Intimate partner violence and condom use among South African adolescents

A.M. Teitelman1, J.B. Jemmott III2, L. Icard3, A. O'Leary4, G.A. Heeren2, Z. Ngwane5, S. J. Ratcliffe2, S. Bellamy2

1University of Pennsylvania, School of Nursing, Philadelphia, 2University of Pennsylvania, Perelman School of Medicine, Philadelphia, 3Temple University, Philadelphia, 4Centers for Disease Control & Prevention, Atlanta,, 5Haverford College, Haverford

.

Council for the Advancement of Nursing Conference

September 2012

AcknowledgementsSouth African research team members:University of Fort Hare's Centre for Health Promotion  Joanne Tyler, PhD�  Pretty Ndyebi, MSW�  Phelisa Mpulu, BHon�  Craig Carty, MSc�Funding:NIMH 1 R01 MH065867 NIMH 1K01MH080649-01A1The Penn Center for AIDS Research AI-

045008

BackgroundIntimate partner violence (IPV) has

been tied to HIV/STI sexual risks among adolescent and adult women globally

In South Africa, this link is especially important because the prevalence of both HIV and intimate partner violence is high (Jewkes et al., 2002).

Background (cont’d)

IPV includes physical abuse; sexual coercion, threats, and emotional abuse and each type of IPV may be related to sexual risk

Little is known about gender comparisons of IPV and sexual risk among South African adolescents

Study PurposeExamine associations between

IPV and condom useMultiple types of IPV were examined: ◦physical◦sexual ◦psychological◦threats◦combined measures of overall IPV

Determine if associations differ by gender

Methods

Sample:702 sexually experienced adolescents in

Eastern Cape, South Africa ◦Urban township◦Rural settlement

During the 54-month follow-up of an HIV risk-reduction intervention trial

Paper and pencil self-report survey, collected by read aloud procedure

Methods- Measures

Outcome Measure Proportion of protected sex acts in

prior 3 months

Background Data -Demographic and health information

Age; lives with mother/father Alcohol/drug use Age of first sex, older sexual partner Transactional sex; history of forced sex

Methods- Measures (cont’d)

Intimate Partner Violence Measure:Total IPV (as victim) (adapted from Wolfe, 2001)

• 22 item scale, • alpha = .92• Comprised of 4 subscales

Physical violence (4 items)Sexual violence (4 items)Threatening behavior (4 items)Psychological/Emotional Abuse (10 items)

Methods - Data Analysis:

Descriptive statistics: Chi- Square tests were used to compare

frequencies t-tests were used to compare means as

appropriate Lowess plots were used to determine log-

transformations needed to meet model assumptions

Logistic regression: examined associations of condom use with IPV

◦ Total IPV◦ 4 types of IPV

and whether the associations differed by gender

Results - Descriptive

Background dataN= 702 (50% male; 50% female)Mean age = 16.9 years

Demographics and Partner Experiences by Gender

Results - Descriptive

Intimate Partner Violence◦Girls more likely to experience

Physical violence Psychological violence Threats

◦Boys more likely to experience Sexual violence

Results- Physical Violence by Gender

Results- Sexual Violence by Gender

Results- Psychological Abuse by Gender

Results- Threats by Gender

Results- Descriptive (con’t)Proportion of protected sex acts in past 3

months

| Percent No 38.99 Yes 61.01

05

1015

Den

sity

0 .2 .4 .6 .8 1COMPUTE PROT7=TMSXCD7 / TMSXS7

Results – Multivariate analysis

Threats, psychological and overall IPV were not associated with condom use

For both males and females physical IPV was significantly associated with the proportion of protected sex acts

(P= 0.002, P= 0.011 respectively)A gender x physical IPV interaction was significant (P =

0.001), such that females reporting more IPV were less likely to use condoms and males reporting more IPV were more likely to use condoms.

Males reporting more sexual IPV were less likely to use condoms (P=0.009)

Multiple regressionOdds of Having Protected Sex in Past 3 months

Correlate

Males Only Females Only

Gender x

Correlate

Interaction

Odds Ratio

95% CI p-value

Odds

Ratio

95% CI p-value

p-value

Physical abuse

1.99 1.08, 3.68 0.028 0.65 0.47, 0.91 0.011 0.002

Sexual abuse

0.72 0.56, 0.92 0.009 0.84 0.66, 1.07 0.156 0.355

Results Gender by Physical IPV Interaction

.2.4

.6.8

1P

r(P

rot7

_1

00

)

.01 .51 1.01 1.51 2.01 2.51 3.01 3.51 4.01 4.51Physical_AbuseVictimMEANS

Male Female

Highly significant (p<0.001) interaction of effect by gender.

For males: > physical

abuse MORE condom

use

For females: physical

abuseLESS condom

use

Conclusion

For females, physical IPV may increase sexual risk through condom non-use

For males, physical IPV may occasion greater condom use, but sexual IPV may increase sexual risk through condom non-use These findings highlight the importance of addressing

multiple types of IPV in HIV prevention interventions for both males and females and tailoring by gender.

Sexual risk consequences of IPV may differ by gender among adolescents in this region of South Africa.