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Intimate partner violence and condom use among South African adolescents
A.M. Teitelman1, J.B. Jemmott III2, L. Icard3, A. O'Leary4, G.A. Heeren2, Z. Ngwane5, S. J. Ratcliffe2, S. Bellamy2
1University of Pennsylvania, School of Nursing, Philadelphia, 2University of Pennsylvania, Perelman School of Medicine, Philadelphia, 3Temple University, Philadelphia, 4Centers for Disease Control & Prevention, Atlanta,, 5Haverford College, Haverford
.
Council for the Advancement of Nursing Conference
September 2012
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AcknowledgementsSouth African research team members:University of Fort Hare's Centre for Health Promotion Joanne Tyler, PhD� Pretty Ndyebi, MSW� Phelisa Mpulu, BHon� Craig Carty, MSc�Funding:NIMH 1 R01 MH065867 NIMH 1K01MH080649-01A1The Penn Center for AIDS Research AI-
045008
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BackgroundIntimate partner violence (IPV) has
been tied to HIV/STI sexual risks among adolescent and adult women globally
In South Africa, this link is especially important because the prevalence of both HIV and intimate partner violence is high (Jewkes et al., 2002).
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Background (cont’d)
IPV includes physical abuse; sexual coercion, threats, and emotional abuse and each type of IPV may be related to sexual risk
Little is known about gender comparisons of IPV and sexual risk among South African adolescents
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Study PurposeExamine associations between
IPV and condom useMultiple types of IPV were examined: ◦physical◦sexual ◦psychological◦threats◦combined measures of overall IPV
Determine if associations differ by gender
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Methods
Sample:702 sexually experienced adolescents in
Eastern Cape, South Africa ◦Urban township◦Rural settlement
During the 54-month follow-up of an HIV risk-reduction intervention trial
Paper and pencil self-report survey, collected by read aloud procedure
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Methods- Measures
Outcome Measure Proportion of protected sex acts in
prior 3 months
Background Data -Demographic and health information
Age; lives with mother/father Alcohol/drug use Age of first sex, older sexual partner Transactional sex; history of forced sex
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Methods- Measures (cont’d)
Intimate Partner Violence Measure:Total IPV (as victim) (adapted from Wolfe, 2001)
• 22 item scale, • alpha = .92• Comprised of 4 subscales
Physical violence (4 items)Sexual violence (4 items)Threatening behavior (4 items)Psychological/Emotional Abuse (10 items)
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Methods - Data Analysis:
Descriptive statistics: Chi- Square tests were used to compare
frequencies t-tests were used to compare means as
appropriate Lowess plots were used to determine log-
transformations needed to meet model assumptions
Logistic regression: examined associations of condom use with IPV
◦ Total IPV◦ 4 types of IPV
and whether the associations differed by gender
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Results - Descriptive
Background dataN= 702 (50% male; 50% female)Mean age = 16.9 years
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Demographics and Partner Experiences by Gender
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Results - Descriptive
Intimate Partner Violence◦Girls more likely to experience
Physical violence Psychological violence Threats
◦Boys more likely to experience Sexual violence
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Results- Physical Violence by Gender
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Results- Sexual Violence by Gender
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Results- Psychological Abuse by Gender
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Results- Threats by Gender
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Results- Descriptive (con’t)Proportion of protected sex acts in past 3
months
| Percent No 38.99 Yes 61.01
05
1015
Den
sity
0 .2 .4 .6 .8 1COMPUTE PROT7=TMSXCD7 / TMSXS7
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Results – Multivariate analysis
Threats, psychological and overall IPV were not associated with condom use
For both males and females physical IPV was significantly associated with the proportion of protected sex acts
(P= 0.002, P= 0.011 respectively)A gender x physical IPV interaction was significant (P =
0.001), such that females reporting more IPV were less likely to use condoms and males reporting more IPV were more likely to use condoms.
Males reporting more sexual IPV were less likely to use condoms (P=0.009)
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Multiple regressionOdds of Having Protected Sex in Past 3 months
Correlate
Males Only Females Only
Gender x
Correlate
Interaction
Odds Ratio
95% CI p-value
Odds
Ratio
95% CI p-value
p-value
Physical abuse
1.99 1.08, 3.68 0.028 0.65 0.47, 0.91 0.011 0.002
Sexual abuse
0.72 0.56, 0.92 0.009 0.84 0.66, 1.07 0.156 0.355
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Results Gender by Physical IPV Interaction
.2.4
.6.8
1P
r(P
rot7
_1
00
)
.01 .51 1.01 1.51 2.01 2.51 3.01 3.51 4.01 4.51Physical_AbuseVictimMEANS
Male Female
Highly significant (p<0.001) interaction of effect by gender.
For males: > physical
abuse MORE condom
use
For females: physical
abuseLESS condom
use
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Conclusion
For females, physical IPV may increase sexual risk through condom non-use
For males, physical IPV may occasion greater condom use, but sexual IPV may increase sexual risk through condom non-use These findings highlight the importance of addressing
multiple types of IPV in HIV prevention interventions for both males and females and tailoring by gender.
Sexual risk consequences of IPV may differ by gender among adolescents in this region of South Africa.