Tia Palermo

Estimates and Determinants of Sexual Violence Against Women in the Democratic Republic of Congo

OBJECTIVES We sought to provide data-based estimates of sexual violence in the Democratic Republic of Congo (DRC) and describe risk factors for such violence. METHODS We used nationally representative household survey data from 3436 women selected to answer the domestic violence module who took part in the 2007 DRC Demographic and Health Survey along with population estimates to estimate levels of sexual violence. We used multivariate logistic regression to analyze correlates of sexual violence. RESULTS Approximately 1.69 to 1.80 million women reported having been raped in their lifetime (with 407 397-433 785 women reporting having been raped in the preceding 12 months), and approximately 3.07 to 3.37 million women reported experiencing intimate partner sexual violence. Reports of sexual violence were largely independent of individual-level background factors. However, compared with women in Kinshasa, women in Nord-Kivu were significantly more likely to report all types of sexual violence. CONCLUSIONS Not only is sexual violence more generalized than previously thought, but our findings suggest that future policies and programs should focus on abuse within families and eliminate the acceptance of and impunity surrounding sexual violence nationwide while also maintaining and enhancing efforts to stop militias from perpetrating rape.

Tip of the Iceberg: Reporting and Gender-Based Violence in Developing Countries

Gender-based violence (GBV) is widespread globally and has myriad adverse health effects but is vastly underreported. Few studies address the extent of reporting bias in existing estimates. We provide bounds for underestimation of reporting of GBV to formal and informal sources conditional on having experienced GBV and characterize differences between women who report and those who do not. We analyzed Demographic and Health Survey data from 284,281 women in 24 countries collected between 2004 and 2011. We performed descriptive analysis and multivariate logistic regressions examining characteristics associated with reporting to formal sources. Forty percent of women experiencing GBV previously disclosed to someone; however, only 7% reported to a formal source (regional variation, 2% in India and East Asia to 14% in Latin America and the Caribbean). Formerly married and never married status, urban residence, and increasing age were characteristics associated with increased likelihood of formal reporting. Our results imply that estimates of GBV prevalence based on health systems data or on police reports may underestimate the total prevalence of GBV, ranging from 11- to 128-fold, depending on the region and type of reporting. In addition, women who report GBV differ from those who do not, with implications for program targeting and design of interventions.

Seroprevalence of Epstein-Barr virus infection in U.S. children ages 6-19, 2003-2010.

Background Epstein-Barr virus (EBV) is a common herpesvirus linked to infectious mononucleosis and multiple cancers. There are no national estimates of EBV seroprevalence in the United States. Our objective was to estimate the overall prevalence and sociodemographic predictors of EBV among U.S. children and adolescents aged 6–19. Methods We calculated prevalence estimates and prevalence ratios for EBV seroprevalence using data from the 2003–2010 U.S. National Health and Nutrition Examination Survey (NHANES) for children aged 6–19 (n = 8417). Poisson regression was used to calculate multivariable-adjusted prevalence ratios across subgroup categories (sex, race/ethnicity, parental education, household income, household size, foreign-born, BMI, and household smoking). Findings Overall EBV seroprevalence was 66.5% (95% CI 64.3%–68.7%.). Seroprevalence increased with age, ranging from 54.1% (95% CI 50.2%–57.9%) for 6–8 year olds to 82.9% (95% CI 80.0%–85.9%) for 18–19 year olds. Females had slightly higher seroprevalence (68.9%, 95% CI 66.3%–71.6%) compared to males (64.2%, 95% CI 61.7%–66.8%). Seroprevalence was substantially higher for Mexican-Americans (85.4%, 95% CI 83.1%–87.8%) and Non-Hispanic Blacks (83.1%, 95% CI 81.1%–85.1%) than Non-Hispanic Whites (56.9%, 95% CI 54.1%–59.8%). Large differences were also seen by family income, with children in the lowest income quartile having 81.0% (95% CI 77.6%–84.5%) seroprevalence compared to 53.9% (95% CI 50.5%–57.3%) in the highest income quartile, with similar results for parental education level. These results were not explained by household size, BMI, or parental smoking. Among those who were seropositive, EBV antibody titers were significantly higher for females, Non-Hispanic Blacks and Mexican-Americans, with no association found for socioeconomic factors. Conclusions In the first nationally representative U.S. estimates, we found substantial socioeconomic and race/ethnic differences in the seroprevalence of EBV across all ages for U.S. children and adolescents. These estimates can help researchers and clinicians identify groups most at risk, inform research on EBV-cancer etiology, and motivate potential vaccine development.

Food access and diet quality are associated with quality of life outcomes among HIV-infected individuals in Uganda.

Background Food insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with HIV/AIDS. Objective We investigated whether household food access and individual dietary diversity are associated with health-related quality of life among people living with HIV/AIDS in Uganda. Methods We surveyed 902 people living with HIV/AIDS and their households from two clinics in Northern Uganda. Health-related quality of life outcomes were assessed using the Medical Outcomes Study (MOS)-HIV Survey. We performed multivariate regressions to investigate the relationship between health-related quality of life, household food insecurity and individual dietary diversity. Results People living with HIV/AIDS from severe food insecurity households have mean mental health status scores that are 1.7 points lower (p<.001) and physical health status scores that are 1.5 points lower (p<.01). Individuals with high dietary diversity have mean mental health status scores that were 3.6 points higher (p<.001) and physical health status scores that were 2.8 points higher (p<.05). Conclusions Food access and diet quality are associated with health-related quality of life and may be considered as part of comprehensive interventions designed to mitigate psychosocial consequences of HIV.

Family poverty is associated with cytomegalovirus antibody titers in U.S. children.

OBJECTIVE Early life environmental and psychological influences are thought to play an important role in the development of the immune system. Antibody response to latent herpesviruses has been used as an indirect measure of cell-mediated immune function but has seldom been applied to younger age groups. METHODS We used data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) to test for an association between family poverty and continuous antibody response to cytomegalovirus in U.S. children aged 6-16 (N = 2,226) using ordinary least squares regression. RESULTS Poverty was significantly associated with increased antibody levels among seropositive individuals. The association between income and antibody levels exhibited a threshold effect, with additional income beyond the poverty line not associated with increased antibody titers. This relationship was more robust among older compared with younger children. CONCLUSIONS Early life social factors such as family poverty could have detrimental impacts on the developing immune system, with potentially important consequences for later life health outcomes. Exposure to socioeconomic stressors for longer periods during childhood may further enhance alterations in immune response to cytomegalovirus.

Assessing the "orphan effect" in determining development outcomes for children in 11 eastern and southern African countries.

There are more than 45 million orphaned children in sub-Saharan Africa, 11.4 million because of AIDS – representing approximately 80% of all such orphans worldwide. Programming for orphans is therefore a major policy issue. This article uses the latest publicly available Demographic Health Survey data from 11 eastern and southern African countries to provide a snapshot of the distribution and demographic characteristics of orphans, and to test whether orphans have worse outcomes along a series of socioeconomic outcomes. While the analysis is primarily descriptive, multivariate analysis is undertaken to determine whether orphan/non-orphan differences persist after controlling for age, region of residence and household wealth. Results show, among other things, that while orphan prevalence is higher in urban areas, the majority of orphans live in rural areas. Furthermore, while urban orphans appear to be more vulnerable than their urban peers the most vulnerable children in the region are, in fact, living in rural areas. Multivariate regression analysis also revealed that after controlling for other cofounders, orphan status per se is not the most important negative determinant of childrens wellbeing. Gender and region of residence are much more important predictors of poor schooling outcomes, and for all outcomes household wealth is the single most important correlate of better outcomes, with the threshold falling typically between the second and third quintiles. While orphanhood is clearly one important dimension of child vulnerability, other factors are not only important but in some cases have a much stronger quantitative association with child development (e.g. household poverty). Overall social policy as well as the targeting of specific interventions should recognize this fact, and approach child development in a holistic and integrated manner; for example combining specific orphan services such as psychosocial support within broader poverty alleviation and social protection programming such as social cash transfers, school bursaries and health service fee waivers.

Abuse during pregnancy in Mexico City

Objective: Measure the prevalence of physical and sexual abuse during pregnancy, determine the nature and severity of abuse, and assess correlates with abuse. Method: A total of 1314 women seeking prenatal care between July 2000 and January 2003 were approached at three public hospitals in Mexico City. An original composite case record form was created to measure physical and sexual abuse before and during pregnancy. Result: Forty‐one percent of respondents had a history of physical or sexual abuse, with current abuse reported by 11.1%, and abuse during pregnancy by 7.6%. Among abused women, 71% reported an increase in the severity of abuse since becoming pregnant. Logistic regression revealed physically fighting with a partner and a history of abuse best predict violence during pregnancy. Conclusion: The severity of abuse among abused women appears to increase during pregnancy. Prenatal care visits in Mexico are an important opportunity for violence screening and intervention.

Association between breast cancer and allostatic load by race: National Health and Nutrition Examination Survey 1999–2008

Breast cancer and its treatment introduce numerous physiologic, psychological, social, and economic stressors to a woman with the diagnosis. Allostatic load, a composite score of biomarkers representing physiologic dysregulation, may serve as a measure of the biological burden of breast cancer. This study investigates the association between breast cancer and allostatic load scores by comparing allostatic load scores in those with a history of breast cancer to those without, stratified by race.

A review of global access to emergency contraception

Emergency contraception has been known for several decades, and dedicated products have been on the market for close to 20 years. Yet it is unclear whether women, particularly in low‐resource countries, have access to this important second‐chance method of contraception.

Age and intimate partner violence: an analysis of global trends among women experiencing victimization in 30 developing countries

PURPOSE Young women are at elevated risk of violence victimization, yet generalizable evidence on age at which abuse first occurs is lacking. This analysis provides new descriptive evidence on age and duration into partnership of womens first intimate partner violence (IPV) victimization. METHODS Data come from ever married women ages of 15-49 years in nationally representative Demographic and Health Surveys in 30 countries collected from 2005 to 2014 in Africa, Asia, Eastern Europe, and Latin America and the Caribbean. Descriptive analysis is performed. RESULTS Approximately 29.0% (95% confidence interval [CI]: 28.8, 29.3) of women reported any physical or sexual IPV. Among ever married women who first experienced violence post-union, abuse began, on average, 3.5 years (95% CI 3.4, 3.5), after union formation. Approximately 38.5% (95% CI 37.9, 39.0) and 67.5% (95% CI 67.0, 68.1) of those ever experiencing abuse did so within 1 year and 3 years, respectively, of union formation. Regionally, average years into union of abuse initiation showed little variation and average age at first abuse among once married women is 22.1 years. CONCLUSIONS Results imply that primary prevention for IPV must take place on average before first union before age 19 years, to capture the most relevant and at risk target population. Resources allocated toward risk factors in childhood and adolescence may be most effective in combating initiation of IPV globally. Despite this finding, there remains a lack of evidence on effective interventions for primary prevention of abuse during womens early years in developing settings.