Intimate partner violence among HIV index case testing clients in Malawi, a mixed-methods study

Area of Science:

• Public Health
• Epidemiology
• HIV/AIDS Research

Background:

• Intimate partner violence (IPV) is a significant public health issue, particularly in sub-Saharan Africa.
• Routine index case testing (ICT) services for HIV in Malawi have low rates of IPV reporting.
• Understanding the prevalence and barriers to reporting IPV among people with HIV (PWH) is critical.

Purpose of the Study:

• To determine the occurrence of IPV among PWH accessing ICT services in Malawi.
• To explore the reasons behind the underreporting of IPV by PWH to healthcare workers (HCWs).

Main Methods:

• Retrospective study of PWH aged ≥18 years who received ICT services within 6 months.
• Utilized the World Health Organization tool to assess IPV (physical, sexual, emotional abuse, controlling behaviors) in the past 12 months.
• Conducted in-depth interviews (IDIs) with a subset of PWH who experienced IPV and with HCWs providing ICT services to understand reporting barriers.

Main Results:

• Overall IPV prevalence was 71.1% among 149 enrolled PWH, with higher rates in females (76.6%) than males (57.1%).
• Controlling behavior was the most common form of IPV (65.7%), followed by emotional (33.6%), physical (24.8%), and sexual abuse (20.8%).
• Only 13.3% of PWH who experienced IPV reported it to HCWs, citing concerns about privacy, appropriateness, and potential delays.

Conclusions:

• IPV is highly prevalent among PWH in Malawi, despite low reporting rates during ICT services.
• Significant barriers exist for PWH in reporting IPV, including patient-provider communication and systemic issues like workload and privacy.
• Urgent interventions are needed to address IPV reporting barriers to improve HIV treatment and overall health outcomes for PWH.