIV incidence found between the study arms, our analysis suggests SHARE’s greatest impact on HIV risk behaviors was the reduction of women’s experiences of forced sex and improvements rates of HIV results disclosure. The SHARE intervention model could inform programs in the prevention of IPV and HIV.
Evaluation research, intimate partner violence, HIV infection, sexual risk behaviors, rural Uganda, sub-Saharan Africa