Water Insecurity is Associated with Intimate Partner Violence Among Women Living with HIV in Western Kenya

Water insecurity is a pervasive problem in sub-Saharan Africa that co-occurs with other challenges like food insecurity and intimate partner violence (IPV), which may intersect to worsen HIV/AIDS outcomes. However, little is known about its association with IPV among women living with HIV (WLWH) who are vulnerable to both. We assessed the prevalence of IPV among WLWH in western Kenya and whether water insecurity was associated with a higher likelihood of IPV. We analyzed baseline data for WLWH enrolled in the Shamba Maisha cluster randomized controlled trial, a multisectoral intervention designed to reduce food insecurity and improve HIV/AIDS outcomes among people living with HIV (PLWH) in western Kenya. Water insecurity was assessed using a validated scale for this region; dichotomously and across four levels of severity. IPV (physical, sexual and emotional) was assessed using an adapted WHO instrument on women's health. Mixed effects regression models were used to assess associations between water insecurity and IPV (lifetime and recent), adjusting for covariates. Among 395 WLWH, 58.5% reported lifetime IPV and 18.5% reported recent IPV. Any water insecurity was associated with higher odds of lifetime (AOR = 2.1; 95% CI: 1.22, 3.60) and recent IPV (AOR = 2.3; 95% CI: 1.06, 5.16). Severe water insecurity was associated with about fivefold greater odds of lifetime (AOR = 4.9; 95% CI: 2.02, 11.81) and recent IPV (AOR = 5.2, 95% CI: 1.78, 15.38). These findings demonstrate water insecurity as a critical structural driver of IPV among WLWH, with potentially important implications for HIV/AIDS.