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

Wendee M. Wechsberg; William A. Zule; Tracy L. Kline; Felicia Amira Browne; Jacqueline Wanjiku Ndirangu; Brittni Nicole Howard; Courtney Peasant Bonner; Courtney Peasant Bonner; Felicia Amira Browne; Jacqueline Wanjiku Ndirangu; Brittni Nicole Howard; William A. Zule; Ilene S Speizer; Tracy L. Kline; Wendee M. Wechsberg

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

Bonner, C. P., Browne, F. A., Ndirangu, J. W., Howard, B., Zule, W. A., Speizer, I. S., Kline, T., & Wechsberg, W. M. (2019). 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. AIDS Care, 31(11), 1369-1375. https://doi.org/10.1080/09540121.2019.1595512

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Abstract

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.