Intimate Partner Violence Functions as Both a Risk Marker and Risk Factor for Women's HIV Infection: Findings From Indian Husband-Wife Dyads

Decker, Michele R ScD*; Seage, George R III ScD†; Hemenway, David PhD‡; Raj, Anita PhD§; Saggurti, Niranjan PhD‖; Balaiah, Donta MSc, PhD¶; Silverman, Jay G PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 2009 - Volume 51 - Issue 5 - pp 593-600
doi: 10.1097/QAI.0b013e3181a255d6
Epidemiology and Social Science

Context and Objective: Female victims of intimate partner violence (IPV) consistently demonstrate elevated sexually transmitted infection/HIV prevalence. IPV is thought to function indirectly as a marker of abusive men's elevated sexually transmitted infection/HIV infection and/or directly via facilitating transmission to wives. The present examination utilizes a nationally representative sample of married Indian couples to test these mechanisms and determine whether (1) abusive husbands demonstrate higher HIV infection prevalence compared with nonabusive husbands and (2) the risk of wives' HIV infection based on husbands' HIV infection varies as a function of their exposure to IPV.

Design, Setting, and Participants: The Indian National Family Health Survey-3 was conducted across all Indian states in 2005-2006. Analyses were limited to 20,425 husband-wife dyads, which provided both IPV data and HIV test results.

Analyses: Logistic regression models estimated the odds ratios and 95% confidence intervals (CIs) to evaluate the following associations: (1) husbands' HIV acquisition outside the marital relationship based on their perpetration of IPV and (2) wives' HIV infection based on husbands' HIV infection, as a function of their IPV exposure.

Results: One third (37.4%) of wives experienced IPV; 0.4% of husbands and 0.2% of wives were HIV infected. Compared with nonabusive husbands, abusive husbands demonstrated increased odds of HIV acquisition outside the marital relationship in adjusted models (adjusted odds ratio [AOR] = 1.91; 95% CI 1.11 to 3.27). Husbands' HIV infection was associated with increased HIV risk among wives; this risk was elevated 7-fold in abusive relationships in adjusted models (AOR = 7.22; 95% CI 1.05 to 49.88).

Conclusions: Findings provide the first empirical evidence that abused wives face increased HIV risk based both on the greater likelihood of HIV infection among abusive husbands and elevated HIV transmission within abusive relationships. Thus, IPV seems to function both as a risk marker and as a risk factor for HIV among women, indicating the need for interwoven efforts to prevent both men's sexual risk and IPV perpetration.

From the Departments of *Society, Human Development and Health; †Epidemiology; and ‡Health Policy and Management, Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA; §Department of Social and Behavioral Sciences, Boston University of Public Health, Boston, MA; ∥Population Council, New Delhi, India; and ¶National Institute for Research in Reproductive Health, Indian Council for Medical Research, Mumbai, India.

Received for publication September 24, 2008; accepted February 5, 2009.

Support for the creation of this article was provided to Dr. M. R. Decker via the Harvard University Center for AIDS Research (HU CFAR National Institutes of Health/National Institute of Allergy and Infectious Diseases fund P30-AI060354).

Correspondence to: Michele R. Decker, ScD, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.