South African research published in this week's issue of THE LANCET
highlights how women with physically violent and controlling male partners are at an increased risk of HIV-1 infection.
HIV/AIDS is more widespread among women in sub-Saharan Africa than any other population. Although violence from a male partner and relationship inequalities are thought to be associated with increased HIV risk among women, no study has yet assessed gender-based violence as a risk factor for HIV after adjustment for women's own high-risk sexual behaviours.
Rachel Jewkes and colleagues from South Africa's Medical Research Council studied 1366 women who agreed to HIV testing while attending antenatal care at four health centres in Soweto, South Africa. Private face-to-face interviews included the assessement of sociodemographic characteristics, experience of gender-based violence, assessment of gender equality in their relationships, and of risky sexual practices.
Two factors were identified that were associated with a 50% higher prevalence of HIV-1 infection: receiving physical abuse from a male partner, and being in a relationship where the male partner had excessive control of the relationship. Child sexual assault, forced first intercourse, and adult sexual assault by non-partners were not associated with increased HIV risk.
Dr Jewkes comments: "Women with violent or controlling male partners are at increased risk of HIV infection. We postulate that abusive men are more likely to have HIV and impose risky sexual practices on partners. Research on connections between social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviours in men, as well as effective interventions, are urgently needed".
In an accompanying Commentary (p 1410), Sandra L Martin from the University of North Carolina, USA, concludes: "no one strategy can alleviate gender-based violence and enhance gender-equity. Numerous groups are, however, working toward these goals. The challenge now is to encourage policy makers, health organisations, women's advocates, violence-prevention specialists, researchers, and others to work together to turn the global rhetoric into effective actions to reduce gender-based violence and increase the effectiveness of HIV/AIDS programmes, thereby making a real difference to the lives of women and girls worldwide".