Abstract: I Would Have Managed By Force Because I Have to Live: Intimate Partner Violence Coping Strategies Among Women Living with HIV in Rural Uganda (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

I Would Have Managed By Force Because I Have to Live: Intimate Partner Violence Coping Strategies Among Women Living with HIV in Rural Uganda

Saturday, January 15, 2022
Marquis BR Salon 7, ML 2 (Marriott Marquis Washington, DC)
* noted as presenting author
Ijeoma Nwabuzor Ogbonnaya, PhD, Assistant Professor, Arizona State University, AZ
Susan Kiene, PhD, Professor, San Diego State University, CA
Katherine Schmarje, Doctoral Student, San Diego State University, CA
Kazi Silmi, Doctoral Student, San Diego Sate University, CA
Alexandra Almeida, PhD, Doctoral Candidate, San Diego State University, CA
Michael Ediau, Doctoral Student, San Diego State University, CA
Rose Naigino, Doctoral Student, San Diego State University, CA
Rhoda Wanyenze, PhD, Professor and Dean, Makerere University, Uganda
Background/Purpose: Research indicates that intimate partner violence (IPV) negatively affects HIV care engagement and treatment. However, the reason(s) for this relationship is unclear. Further, the evidence-base regarding the impact of IPV on HIV care and treatment is primarily built on research conducted in the United States. This qualitative study explores (a) IPV-related barriers to staying healthy and (b) coping strategies used to overcome these barriers among newly diagnosed women living with HIV (WLHIV) in rural Uganda.

Methods: We conducted semi-structured qualitative interviews with WLHIV participating in the intervention trial of the PATH/Ekkubo study. Women were eligible to participate in the study if they reported an experience of past-six months or lifetime physical, sexual, or emotional IPV and completed the 12-month follow-up of the intervention trial. We screened for IPV using existing data collected with a 10-item instrument developed by the World Health Organization. Using this data, we selected participants meeting eligibility criteria using maximum variation sampling techniques to represent those whose HIV care engagement and/or treatment were possibly “most affected” by IPV (e.g., women who experienced both recent and lifetime IPV, experienced all three forms of IPV, had unsuppressed viral load). Data were collected by an experienced Luganda speaking qualitative interviewer, and audio-recorded, transcribed, and translated into English for analysis. We identified major themes through a process of open, first-level, and second-level coding using Atlas.ti software.

Results: Recruitment and data collection are ongoing, however, the current sample consisted of 21 participants: 66.7% had suppressed viral loads, and 33.3% unsuppressed. Most participants reported lifetime physical (66.7%) or emotional (81.0%) IPV; 23.8% lifetime sexual IPV. Further, 19.1% reported physical IPV during the past six months, among which 50.0% was severe (e.g., being beaten, choked, stabbed). Approximately 40.0% and 14.3% experienced recent emotional and sexual IPV, respectively. Yet, controlling behavior was the primary form of IPV identified as a barrier to HIV care engagement and medication adherence in qualitative interviews. Participants spoke about challenges with initiating and adhering to treatment due to partners monitoring their movements and becoming jealous when interacting with healthcare providers or spending long waiting times at the clinic.

Four themes emerged regarding IPV coping strategies for staying healthy. These themes were 1) adhering to HIV treatment to stay healthy for children, 2) leaving the abusive relationship, 3) hiding HIV medication from abusive partners (either themselves or asking a healthcare provider to hide medication), and 4) seeking help from family members.

Conclusions/Implications: Current studies examining the relationship between IPV and HIV care and treatment do not comprehensively measure IPV, ignoring controlling behaviors. Our preliminary findings suggest that additional research is needed to further explore how partners’ controlling behaviors may interfere with women’s HIV care and treatment routines. Relatedly, healthcare facilities with minimum technical and referral capacity to provide IPV support should screen for controlling behaviors by an intimate partner, as well as other forms of IPV. Despite their IPV barriers, WLHIV are resilient and manage ways to cope with their barriers. Interventions should focus on building and promoting this resilience.