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© 2014. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Prevention of mother‐to‐child transmission (PMTCT) has the potential to eliminate new HIV infections among infants. Yet in many parts of sub‐Saharan Africa, PMTCT coverage remains low, leading to unacceptably high rates of morbidity among mothers and new infections among infants. Intimate partner violence (IPV) may be a structural driver of poor PMTCT uptake, but has received little attention in the literature to date.

Methods

We conducted qualitative research in three Johannesburg antenatal clinics to understand the links between IPV and HIV‐related health of pregnant women. We held focus group discussions with pregnant women (n=13) alongside qualitative interviews with health care providers (n=10), district health managers (n=10) and pregnant abused women (n=5). Data were analysed in Nvivo10 using a team‐based approach to thematic coding.

Findings

We found qualitative evidence of strong bidirectional links between IPV and HIV among pregnant women. HIV diagnosis during pregnancy, and subsequent partner disclosure, were noted as a common trigger of IPV. Disclosure leads to violence because it causes relationship conflict, usually related to perceived infidelity and the notion that women are “bringing” the disease into the relationship. IPV worsened HIV‐related health through poor PMTCT adherence, since taking medication or accessing health services might unintentionally alert male partners of the women's HIV status. IPV also impacted on HIV‐related health via mental health, as women described feeling depressed and anxious due to the violence. IPV led to secondary HIV risk as women experienced forced sex, often with little power to negotiate condom use. Pregnant women described staying silent about condom negotiation in order to stay physically safe during pregnancy.

Conclusions

IPV is a crucial issue in the lives of pregnant women and has bidirectional links with HIV‐related health. IPV may worsen access to PMTCT and secondary prevention behaviours, thereby posing a risk of secondary transmission. IPV should be urgently addressed in antenatal care settings to improve uptake of PMTCT and ensure that goals of maternal and child health are met in sub‐Saharan African settings.

Details

Title
Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother‐to‐child transmission
Author
Hatcher, Abigail M 1 ; Woollett, Nataly 2 ; Pallitto, Christina C 3 ; Mokoatle, Keneuoe 2 ; Stöckl, Heidi 4 ; MacPhail, Catherine 5 ; Sinead Delany‐Moretlwe 2 ; Claudia García‐Moreno 3 

 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; Division of HIV/AIDS, University of California, San Francisco, CA, USA 
 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa 
 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland 
 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK 
 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; Collaborative Research Network for Mental Health and Wellbeing, University of New England, New South Wales, Australia 
Section
Research Article
Publication year
2014
Publication date
Jan 2014
Publisher
John Wiley & Sons, Inc.
e-ISSN
1758-2652
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2289561587
Copyright
© 2014. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.