Informing Intervention Strategies to Address Intimate Partner Violence and HIV: Finding from a Qualitative Study in Rural Uganda

Background/Purpose: Addressing intimate partner violence (IPV) is of paramount importance to achieving the United Nation’s target to end the HIV/AIDS epidemic by 2030. Research highlights significant barriers to long-term engagement with HIV care, as well as the salient role IPV plays in exacerbating disparities. Yet, there are no interventions in Uganda designed to specifically help people navigate IPV-related barriers to HIV care engagement. To inform the design of HIV care engagement and treatment intervention, this qualitative study sought the input and perceptions of people living with HIV (PLHIV) in rural Uganda who have experienced IPV. Unlike prior research, this study invited both women and men living with HIV (WLHIV and MLHIV, respectively) to participate.

Methods: The research team conducted structured qualitative interviews with WLHIV (n=23) and MLHIV (n=10) participating in the PATH/Ekkubo intervention trial who reported physical, sexual, or emotional IPV and completed the 12-month follow-up. We screened for IPV using existing data collected with a 10-item instrument developed by the World Health Organization. Using these data, we selected participants using maximum variation sampling techniques to represent those whose HIV care engagement and/or treatment were possibly “most affected” by IPV (e.g., women and men 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 employed a thematic analytic approach to identify key areas of intervention rooted in participants' lived experiences. We used an inductive approach to develop codes and analyze transcripts, then grouped codes into categories and refined categories into themes by writing memos and engaging in reflexive discussions.

Results: The analysis identified five inter-related areas of intervention. First, participants highlighted the importance of expanding IPV awareness and education at the community level and among couples. Second, addressing alcohol and substance misuse among couples was a priority intervention area. Third, participants reinforced the importance of fostering the vital role that supportive family, partners, and healthcare providers play in HIV care engagement for PLHIV experiencing IPV. Fourth, participants reiterated the need to increase opportunities for WLHIV to safely earn an income, ideally with the support and encouragement of their male partners. Fifth, participants highlighted the importance of HIV testing and reducing barriers among couples to share test results.

Conclusions/Implications: The findings reiterate the need for multi-level interventions. Evidence-based community-level HIV/IPV interventions developed in Uganda should be implemented at scale to address social norms and stigma associated with IPV and HIV. Couples-based interventions shown to effectively reduce alcohol use and IPV should be studied to see if they are also effective in improving HIV care engagement and viral suppression. HIV/IPV interventions should actively seek to strengthen economic support among WLHIV and family support among HIV seroconcordant couples and extended family. Considering the ongoing reality of HIV stigma evident across interviews, Ugandan healthcare providers can mitigate fear of disclosure-related IPV through home-based testing and counseling and assist with helping partners to disclose or safeguard their HIV status.