![[ Visit Client Website ]](images/banner.gif)
Background/Purpose: Uganda has one of the highest per capita annual levels of alcohol consumption in the world, particularly among men. Male partner alcohol use increases AGYW’s IPV risk. AGYWLHV who report IPV have worse HIV outcomes than AGYWLHIV who do not report IPV. We are designing a couples-based intervention, Kisoboka Mukwano, to reduce IPV risk and improve HIV care engagement among AGYWLHIV in Uganda by reducing male partner alcohol use. We report findings from formative research eliciting feedback on the role of alcohol use and IPV in AGYW’s HIV care engagement.
Methods: This is a qualitative study of stakeholder perspectives on the role of alcohol use and IPV in HIV care engagement among married/cohabiting AGYWLHIV. This study took place in Wakiso District, Uganda. Participants were recruited through community partners, HIV clinics, and eligible AGYWLHIV. We conducted two focus groups (n=13) and 8 interviews with AGYWLHIV who reported IPV (measured using the WHO Instrument) in their current relationship and non-engagement in HIV care (measured using the AIDS Clinical Trials Group Adherence measures), and 11 interviews with service providers working with the population of focus. Interviews/focus groups were conducted in Luganda, transcribed, translated into English, and thematically coded through an inductive process.
Results: AGYW’s average age was 21.0 years. All AGYW were linked to HIV care; however, 81% were not currently on antiretroviral therapy (ART) and among those taking ART, 50% (n=4) were non-adherent. Regarding IPV, most AGYW reported experiencing either controlling behavior (90.5%) or emotional IPV (81.0%); 23.8% reported physical IPV and 19.1% sexual IPV.
Four alcohol-and-IPV-related themes emerged from the data: alcohol use is indirectly related to AGYW’s HIV care engagement via (1) economic barriers (“He might have made the money, spends it on drinking and yet you spent the whole day hungry...that might also cause you to miss taking the medication, since you can’t take it on an empty stomach.”) and (2) IPV ( “...he might come back when he is drunk and he starts insulting you...You will start quarreling and fighting and by the time you remember the time has already elapsed [to take ART]”). Additionally, (3) alcohol use (“So you decide to sacrifice [ART] that one day, and you continue drinking”) and (4) IPV, including controlling behavior related to cultural norms (“The man refused the girl to take ART...She cannot make her own decisions and go against what the husband says...these men are older, they stop those girls from taking ART”), are directly associated with AGYW’s poor ART adherence.
Conclusions/Implications: Interventions aiming to improve HIV care engagement among married/cohabiting AGYWLHIV must involve male partners, due to relationship factors. IPV alone and IPV related to male partner alcohol use negatively affect AGYW’s HIV care engagement and treatment adherence. To improve HIV outcomes, combined IPV and HIV interventions for AGYWLHIV must aim to reduce both male and female alcohol use, address economic barriers, and address emotional abuse and controlling behaviors. Incorporating a gender-transformative approach is important for shifting norms that increase AGYW’s risk of being in controlling relationships.