"That pregnancy can bring noise into the family": exploring intimate partner sexual violence during pregnancy in the context of HIV in Zimbabwe

• Published in: PloS one Vol. 7; no. 8; p. e43148
• Main Authors: Shamu, Simukai, Abrahams, Naeemah, Temmerman, Marleen, Shefer, Tamara, Zarowsky, Christina
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24-08-2012; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Aggression; AIDS; Alcoholic beverages; Analysis; Assaults; Audio data; Biology; Breast feeding; Clinics; Coercivity; Content analysis; Criminalization; Domestic violence; Drug abuse; Drugs; Economic factors; Emotions; Female; Females; Gender; Gender roles; Gynecology; Health aspects; Health risks; HIV; HIV infections; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Infections; Intimate partner violence; Low income groups; Male; Marriage; Medical personnel; Medicine; Men; Mens health; Norms; Nurses; Nursing; Obstetrics; Occupational health; Patient outcomes; Personal relationships; Pregnancy; Pregnant women; Public health; Sex crimes; Sex discrimination; Sex Offenses - statistics & numerical data; Sex roles; Sexual assault; Sexual behavior; Sexual Partners; Sexuality; Sexually transmitted diseases; Social and Behavioral Sciences; Social aspects; STD; Studies; Systematic review; Violence; Women; Womens health; Workers; Zimbabwe - epidemiology; Zimbabwe; South Africa; Belgium; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0043148

Globally, studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. Despite the criminalisation of IPSV and deliberate sexual HIV infection in Zimbabwe, IPSV remains common. This study explored women's and health workers' perspectives and experiences of sexuality and sexual violence in pregnancy, including in relation to HIV testing.
This qualitative study was part of a larger study of the dynamics of intimate partner violence and HIV in pregnancy in Zimbabwe. Key informant interviews were conducted with health workers and focus group discussions were held with 64 pregnant or nursing mothers attending antenatal and postnatal care clinics in low-income neighbourhoods of Harare, covering the major thematic areas of validated sexual violence research instruments. Thematic content analysis of audio-recorded and transcribed data was conducted.
While women reported some positive experiences of sex in pregnancy, most participants commonly experienced coercive sexual practices. They reported that men failed to understand, or refused to accept, pregnancy and its associated emotional changes, and often forced painful and degrading sexual acts on them, usually while the men were under the influence of alcohol or illicit drugs. Men often refused or delayed HIV testing, and participants reported accounts of HIV-positive men not disclosing their status to their partners and deliberately infecting or attempting to infect them. Women's passive acceptance of sexual violence was influenced by advice they received from other females to subordinate to their partners and to not deprive men of their conjugal sexual rights.
Cultural and societal factors, unequal gender norms and practices, women's economic vulnerability, and men's failure to understand pregnancy and emotional changes, influence men to perpetrate IPSV, leading to high risk of HIV infection.