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Intimate partner violence is associated with incident HIV infection in women in Uganda

Kouyoumdjian, Fiona G.a; Calzavara, Liviana M.a; Bondy, Susan J.a; O’Campo, Patriciaa; Serwadda, Davidb; Nalugoda, Fredc; Kagaayi, Josephc; Kigozi, Godfreyc; Wawer, Mariad; Gray, Rond

doi: 10.1097/QAD.0b013e32835fd851
Epidemiology and Social

Objectives: To quantify the association between intimate partner violence (IPV) and incident HIV infection in women in the Rakai Community Cohort Study between 2000 and 2009.

Design and methods: Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Longitudinal data analysis was used to estimate the adjusted incidence rate ratio (IRR) of incident HIV associated with IPV in sexually active women aged 15–49 years, using a multivariable Poisson regression model with random effects. The population attributable fraction was calculated. Putative mediators were assessed using Baron and Kenny's criteria and the Sobel–Goodman test.

Results: Women who had ever experienced IPV had an adjusted IRR of incident HIV infection of 1.55 (95% CI 1.25–1.94, P = 0.000), compared with women who had never experienced IPV. Risk of HIV infection tended to be greater for longer duration of IPV exposure and for women exposed to more severe and more frequent IPV. The adjusted population attributable fraction of incident HIV attributable to IPV was 22.2% (95% CI 12.5–30.4). There was no evidence that either condom use or number of sex partners in the past year mediated the relationship between IPV and HIV.

Conclusion: IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the adjusted population attributable fraction is modest. The prevention of IPV should be a public health priority, and could contribute to HIV prevention.

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aDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

bMakerere University, School of Public Health, Kampala

cRakai Health Sciences Program, Entebbe, Uganda

dDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.

Correspondence to Dr Fiona Kouyoumdjian, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada. E-mail:

Received 12 November, 2012

Revised 8 January, 2013

Accepted 5 February, 2013

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© 2013 Lippincott Williams & Wilkins, Inc.