Male Partner Alcohol Use and Intimate Partner Violence Among Adolescent Girls and Young Women Living with HIV: Does Who Reports Alcohol Use and Agreement in Reports Matter?

Background and Purpose: Evidence suggests that male partner alcohol use increases intimate partner violence (IPV) victimization risk among women; however, findings vary depending on whether the female or male partner reports alcohol use. We examined the relationship between male partner alcohol use and physical IPV among adolescent girls and young women living with HIV (AGYWLHIV) in Uganda. We investigated this relationship based on correspondence between self-reported and female-reported male partner alcohol use Findings can help better understand the relationship between male partner alcohol use and IPV risk and potential ways to assess and prevent this risk among AGYWLHIV, thereby improving their HIV care engagement.

Methods: We used screening data from the Kisoboka Mukwano study, a couples-based intervention to reduce IPV and improve HIV care engagement among AGYWLHIV (aged 15-24) by reducing male partner alcohol use. The study was conducted in Wakiso District, Uganda. Participants were recruited through community partners and HIV clinics. The analytic sample included 117 married/cohabiting couples (234 participants) with AGYWLHIV and male partners. Data were collected between November 2023 and November 2024. Hazardous alcohol use self-reported by male partners was defined as consuming ≥6 drinks per occasion at least once in the prior 30 days or scoring ≥4 on the AUDIT-C. Female-reported male alcohol use was assessed by asking: “How often does your husband/partner drink alcohol?” (never, less than once a month, at least once a month, at least once a week, or almost every day/every day). We categorized male partners as hazardous drinkers based on female reports if their female partners reported they drink at least once a week or almost every day. Physical IPV was assessed based on female partner reports using the WHO/DHS Domestic Violence Modules. We conducted descriptive and multivariate regression analyses.

Results: Overall, 47.7% of female partners reported physical IPV. Most couples (80.8%) had been in their relationship for over a year and had an average of 1.8 children. Female partners had a mean age of 22.6 years, compared to 30.0 years for male partners. Regarding male partner hazardous alcohol use, 56.9% of the sample consisted of concordant non-hazardous reports; 19.1% of discordant reports (female report positive); 24.1% of discordant reports (male report positive); 0.0% of concordant hazardous reports. Compared to couples with the concordant non-hazardous reports, couples with discordant reports (female report positive) had greater odds of physical IPV (AOR= 4.9, 95% CI [2.2, 10.7]). Additionally, couples with discordant (male report positive) had greater odds of physical IPV (AOR= 3.6, 95% CI [1.8, 7.4]).

Conclusions and Implications: Female partner report of male partner alcohol use is an important indicator of IPV risk among AGYWLHIV, possibly just as important as male partner report. We recommend qualitative research to explore underlying reasons for gender differences in perceptions of hazardous alcohol use. Service providers working with couples to decrease IPV risk should assess alcohol use based on both partner’s perspectives. Greater risk for IPV may exist when these perspectives differ. Couples-based IPV interventions for AGYWLHIV should help couples create shared goals for alcohol treatment.