Domestic violence and prevention of mother-to-child transmission of HIV-1

Abstract

Objectives Todeterminetheprevalenceof life-timedomesticviolencebythecurrent partnerbeforeHIV-1testing,itsimpactontheuptakeofpreventionofmother-to-child transmission (PMTCT) interventions and frequency after testing. Design A prospective cohort. Methods Antenatally,womenandtheirpartnerswereinterviewedregardingphysical, financial, and psychological abuse by the male partner before HIV-1 testing and 2 weeks after receiving results. Results Beforetesting,804of2836women(28%)reportedpreviousdomesticviolence, whichtendedtobeassociatedwithincreasedoddsofHIV-1infection[univariateodds ratio (OR) 1.7, 95% confidence interval (CI) 1.3–2.2; P<0.0001, adjusted OR 1.2, 95% CI 0.9–1.6; P¼0.1], decreased odds of coming with partners for counseling (adjusted OR 0.7, 95% CI 0.5–1.0; P¼0.04), and decreased odds of partner notification(adjustedOR0.7,95%CI0.5–1.1;P¼0.09).Previousdomesticviolencewasnot associated with a reduced uptake of HIV-1 counseling, HIV-1 testing, or nevirapine. Afterreceivingresults,15outof1638women(0.9%)reporteddomesticviolence.After notifyingpartnersofresults,theoddsofHIV-1-seropositivewomenreportingdomestic violence were 4.8 times those of HIV-1-seronegative women (95% CI 1.4–16; P¼0.01). Compared with women, men reported similar or more male-perpetrated domestic violence, suggesting a cultural acceptability of violence. Conclusion DomesticviolencebeforetestingmaylimitpartnerinvolvementinPMTCT. Although infrequent, immediate post-test domestic violence is more common among HIV-1-infected than uninfected women. Domestic violence prevention programmes need to be integrated into PMTCT, particularly for HIV-1-seropositive women.