Jhumka Gupta

The context of economic insecurity and its relation to violence and risk factors for HIV among female sex workers in Andhra Pradesh, India.

Objective. We examined the context of economic insecurity and debt among female sex workers (FSWs), how this context varies among FSWs, and its association with experiences of violence and sexual risk factors for human immunodeficiency virus (HIV). Methods. We recruited FSWs aged ≥18 years (n=673) through respondent-driven sampling for a survey on HIV risk in this region. Using logistic regression models (adjusted for partner status, education, financial support, and literacy), we assessed the relation between debt and sexual and physical victimization as well as sexual risk. We also conducted qualitative interviews with a subsample of the survey participants and examined these for related themes. Results. In adjusted logistic regression models, FSWs who reported debt were more likely to report the following: recent physical violence (adjusted odds ratio [AOR] = 2.4, 95% confidence interval [CI] 1.5, 3.9), unprotected sex with occasional clients in the past week (AOR=2.3, 95% CI 1.2, 4.3), anal sex with clients in the past 30 days (AOR=2.0, 95% CI 1.1, 3.9), and at least one sexually transmitted infection symptom in the past six months (AOR=1.6, 95% CI 1.1, 2.4). FSWs with debt were more likely to report current husbands or other male partners, and less likely to report condom use with these partners, further increasing their sexual risk. Qualitative data elaborated on these findings. Conclusion. Findings indicate the violence- and HIV-related vulnerability of FSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of FSWs.

Victims of Intimate Partner Violence More Likely to Report Abuse From In-Laws:

The current study of South Asians in the United States was designed to assess quantitatively the association between intimate partner violence (IPV) and emotional abuse by in-laws (n = 169) and to qualitatively identify via in-depth interviews with battered women (n = 23) forms of abuse perpetrated by in-laws. Quantitative findings demonstrate a significant relationship between IPV and abuse from in-laws (odds ratio = 5.7, 95% confidence interval = 1.5-21.5). Qualitative data demonstrate that abuse by in-laws includes emotional abuse (e.g., isolation, social and economic control, and domestic servitude), awareness or support of IPV, and direct physical abuse. Domestic violence interventions with South Asian women must consider abuse from in-laws and IPV experiences.

Intimate partner violence perpetration, standard and gendered STI/HIV risk behaviour, and STI/HIV diagnosis among a clinic-based sample of men

Background: The estimated one in three women worldwide victimised by intimate partner violence (IPV) consistently demonstrate elevated STI/HIV prevalence, with their abusive male partners’ risky sexual behaviours and subsequent infection increasingly implicated. To date, little empirical data exist to characterise the nature of men’s sexual risk as it relates to both their violence perpetration, and STI/HIV infection. Methods: Data from a cross-sectional survey of men ages 18–35 recruited from three community-based health clinics in an urban metropolitan area of the northeastern US (n = 1585) were analysed to estimate the prevalence of IPV perpetration and associations of such violent behaviour with both standard (eg, anal sex, injection drug use) and gendered (eg, coercive condom practices, sexual infidelity, transactional sex with a female partner) forms of sexual-risk behaviour, and self-reported STI/HIV diagnosis. Results: Approximately one-third of participants (32.7%) reported perpetrating physical or sexual violence against a female intimate partner in their lifetime; one in eight (12.4%) participants self-reported a history of STI/HIV diagnosis. Men’s IPV perpetration was associated with both standard and gendered STI/HIV risk behaviours, and to STI/HIV diagnosis (OR 4.85, 95% CI 3.54 to 6.66). The association of men’s IPV perpetration with STI/HIV diagnosis was partially attenuated (adjusted odds ratio (AOR) 2.55, 95% CI 1.77 to 3.67) in the multivariate model, and a subset of gendered sexual-risk behaviours were found to be independently associated with STI/HIV diagnosis—for example, coercive condom practices (AOR 1.67, 95% CI 1.04 to 2.69), sexual infidelity (AOR 2.46, 95% CI 1.65 to 3.68), and transactional sex with a female partner (AOR 2.03, 95% CI 1.36 to 3.04). Conclusions: Men’s perpetration of physical and sexual violence against intimate partners is common among this population. Abusive men are at increased risk for STI/HIV, with gendered forms of sexual-risk behaviour partially responsible for this association. Thus, such men likely pose an elevated infection risk to their female partners. Findings indicate the need for interwoven sexual health promotion and violence prevention efforts targeted to men; critical to such efforts may be reduction in gendered sexual-risk behaviours and modification of norms of masculinity that likely promote both sexual risk and violence

Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d’Ivoire: a randomized controlled pilot study

BackgroundGender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding “gender dialogue groups” to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Côte d’Ivoire.MethodsBetween 2010 and 2012, we conducted a two-armed, non-blinded randomized-controlled trial (RCT) comparing group savings only (control) to “gender dialogue groups” added to group savings (treatment). The gender dialogue group consisted of eight sessions that targeted women and their male partner. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate. 934 out of 981 (95.2%) partnered women completed baseline and endline data collection. The primary trial outcome measure was an overall measure of past-year physical and/or sexual IPV. Past year physical IPV, sexual IPV, and economic abuse were also separately assessed, as were attitudes towards justification of wife beating and a woman’s ability to refuse sex with her husband.ResultsIntent to treat analyses revealed that compared to groups savings alone, the addition of gender dialogue groups resulted in a slightly lower odds of reporting past year physical and/or sexual IPV (OR: 0.92; 95% CI: 0.58, 1.47; not statistically significant). Reductions in reporting of physical IPV and sexual IPV were also observed (not statistically significant). Women in the treatment group were significantly less likely to report economic abuse than control group counterparts (OR = 0.39; 95% CI: 0.25, 0.60, p < .0001). Acceptance of wife beating was significantly reduced among the treatment group (β = -0.97; 95% CI: -1.67, -0.28, p = 0.006), while attitudes towards refusal of sex did not significantly change Per protocol analysis suggests that compared to control women, treatment women attending more than 75% of intervention sessions with their male partner were less likely to report physical IPV (a OR: 0.45; 95% CI: 0.21, 0.94; p = .04) and report fewer justifications for wife beating (adjusted β = -1.14; 95% CI: -2.01, -0.28, p = 0.01) ; and both low and high adherent women reported significantly decreased economic abuse (a OR: 0.31; 95% CI: 0.18, 0.52, p < 0.0001; a OR: 0.47; 95% CI: 0.27, 0.81, p = 01, respectively). No significant reductions were observed for physical and/or sexual IPV, or sexual IPV alone.ConclusionsResults from this pilot RCT suggest the importance of addressing household gender inequities alongside economic programming, because this type of combined intervention has potential to reduce levels of IPV. Additional large-scale intervention research is needed to replicate these findings.Trial registrationRegistration Number: NCT01629472.

HIV vulnerabilities of sex-trafficked Indian women and girls

To qualitatively explore potential mechanisms that may confer heightened risk for HIV infection among survivors of sex trafficking in India.

Physical violence against intimate partners and related exposures to violence among South African men

Background: Despite high rates of intimate partner violence in South Africa, there have been no national studies of mens perpetration of violence against female partners. Methods: We analyzed data from the South Africa Stress and Health Study, a cross-sectional, nationally representative study, specifically examining data for men who had ever been married or had ever cohabited with a female partner. We calculated the prevalence of physical violence against intimate female partners and used logistic regression to examine associations with physical abuse during childhood and exposure to parental and community violence. Results: A total of 834 male participants in the South Africa Stress and Health Study met the study criteria. Of these, 27.5% reported using physical violence against their current or most recent female partner during their current or most recent marriage or cohabiting relationship. Crude odds ratios (ORs) and 95% confidence intervals (CIs) indicated significant associations between perpetration of violence against an intimate partner and witnessing parental violence (OR 3.91, 95% CI 2.66–5.73) or experiencing physical abuse during childhood (OR 3.24, 95% CI 2.27–4.63), but not exposure to community violence (OR 1.29, 95% CI 0.88–1.88). The 2 significant associations persisted in adjusted analyses: OR 3.22 (95% CI 1.94–5.33) for witnessing parental violence and OR 1.73 (95% CI 1.07–2.79) for experiencing physical abuse during childhood. Interpretation: We found a high prevalence of physical violence perpetrated by men against their intimate partners. Men who experienced physical abuse during childhood or were exposed to parental violence were at the greatest risk.

Male Perpetration of Intimate Partner Violence and Involvement in Abortions and Abortion-Related Conflict

Men aged 18 to 35 years (n = 1318) completed assessments of perpetration of intimate partner violence (IPV), abortion involvement, and conflict regarding decisions to seek abortion. IPV was associated with greater involvement by men in pregnancies ending in abortion and greater conflict regarding decisions to seek abortion. IPV should be considered within family planning and abortion services; policies requiring women to notify or obtain consent of partners before seeking an abortion should be reconsidered; they may facilitate endangerment and coercion regarding such decisions.

The role of housing in determining HIV risk among female sex workers in Andhra Pradesh, India: Considering women’s life contexts

Recent research on HIV prevention, regardless of the population, has increasingly recognized the relevance of contextual factors in determining HIV risk. Investigating such factors among female sex workers (FSW) is especially relevant in the South Indian state of Andhra Pradesh, where HIV rates are among the highest across Indian states and where HIV has largely affected FSW. Stable housing is a particular contextual challenge experienced by female sex workers in this region (as well as elsewhere); however, local studies have not examined the impact of this issue on HIV risk. In this paper, we examine residential instability, defined as a high frequency of reported evictions, among FSW and relation to experiences of violence (as a factor increasing risk for HIV) and sexual risk factors for HIV. Women were recruited through respondent-driven sampling for a survey on HIV risk. Using logistic regression models, we assessed: (1) residential instability and association with HIV sexual risk variables (including unprotected sex, reported STIs, and recent physical and sexual victimization) and (2) whether the association between residential instability and reported STI (as an indicator of HIV risk) was attenuated by individual risk behaviors and violence. In adjusted logistic regression models, FSW who reported residential instability were more likely to report: sexual violence, physical violence, accepting more money for unprotected sex, and a recent STI symptom. Violence associated with residential instability contributed to reported STIs; however, residential instability remained significantly associated with STIs beyond the influence of both violence and unprotected sex with clients. Findings highlight the interrelation among residential instability, violence, and HIV risk. Residential instability appears to be associated with womens HIV risk, above and beyond its association with individual risky sexual behaviors.

Assessment of reproductive health and violence against women among displaced Syrians in Lebanon

BackgroundThe current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population.MethodsWe conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes.ResultsWe interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.ConclusionsThis study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

School bullying perpetration and other childhood risk factors as predictors of adult intimate partner violence perpetration

OBJECTIVE To assess the relationship between bullying peers as a child and adult intimate partner violence perpetration in a clinic-based sample of adult men. School bullying perpetration and intimate partner violence perpetration are both thought to stem from desire for power and control over others. DESIGN A cross-sectional survey was conducted between January 2005 and December 2006. SETTING Three urban community health centers in Boston, Massachusetts. PARTICIPANTS Men aged 18 to 35 years (n = 1491) seeking services at participating community health centers. MAIN EXPOSURE School bullying perpetration. OUTCOME MEASURE Past-year physical or sexual violence perpetration against a female partner (intimate-partner violence [IPV]). RESULTS Two-fifths of men reported perpetrating school bullying as a child (n = 610; 40.9%). Men who rarely bullied in school were 1.53 times more likely to perpetrate past-year IPV than men who did not bully (95% confidence interval [CI], 1.02-2.29); this risk was elevated to 3.82 times more likely to perpetrate any past-year IPV for those men who bullied peers frequently (95% CI, 2.55-5.73). CONCLUSIONS The present study indicates that bullying peers in school as a child, especially frequent bullying perpetration, is associated with increased risk for mens perpetration of IPV as an adult. The effect remains strong after controlling for common prior risk factors for both bullying and IPV perpetration. Future research is needed to discern the mechanisms and underlying root causes of abusive behavior, such as power and control, as a means to prevent violence perpetration across settings and life stages.