Exploring the associations between physical and sexual gender-based violence and HIV among women who use substances in South Africa: the role of agency and alcohol

• Published in: AIDS care Vol. 31; no. 11; pp. 1369 - 1375
• Main Authors: Bonner, Courtney Peasant, Browne, Felicia A., Ndirangu, Jacqueline W., Howard, Brittni, Zule, William A., Speizer, Ilene S., Kline, Tracy, Wechsberg, Wendee M.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02-11-2019; Taylor & Francis Ltd
• Subjects: Adolescent; Adult; African Continental Ancestry Group; African cultural groups; Aggression; AIDS/HIV; Alcohol; Alcohol abuse; Alcohol Drinking; Alcohol use; Alcohols; Blood tests; Disadvantaged; Drinking behavior; empowerment; Female; Gender; Gender-Based Violence; HIV; HIV Infections - complications; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Infections; Male; Mass Screening; Middle Aged; Prevalence; Prevention programs; Preventive medicine; Protective factors; Risk-Taking; Sexual abuse; Sexual Behavior; sexual negotiation; Sexual Partners; Sexually transmitted diseases; South Africa; South Africa - epidemiology; STD; Substance abuse; Tests; Violence; Women; Young Adult; South Africa; empowerment; Alcohol abuse; HIV; South Africa; protective factors; sexual negotiation; women
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2019.1595512

Objective: South Africa has the highest prevalence of HIV among women, the highest prevalence of gender-based violence (GBV), and the highest rates of per capita alcohol consumption in the world. The nuanced associations between GBV, alcohol misuse, and HIV must be explored and protective factors identified. This study examines the associations between physical and sexual GBV and HIV infection and explores how alcohol misuse and sexual agency may mediate the GBV-HIV association.
Method: Participants were 361 Black African women (Mean age

=

28.39, SD = 7.92) who reported using alcohol and/or drugs weekly in the past 3 months, engaging in condomless sex, and having a boyfriend. Women were recruited from disadvantaged communities in Pretoria, South Africa. Individuals who met the eligibility criteria and enrolled in the study consented and completed a computer-assisted personal interview assessing GBV, alcohol misuse, and sexual agency and underwent HIV testing (i.e., blood test).
Results: The indirect effect of physical assault on HIV status at enrollment through alcohol misuse was significant (log odds = 0.23, SE = 0.12, 95% CI [0.0151, 0.4998]).
Conclusions: HIV prevention efforts focusing on reducing alcohol misuse may be more effective, which might reduce the HIV burden among this group of vulnerable South African women.