Millions of those infected with HIV worldwide are young women, ages 15-24, according to the World Health Organisation. Because the HIV epidemic overlaps with an epidemic of intimate partner violence (IPV) against women and girls, researchers have suspected a correlation between inequities in relationship power and the risky sexual behaviour that can lead to HIV transmission.
Medical Xpress reports that a new research study from the University of Pennsylvania’s School of Nursing (Penn Nursing), Annenberg School for Communication, and Perelman School of Medicine investigated and confirmed those associations of intimate partner violence (IPV) and relationship power with sexual-risk behaviours in adolescents. The researchers identified promising pathways to reduce IPV and help prevent HIV infection, including promotion of gender equity as a social norm.
The research was conducted in South Africa, where the prevalence of both HIV and IPV is high and men often have more power in relationships than women. The team assessed data from more than 700 sexually experienced adolescents in Eastern Cape Province, South Africa who had been followed at regular intervals for 54 months as part of a separate NIH-funded trial.
The researchers focused on HIV sexual risk-related behaviours including condom use and having multiple sex partners, and instances of intimate partner violence as well as relationship power.
Overall, 83% of the participants had experienced at least one type of IPV within the past year. Girls who reported suffering more instances of intimate partner violence were less likely to use condoms the last time they had sex. In addition, both boys and girls with less power in their relationship were more likely to report sex with multiple partners in the past 3 months.
“For girls, IPV and lower relationship power affect interpersonal dynamics, which increase sexual risk through condom nonuse. In addition, girls with higher levels of relationship power are less likely to have multiple partners,” explains the article’s lead author Dr Anne M Teitelman, the Patricia Bleznak Silverstein and Howard A Silverstein endowed term chair in Global Women’s Health and associate professor at Penn Nursing.
The research is the first known study to examine IPV and relationship power among adolescent boys in South Africa. It found that boys who reported experiencing more victimisation were more likely to report having multiple partners. It also showed that boys who experience IPV and who have lower relationship power are more likely to use condoms.
The findings indicate that the impact of IPV and relationship power on sexual risk behaviours differs significantly by gender; therefore, an important consideration is how sexual risk-reduction interventions for adolescents in South Africa should be implemented.
“Our findings suggest that HIV prevention interventions should incorporate gender-specific components and not only address individual attitudes about IPV and interpersonal gender power dynamics, but use community-level approaches to change harmful social gender norms that perpetuate inequalities,” says Teitelman.
Objectives: Low relationship power and victimization by intimate partner violence (IPV) have been linked to HIV risks among adult and adolescent women. This article examines associations of IPV and relationship power with sexual-risk behaviors and whether the associations differ by gender among South African adolescents. Method: Sexual-risk behaviors (multiple partners in past 3 months; condom use at last sex), IPV, and relationship power were collected from 786 sexually experienced adolescents (mean age = 16.9) in Eastern Cape Province, South Africa, during the 54-month follow-up of a HIV/sexually transmitted infection (STI) risk-reduction intervention trial. The data were analyzed with logistic regression models. Results: Adolescent boys were less likely to report condom use at last sex (p = .001) and more likely to report multiple partners (p < .001). A Gender × IPV interaction (p = .002) revealed that as IPV victimization increased, self-reported condom use at last sex decreased among girls, but increased among boys. A Gender × Relationship Power interaction (p = .004) indicated that as relationship power increased, self-reported condom use at last sex increased among girls, but decreased among boys. A Gender × IPV interaction (p = .004) indicated that as IPV victimization increased, self-reports of having multiple partners increased among boys, but not among girls. As relationship power increased, self-reports of having multiple partners decreased irrespective of gender. Conclusions: HIV risk-reduction interventions and policies should address gender differences in sexual-risk consequences of IPV and relationship power among adolescents and promote gender equity.