Intimate partner violence (IPV) is common worldwide and is an important consideration in couples HIV voluntary counseling and testing (CVCT), especially for HIV serodiscordant couples (i.e., in which only one member is HIV infected).
Many countries in sub-Saharan Africa have experienced rapid development and urbanisation in recent years. This, along with internal instability and other factors, has led to sexual gender-based violence (SGBV) becoming a major problem. Addressing SGBV is important given its physical, psychological and social consequences. The consequences in terms of human immunodeficiency virus (HIV) infection, unwanted pregnancies and long-term psychological effects are not well described, especially in sub-Saharan African countries.
Although there are no national data on the prevalence of SGBV in Kenya, 1400 cases of rape, estimated at only 11% of the actual number of rape cases, were reported during the post-election violence between December 2007 and March 2008.6 These estimates suggest that, as in several other sub-Saharan African countries, there is a need to provide adequate and effective prevention, care and protection strategies for SGBV in Kenya.
Médecins Sans Frontières (MSF) has been offering care to survivors of SGBV in Eastern Nairobi, Kenya, since 2007. It is one of the few organisations in the country to offer a comprehensive package of care to such victims. The present study attempts to fill the knowledge gap and describe the care and support offered to SGBV survivors in a slum in Nairobi, Kenya, in 2011. Specific objectives were to describe amongst SGBV survivors: 1) individual demographic characteristics and episodes of sexual violence, 2) medical and psychological management, including medico-legal certification, and 3) HIV infection and pregnancy outcomes associated with the provision of care.
HIV-infected (HIV+) women have high rates of Gender Based Violence (GBV). Studies of GBV find that approximately 50-90% of survivors develop mood and anxiety disorders. Given that women in sub-Saharan African constitute the largest population of HIV+ individuals in the world and the region's high GBV prevalence, mental health research with HIV+ women affected by GBV (HIV+GBV+) in this region is urgently needed.
Kenya is a generally homophobic country where homosexuality is criminalised and people who engage in same sex sexuality face stigma and discrimination. In 2013, we developed a 16 min documentary entitled “Facing Our Fears” that aimed at sharing information on how and why men who have sex with men (MSM) are involved in on-going KEMRI HIV prevention research, and associated community engagement. To consider the film’s usefulness as a communication tool, and its perceived security risks in case the film was publicly released, we conducted nine facilitated viewings with 122 individuals representing seven different stakeholder groups. The documentary was seen as a strong visual communication tool with potential to reduce stigma related to homosexuality, and facilitated film viewings were identified as platforms with potential to support open dialogue about HIV research involving MSM. Despite the potential, there were concerns over possible risks to LGBT communities and those working with them following public release. We opted—giving emphasis to the “do no harm” principle—to use the film only in facilitated settings where audience knowledge and attitudes can be carefully considered and discussed. The results highlight the importance of carefully assessing the range of possible impacts when using visuals in community engagement.
We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits).
In Haiti, Kenya, and Cambodia, respectively, 1459, 1456, and 1255 males completed surveys. The prevalence of experiencing any form of sexual violence ranged from 23.1% (95% confidence Interval [CI]: 20.0-26.2) in Haiti to 14.8% (95% CI: 12.0-17.7) in Kenya, and 5.6% (95% CI: 4.0-7.2) in Cambodia. The largest share of perpetrators in Haiti, Kenya, and Cambodia, respectively, were friends/neighbors (64.7%), romantic partners (37.2%), and relatives (37.0%). Most episodes occurred inside perpetrators' or victims' homes in Haiti (60.4%), contrasted with outside the home in Kenya (65.3%) and Cambodia (52.1%). The most common time period for violence in Haiti, Kenya, and Cambodia was the afternoon (55.0%), evening (41.3%), and morning (38.2%), respectively. Adverse health effects associated with violence were common, including increased odds of transactional sex, alcohol abuse, sexually transmitted infections, anxiety/depression, suicidal ideation/attempts, and violent gender attitudes.
The overarching goal of this study is to pilot an approach to HIV testing and counseling (HTC) that addresses intimate partner violence. The results of the study will fill an important gap in the literature and contribute to efforts by Kenyatta National Hospital in Nairobi, Kenya—and the HIV and sexual and reproductive health field globally—to better address intimate partner violence in our work.