Intimate Partner Violence among HIV-seropositive and HIV-seronegative Pregnant Women Receiving Partner Services in Kisumu, Kenya: Correlates and Incidence during Postpartum

Introduction: Intimate partner violence (IPV) is the most common form of violence amongst women. IPV experienced during pregnancy can expose women and their babies to fatal and non-fatal adverse outcomes. This study assessed socio-demographic factors associated with current or past intimate partner violence to better identify women who are at risk or those currently experiencing IPV. Methods: We evaluated the prevalence, incidence and correlates of lifetime IPV and IPV in the past 6 months and past month in pregnant women seeking antenatal care at the Kisumu County Hospital in Kisumu, Kenya. This study is a nested analysis within the Home-based Partner Education and Testing (HOPE) Study, which was a randomized trial with the aim of increasing the uptake of interventions to improve maternal and child health and reduce vertical and heterosexual HIV transmission. We conducted both a nested cross-sectional and cohort analysis, using data from standardized questionnaires to assess participant self-reported IPV by their current partner at baseline and at 6-months postpartum where women were asked about IPV that had happened after the baseline visit. A woman was classified as having experienced IPV if she reported that her husband/partner had physically hurt her or forced her to participate in sexual activities that made her feel uncomfortable. Associations between baseline IPV, incident IPV and the correlates were assessed using univariate and multivariate logistics regressions. Results: Overall, among 1101 women screened, 929 (84%) reported never having experienced IPV; 73 (7%) reported having experienced IPV at least once in their lifetime, but not in the past 6 months (Lifetime IPV); 45 (4%) reported IPV in the past 6 months, but not in the past month (6 month IPV); and 54 (5%) reported IPV in the past month (1 month IPV). Women who reported IPV in the past month were found to have a higher gravidity, reported more lifetime sexual partners, were more likely to be in a polygamous marriage, and were less likely to have completed secondary school or higher, had higher incomes, and were more likely to report having been threatened or frightened by their current partner. When assessing incident IPV we found that women who reported IPV in the past 6 months at baseline were at 4-fold higher risk of experiencing IPV in the 6-month post-partum period (OR=4.39; 95% CI: 1.61, 11.99). This association remained after adjustment for lifetime sexual partners, marital status, educational level, and being threatened or frightened by current partner (OR= 3.89; 95% CI:1.34-11.28; p = 0.01). A prior primary paper of the HOPE study found that home-based partner testing was not associated with IPV. Conclusions: Women who self-reported experiencing IPV within the past 6 months at their antenatal visit were at a 4-fold greater risk of incident IPV in the late antepartum and postpartum periods. Screening for recent IPV may be an effective means of identifying women at risk of IPV in the near future following an antenatal visit. It may be possible to target efforts to prevent IPV on these women. Further studies focused on assessing the incidence of IPV among pregnant women need to be conducted making sure to collect sociodemographic factors about the partner as these are very important in assessing the correlates of intimate partner violence.