The relationship between intimate partner violence and HIV outcomes among pregnant women living with HIV in Malawi

Elizabeth C. Wetzel^1,2, Tapiwa Tembo², Elaine J. Abrams⁴, Alick Mazenga², Mike J. Chitani², Saeed
Ahmed^1,2, Xiaoying Yu³, Maria H. Kim^1,2

1. Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children’s Hospital, Houston, United States of America (USA)
2. Baylor College of Medicine – Children’s Foundation Malawi, Lilongwe, Malawi
3. University of Texas Medical Branch at Galveston, Galveston, USA
4. ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA

*Corresponding Author: Elizabeth C. Wetzel; Email: ecwetzel@bcm.edu

Abstract
Background
Intimate partner violence (IPV) is a global public health concern particularly in pregnancy where IPV can have negative health implications for the mother and child. Data suggest IPV disproportionately affects pregnant women living with HIV (PWLWH) compared to those without HIV. HIV-related outcomes are worse among women experiencing IPV. Despite this knowledge, there is paucity of data concerning PWLWH and IPV in Malawi, where there is a high HIV prevalence (10.6%).
Objectives
We aim to characterize IPV amongst PWLWH in Malawi and describe its relationship to demographic characteristics, psychosocial factors, and HIV-related outcomes.
Methods
This analysis used data from the VITAL Start pilot study, which is a video-based intervention targeting retention and ART adherence amongst PWLWH in Malawi. PWLWH not on ART were recruited at antenatal clinic and given study questionnaires to assess demographics, IPV, and psychosocial factors. Questionnaires were also administered at one-month follow-up to assess outcomes related to HIV. Descriptive statistics and logistic regression models were used to explore the risk factors associated with IPV.
Results
Thirty-nine percent of participants reported ever experiencing IPV from their current partner. The majority (53%) reporting IPV experienced more than one type of violence. IPV was associated with being married (p=0.04) and depression (p<0.0001) in the univariable analysis. For women retained at one-month, IPV was associated with reporting a missed ART dose in the past month but not with adherence measured by pill count.
Conclusions
A large proportion of PWLWH experienced IPV from their current partner and IPV was associated with worse self-reported ART adherence at one-month follow-up. Further evidence is needed to understand how IPV impacts PWLWH throughout postpartum and beyond. Given the detrimental impact on health outcomes among PWLWH in Malawi, additional focus on IPV is essential to identify mechanisms to prevent, screen, and manage IPV among this population.
Key words: IPV, abuse, HIV, Malawi, adherence, violence