Intimate Partner Violence Among Sexual Minority Men in Sub-Saharan Africa: A Meta-Analysis

Background and Purpose

Intimate partner violence (IPV) is a critical public health issue that disproportionately affects sexual minority men (SMM), particularly in regions with high levels of stigma and structural barriers to support. Sub-Saharan Africa, home to diverse and often marginalized SMM populations, presents unique challenges regarding IPV, including social discrimination, legal criminalization of same-sex relationships, and limited access to protective resources. Despite growing literature on IPV among SMM, research in Sub-Saharan Africa remains scarce. This systematic review and meta-analysis aim to estimate the pooled prevalence of IPV victimization and perpetration among SMM in Sub-Saharan Africa, identify key factors associated with IPV experiences, and to provide a comprehensive understanding of IPV in this population and offers insights for intervention and policy efforts tailored to the unique needs of SMM in Sub-Saharan Africa.

Methods
A systematic review and meta-analysis was conducted following the PRISMA guidelines, including published studies reporting IPV-related outcomes among SMM in Sub-Saharan Africa. Data extraction was performed to collect information on study characteristics, IPV prevalence, associated factors, and health-related outcomes. A thematic analysis was used to synthesize evidence on patterns and themes related to the experiences of IPV and we used a generalized linear mixed model with a random intercept and a logit link binomial model for prevalence rates to calculate pooled prevalence of IPV victimization and perpetration across the included studies.

Results
Of 231 records identified, 17 studies met the inclusion criteria. Most studies were conducted in South Africa (n=7, 39.29%), followed by Namibia (n=4), Mali (n=3), Burkina Faso (n=3), Cote D’Ivoire (n=3), Togo (n=3), Kenya (n=2), Nigeria (n=2), and Zimbabwe (n=1). The majority were quantitative (n=14, 82.35%), with three qualitative studies (17.65%). Meta-analyses indicated a pooled prevalence of IPV victimization at 20% (95% CI: 13%-29%) and IPV perpetration at 16% (95% CI: 6%-29%), with high heterogeneity between studies (I²>96.0% for both). Meta-regression models showed that IPV prevalence was significantly higher in West Africa compared to Southern Africa (p<0.05 for both). Thematic analysis identified multilevel risk factors for IPV, including childhood adversity, co-existing mental distress, relationship dynamics and sexual agreements, and discrimination. Studies also indicated that experiencing IPV victimization was associated with sexual risk behaviors and heightened HIV vulnerability.

Conclusions
This review highlights the substantial burden of IPV among SMM in Sub-Saharan Africa, with notable regional differences in prevalence. The findings underscore the role of structural and psychosocial factors in shaping IPV experiences, emphasizing the need for context-specific interventions and services. Given the strong association between IPV and sexual risk behaviors, addressing IPV could play a crucial role in HIV prevention strategies. Future research should focus on longitudinal studies, and culturally tailored interventions to mitigate the impact of IPV on SMM in this region. Collaborative efforts between researchers, policymakers, and communities are essential to address multilevel IPV risk factors—such as mental distress, relationship dynamics, and discrimination—through culturally responsive interventions. Integrating IPV prevention into health policy can reduce sexual risk behaviors and HIV vulnerability. Strengthening local capacity ensures sustainable, context-specific responses and improved health outcomes for SMM.