Michele R. Decker

Pregnancy coercion, intimate partner violence and unintended pregnancy ☆

BACKGROUNDnReproductive control including pregnancy coercion (coercion by male partners to become pregnant) and birth control sabotage (partner interference with contraception) may be associated with partner violence and risk for unintended pregnancy among young adult females utilizing family planning clinic services.nnnSTUDY DESIGNnA cross-sectional survey was administered to females ages 16-29 years seeking care in five family planning clinics in Northern California (N=1278).nnnRESULTSnFifty-three percent of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. Both pregnancy coercion and birth control sabotage were associated with unintended pregnancy (AOR 1.83, 95% CI 1.36-2.46, and AOR 1.58, 95% CI 1.14-2.20, respectively). In analyses stratified by partner violence exposure, associations of reproductive control with unintended pregnancy persisted only among women with a history of partner violence.nnnCONCLUSIONSnPregnancy coercion and birth control sabotage are common among young women utilizing family planning clinics, and in the context of partner violence, are associated with increased risk for unintended pregnancy.

Masculine Gender Roles Associated with Increased Sexual Risk and Intimate Partner Violence Perpetration among Young Adult Men

This study sought to assess the association between traditional masculine gender role ideologies and sexual risk and intimate partner violence (IPV) perpetration behaviors in young mens heterosexual relationships. Sexually active men age 18–35xa0years attending an urban community health center in Boston were invited to join a study on mens sexual risk; participants (N=307) completed a brief self-administered survey on sexual risk (unprotected sex, forced unprotected sex, multiple sex partners) and IPV perpetration (physical, sexual and injury from/need for medical services due to IPV) behaviors, as well as demographics. Current analyses included men reporting sex with a main female partner in the past 3xa0months (n=283). Logistic regression analyses adjusted for demographics were used to assess significant associations between male gender role ideologies and the sexual risk and IPV perpetration behaviors. Participants were predominantly Hispanic (74.9%) and Black (21.9%); 55.5% were not born in the continental U.S.; 65% had been in the relationship for more than 1xa0year. Men reporting more traditional ideologies were significantly more likely to report unprotected vaginal sex in the past 3xa0months (ORadj = 2.3, 95% CI = 1.2–4.6) and IPV perpetration in the past year (ORadj = 2.1, 95% CI = 1.2–3.6). Findings indicate that masculine gender role ideologies are linked with young mens unprotected vaginal sex and IPV perpetration in relationships, suggesting that such ideologies may be a useful point of sexual risk reduction and IPV prevention intervention with this population.

Intimate Partner Violence and HIV Infection Among Married Indian Women

CONTEXTnDespite reductions in prevalence of human immunodeficiency virus (HIV) infection among the general population of India, women account for a rising percentage of all HIV cases with husbands risk behavior described as the major source of womens infection. Intimate partner violence (IPV) has been described as being associated with heterosexual transmission of HIV to women in India and elsewhere.nnnOBJECTIVEnTo assess the relationship between experiencing IPV and the occurrence of HIV infection in a nationally representative sample of married Indian women tested for HIV.nnnDESIGN, SETTING, AND PARTICIPANTSnThe Indian National Family Health Survey 3 was conducted across all Indian states in 2005 through 2006. The nationally representative sample included 124,385 married women; analyses conducted in 2007 and 2008 were limited to 28,139 married women who provided IPV data and HIV test results via systematic selection into respective subsamples.nnnMAIN OUTCOME MEASURESnPrevalence estimates of lifetime IPV and HIV infection were calculated and demographic differences assessed. Intimate partner violence was conceptualized as physical violence with or without sexual violence and then was further categorized as physical violence only vs physical and sexual violence. Regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for HIV infection among Indian women based on experiences of IPV after adjusting for demographics and womens HIV risk behaviors.nnnRESULTSnOne-third of married Indian women (35.49%) reported experiencing physical IPV with or without sexual violence from their husbands; 7.68% reported both physical and sexual IPV, and 27.80% reported experiencing physical IPV in the absence of sexual violence. Approximately 1 in 450 women (0.22%) tested positive for HIV. In adjusted models, married Indian women experiencing both physical and sexual violence from husbands demonstrated elevated HIV infection prevalence vs those not experiencing IPV (0.73% vs 0.19%; adjusted OR, 3.92; 95% CI, 1.41-10.94; P = .01). Physical IPV alone was not associated with risk of HIV infection. Womens personal sexual risk behaviors were not associated with HIV infection.nnnCONCLUSIONSnAmong married Indian women, physical violence combined with sexual violence from husbands was associated with an increased prevalence of HIV infection. Prevention of IPV may augment efforts to reduce the spread of HIV/AIDS.

Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women

Objectiveu2002 To estimate (1) lifetime prevalence of physical and sexual victimisation from husbands among a national sample of Bangladeshi women, (2) associations of unwanted pregnancy and experiences of husband violence, and (3) associations of miscarriage, induced abortion, and fetal death/stillbirth and such victimisation.

Intimate Partner Violence Functions as both a Risk Marker and Risk Factor for Women’s HIV Infection: Findings from Indian Husband-Wife Dyads

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 mens 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 mens sexual risk and IPV perpetration.

Dating Violence and Sexually Transmitted Disease/HIV Testing and Diagnosis Among Adolescent Females

Objective.Previous studies demonstrate significant associations between dating-violence victimization and sexual risk behaviors among adolescent girls; however, a relationship between dating violence and actual sexually transmitted disease (STD)/HIV testing and diagnosis has yet to be investigated among a representative sample. The present study assesses associations between dating violence and STD/HIV testing and diagnosis among a representative sample of sexually active adolescent girls. Methods.Data from 9th- to 12th-grade female students completing the 1999 and 2001 Massachusetts Youth Risk Behavior Surveys and reporting having ever had sexual intercourse (N = 1641) were examined. Odds ratios for STD/HIV testing and diagnosis that were based on experiences of dating violence and adjusted for STD/HIV risk behaviors and demographics were calculated. Results.More than one third (38.8%) of adolescent girls tested for STD or HIV and more than half (51.6%) of girls diagnosed with STD/HIV reported experiencing dating violence. Compared with nonabused girls, girls who experienced both physical and sexual dating violence were 3.0 times more likely to have been tested for STD and HIV, and 2.6 times more likely to report an STD diagnosis. Conclusions.After adjusting for STD/HIV risk behaviors, dating violence remains significantly associated with STD/HIV testing and diagnosis among sexually active adolescent girls.

Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men

Objective: To assess the relationship between men’s reported violence against wives and their sexual risk behaviours and sexual health. Design, setting and participants: Cross-sectional analyses of a survey of a nationally representative household-based sample of married men in Bangladesh (nu200a=u200a3096). Main outcome measure(s): Physical and sexual violence against wives during the previous 12 months was assessed and examined for relations to men’s extramarital sexual behaviours and sexually transmitted infection (STI) symptoms or diagnosis during this same period, as well as to men’s disclosure of such infection to wives and condom use while infected. Results: More than 1 in 3 (36.84%) married Bangladeshi men reported physically and/or sexually abusing their wives in the past year. Men perpetrating such violence were more likely to report both premarital and extramarital sex partners (ORadjs 1.80–3.45; 95% CI 1.20 to 8.23); those reporting physical violence were more likely to report STI symptoms or diagnosis in the past year (ORadjs 1.68–2.52; 95% CI 1.24 to 3.73). Men perpetrating physical violence and contracting an STI were somewhat more likely to fail to disclose infection status to wives (ORadj 1.58; 95% CI 0.93 to 2.70) than infected men not reporting such abuse. Conclusions: Violence against wives is common among Bangladeshi men. Men who perpetrate such abuse represent increased risk regarding their wives’ sexual health because they are more likely to both participate in extramarital sexual behaviour and contract an STI compared with non-abusive husbands. Given the growing epidemic of HIV infection among monogamous South Asian women based on intercourse with infected non-monogamous husbands, research and intervention regarding men’s violence in marriage and implications of such behaviour for women’s sexual health should be prioritised.

The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124u2009385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19u2009302 births to 13u2009396 mothers). Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg). Results The majority of births (73%; 13u2009042/19u2009302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India.

HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India.

Objective:Despite the rapid spread of Indias HIV epidemic through commercial sex and the large numbers of minor girls trafficked to India for sex work each year, little HIV research has been conducted among victims of sex trafficking. The present study examines the prevalence and predictors of HIV infection among sex-trafficked women and girls rescued from brothels in Mumbai, India. Design and Methods:Case records and HIV testing results of sex-trafficked women and girls (N = 175) were reviewed. HIV prevalence and HIV risk were assessed based on demographics and exposure to sex work. Results:Approximately one quarter (22.9%) of trafficked individuals tested positive for HIV. The mean age at trafficking was marginally younger for women and girls infected with HIV (15.9 years) as compared to those not infected (17.2 years; P = 0.06). Girls trafficked as minors reported longer periods of brothel confinement as compared to those trafficked at older ages (18.5 vs. 9.6 months; P = 0.007). Among Indian victims, those trafficked from the states of Karnataka or Maharashtra were more likely than those trafficked from West Bengal to be HIV-positive (odds ratio [OR] = 7.35, 95% confidence interval [CI]: 2.23 to 24.21). Longer duration in brothels was associated with greater likelihood of HIV infection; a 3% to 4% increased risk for HIV was observed for each additional month of brothel captivity. Conclusions:Findings demonstrate the need for increased attention to HIV among young victims of sex trafficking in research and practice and to the rescue of sex trafficking victims as a form of HIV prevention.

Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand

Background The trafficking of women and girls for sexual exploitation is an internationally recognised form of gender-based violence, and is thought to confer unique sexual and reproductive health vulnerabilities. To date, little research has compared sexual risk or health outcomes among female sex workers (FSWs) on the basis of experiences of sex trafficking. Aim To compare experiences of sexual risk and sexual and reproductive health outcomes among FSWs on the basis of experiences of trafficking as an entry mechanism to sex work. Methods Data from a national sample of FSWs in Thailand (n=815) was used to assess (a) the prevalence of sex trafficking as an entry mechanism into sex work and (b) associations of sex trafficking with sexual risk and health outcomes. Results Approximately 10% of FSWs met criteria for trafficking as an entry mechanism to sex work. Compared with their non-trafficked counterparts, sex-trafficked FSWs were more likely to have experienced sexual violence at initiation to sex work (adjusted risk ratio (ARR) 2.29, 95% CI 1.11 to 4.72), recent workplace violence or mistreatment (ARR 1.38, 95% CI 1.13 to 1.67), recent condom failure (ARR 1.80, 95% CI 1.15 to 2.80), condom non-use (ARR 3.35, 95% CI 1.49 to 7.52) and abortion (ARR 2.83, 95% CI 1.48 to 5.39). Discussion Both the prevalence of sex trafficking as an entry mechanism to sex work and the threats to sexual and reproductive health observed on the basis of trafficking status show the need for comprehensive efforts to identify and support this vulnerable population. Moreover, existing STI/HIV-prevention programming may be stymied by the limited condom-use capacity and high levels of violence observed among those trafficked into sex work.