Abstract
The assisted partner notification (APN) program is a WHO program adopted by Uganda to increase the number of individuals testing for HIV through their partners who test HIV positive. Thus, early enrolment in treatment and ensuring prevention services for the affected couple. However, APN is associated with high levels of Intimate partner violence (IPV). In this study, we aimed at determining the prevalence of IPV following APN. We conducted a cross-sectional study enrolling newly diagnosed HIV clients in rural health facilities in southwestern Uganda. We used the modified version of the Conflict Tactics Scale to assess for IPV. We also collected information on sociodemographic characteristics of both the index clients and their sexual partners, and outcome of linkage to care of partner. Logistic regression was used to determine the factors associated with IPV. A total of 327 index clients were enrolled in the study, mean (standard deviation) age of 39.1 (±11.2), and the majority were female 63.6%. More than a third (35.5%) of the participants experienced IPV following APN. The likelihood of experiencing IPV was more than twice if a health worker/provider disclosed the status to the partner. However, if the partners turned out to be HIV positive after testing, it was protective against experiencing IPV, adjusted odds ratio 0.39, 95% confidence interval 0.23 – 0.69, p-value = 0.001. We conclude that IPV is common following partner notification in PHC facilities in rural Uganda and should therefore be screened for and addressed.
Keywords: Intimate partner violence, assisted partner notification, Primary healthcare, HIV
Introduction
The prevalence of HIV among people aged 15–64 years in Uganda is 6.2%, corresponding to 1.2 million people(MOH, 2019). In the same age group, only 72.5% Ugandans are aware of their HIV status, falling short of the recommended 95% recommended by UNAIDS(UNAIDS, 2014). To address this gap, Uganda adopted assisted partner notification (APN) program into routine clinical services(MOH, 2018). Assisted partner notification in HIV involves contacting sexual partners of index clients who test HIV positive and referring them to HIV testing and treatment. APN services have a high potential to identify people living with HIV but are unaware of their status. Though acceptability of APN in HIV care in Uganda is high at 81%(Namimbi et al., 2020), it has been found to trigger intimate partner violence (IPV) especially among women(Klabbers et al., 2020, Klabbers et al., 2021, Sileo et al., 2018).
Intimate partner violence is the behavior by an intimate partner or ex-partner that causes physical, sexual, or psychological harm.(WHO, 2013). Violence by intimate partners is the most common form of violence against women. In Uganda, 60% of ever-married women and 40% of men aged 15–49 reported ever having experienced emotional, physical, or sexual violence from a spouse(UDHS, 2011). HIV positive women in Uganda experience high rates of physical and sexual forms of IPV (Young et al., 2018, Kabwama et al., 2019).
IPV and HIV are significantly associated with higher incidence of HIV infection, poor adherence to treatment and less uptake of APN programs. Primary healthcare facilities in southwestern Uganda, where the HIV prevalence of 7.9% in the 15–64 age group, is higher than the national average of 6.2%(MOH, 2019). We aimed to better understand the burden, prevalence and correlations of IPV among index clients enrolled in the HIV APN programs in PHC settings in rural southwestern Uganda. Better knowledge of the burden of IPV among index clients up taking APN program has a potential to provide solutions to help those affected and improve acceptance.
2.0. Materials and methods
2.1. Study design and setting
We used a cross sectional quantitative design and data was collected in April 2021. The study setting was Antiretroviral Therapy (ART) clinics in two Health Centre IVs and one district hospital in Rukungiri District located in southwestern Uganda about 380 kilometers from the capital Kampala. Assisted Partner Notification HIV services in Uganda are offered within the ART clinics and target index clients. The APN services are run by nurses and midwives skilled to identify eligible clients, interview and provide counselling and perform investigations to locate and link partners of the clients to testing and treatment services. The two HC IVs and a district hospital selected run high volume ART clinics and provide Assisted Partner Notification.
2.2. Study participants
We included index clients aged 18 years and above who utilized HIV testing services within the last six months of the study and were enrolled at the APN clinics at the three facilities. At the time of the study, 690 clients were enrolled into APN services at the facilities.
2.3. Sample size:
was determined using Cochran formula n = Z2PQ/E2 (Cochran, 2007): Where n = sample size, Z =1.96, P = 0.29 based on a similar study by Young et al(Young et al., 2018), Q = 0.71, E = 0.05. Thus a total of 316 participants. We added 10% to cater for attrition and our final sample size was 348 participants.
2.4. Data collection
We collected data using interviewer administered questionnaires that had information on sociodemographics of both the index client and their sexual partner, outcome of linkage to care of partner and intimate partner violence. The APN nurse identified newly diagnosed index HIV clients over the last six months who had come for a scheduled clinic visit. The nurse then sought permission from eligible clients to allow the research team to talk to them. The clinic nurse obtaining permission from the clients before they talked to the research team is a mandatory procedure in APN clinics in Uganda. For those who granted permission, informed consent to participate in the study and access to their medical records was obtained. The tool was translated into the local language and an English version availed as an alternative. The questionnaire was pretested among 12 participants; each interview took 30–40 minutes.
After data collection, the questionnaires were labeled with the clinic ID and kept in file for privacy and confidentiality. Participants who require additional counselling were handled by the HIV clinic nurses.
2.5. Measurements
Intimate Partner Violence
Questions on Intimate Partner Violence were adapted from the shortened and modified version of the Conflict Tactics Scale (Straus, 2017) which has been used by the UDHS 2011 and 2016 to collect data on domestic and gender-based Violence in Uganda(UDHS, 2011, UBOS, 2017). A history of physical, sexual or emotional violence within one month following partner notification was assessed using the following questions: a) Physical violence: Did your partner do any of the following within one month after HIV result notification by you, health worker or both health worker and you: push you, shake you, throw something at you, slap you, twist your arm or pull your hair, punch you with his/her fist or something that could hurt you, kick you/drag you/beat you up, try to choke or burn you intentionally, threaten or attack you with a knife, machete, stick, gun or any other weapon? b) Sexual Violence: Did your partner do any of the following within one month after HIV result notification by you, health worker or both health worker and you: physically force to have sexual intercourse with him or her even when you did not want to, physically force you to perform any other sexual acts you did not want to, or force you with threats or in any other way to perform sexual acts you did not want to? c) Emotional Violence: Did your partner do any of the following within one month after HIV result notification by you, health worker or both health worker and you: say or do something to humiliate you in front of others, threaten to hurt you or someone close to you, insult you or make you feel bad about yourself. Each question has a Yes/No response and scored 1 if a response was yes, otherwise a score of 0 was given. A total score of 1 and above signified IPV. The transplanted version had good reliability in our study with a Cronbach alpha of 0.84, 0.82, and 0.70, for IPV, physical violence, and emotional violence, respectively.
Methods of partner notification:
we asked and corroborated from the client records the following three methods of partner notification which are followed by the Uganda MOH guidelines:
Self-notification:
the HIV-positive client agreed to disclose their status and the potential HIV exposure to their partners by themselves, and referred them to HIV testing services. Self-disclosure was verified when the clients came together with the notified partner for HIV testing and possible linkage to HIV services if positive or during the next visit to the clinic by client.
Assisted notification:
the trained APN nurse accompanied and provided support to HIV-positive clients when they disclosed their status and referred them to HIV testing services.
Provider notification:
the HIV-positive client agreed that the APN nurse disclose their HIV status to the partner, and referred them to HIV testing services.
Linkage to care outcomes:
For the index clients who agreed to notify their partners about their HIV positive test results, we asked them, and corroborated with records, if the partners accepted or declined to go for testing, and if they agreed, what the HIV test results were (Positive or Negative), and for those who tested positive, if they were linked or not linked to antiretroviral therapy (ART). We also recorded how long the patient took to get tested for HIV.
History of alcohol and other substance use:
We asked the index clients their use of alcohol and other substances in the past year. The same information on alcohol and other substance use by their partners over the past one year was asked.
2.6. Ethical considerations
The study was approved by the Mbarara University Research and Ethics Committee (# 01/12–20) and registered by the Uganda National Council for Science and Technology. All participants provided written informed consent and allowed access to their records. Participants who required additional counselling were referred to the APN clinic.
Data management and analysis
During data collection, data was cross checked for completeness by two members of the research team (EM and RN). After, the data was entered into Microsoft Excel 2016 by two members (DM and RA) on a daily basis. Any discrepancies were resolved by the principal investigator (EM) and if need be, the participant was contacted for confirmation. Data was cleaned in Microsoft Excel by MMK and later exported to STATA version 16.0 for analysis. Descriptive statistics were summarized using mean and standard deviations for continuous data and percentages for categorical variables. Inferential statistics (t-tests and chi-square tests) were performed to identify relationships between IPV and independent variables. Logistic regression was used to determine the association between IPV and independent variables significant with inferential statistics. A p-value of less than 0.05 for the level of significance was considered at 95% confidence interval.
3.0. Results
We enrolled 327 participants while 11 declined consent into the study; all participants had previous partner notification encounters.
3.1. Prevalence of Intimate partner violence
The prevalence of any form of IPV following notification was 35.5% (116/327), with majority of the participants having experienced emotional abuse, 29.4% (96/327), followed by physical abuse 16.8% (55/327) and least experienced abuse was sexual, 4.9% (16/327).
3.2. Relationship between IPV and participant’s characteristics
The participants’ mean age was 39.1 (±11.2), median of 39, range of 19 – 76, with the majority belonging to the age group of 18 – 30 years. The majority of them were female 63.6%, and had completed primary leaving examination (PLE), 44.0%. A total of 143 (43.7%) participants had used substances of addiction in the previous year. The majority of the participants, 98.8%, accepted their partners to be notified about their HIV status and mainly chose the self-disclosure method, 76.4%. There was a statistically significant difference between those who experienced IPV and those who did not with the method of disclosure chosen. About 49.3% of the participants who chose the provider’s method of disclosure statistically experienced more IPV than those who used other methods of disclosure, (vs 40.0% for assisted and 31.7% for self; X2 = 7.16, p-value = 0.028).
3. Relationship between IPV and partner’s characteristics
The mean age of the partners was 39.6 (±11.8), median of 38, range of 18 – 89 years, with majority (39.0%) being in the age group of 31 – 40 years. Only two participants preferred not to say the gender of their spouse, but the majority were male, 63.0% (n = 206). Similar to the participants, the majority of the partners were reported to be informally employed, 63.3% (n = 207). There was a statistical difference between experience of abuse and the following reported partner variables: linkage outcome and HIV test results. Partners who declined HIV testing services abused the participants more than those who accepted (60.0% vs 34.5%, X2 = 4.05, p-value = 0.044). Partners that tested negative after linkage had violated the participants more, 51.4%, than those who turned positive, 29.5%. (X2 = 11.60, p-value = 0.001).
3.4. Factors associated with IPV experience among the study participants
Factors with statistical significance at the chi-square test were used to perform logistic regression to obtain the factors associated with IPV experience following linkage, included: method of disclosure chosen, linkage outcome, and spouse HIV test results after linkage. The factors that remained significantly associated with IPV experience at bivariate analysis i.e., method of disclosure chosen and spouse HIV test results were tested for collinearity and all had a VIF of 1.00. Using a backward stepwise selection model, the final model had a sensitivity of 14.0% and specificity of 97.5%. It could correctly predict IPV experience at 68.7%. The likelihood of experiencing IPV was more than twice if a health worker/provider disclosed the status to the partner. However, partners who turned HIV positive were protective against experiencing IPV, adjusted odds ratio 0.39, 95% confidence interval 0.23 – 0.69, p-value = 0.001.
3.0. Discussion
Assisted Partner Notification has been found effective in identifying and linking to care people living with HIV and is key in HIV prevention and control. Following WHO recommendation, countries with high HIV burden including those in sub-Saharan Africa have implemented assisted partner notification (APN) as a critical strategy to increase HIV testing of partners at risk(Kariuki et al., 2020, Tih et al., 2019, Kamanga et al., 2015, Klabbers et al., 2020, Wamuti et al., 2015). However, IPV among APN index clients may pose a threat to its utilization.
This study is the first in Uganda to describe the prevalence of IPV following APN and the factors related to the prevalence of IPV among the index clients. The prevalence of IPV among the participants was 35.5%, similar to other studies among HIV positive clients in the same region of the country where the same culture is practiced i.e. Kabale at 36.6% among 317 women and 29% among women involved in the Uganda rural treatment outcome cohort(Young et al., 2018, Osinde et al., 2011). However, the prevalence was lower than 58.9% among 10198 women nested from the Rakai Health Science Program Cohort between 2000 to 2009, which used a similar scale to determine IPV(Kouyoumdjian et al., 2013). The difference may be due to studies being done at different times since recently more laws have been reinforced to fight IPV in Uganda(Kyegombe et al., 2015). Our study also included men who surfer less IPV than women thus making the overall prevalence lower, historically men experience less IPV than women with prevalence of 8 – 23%(Reid et al., 2008). The commonest form of IPV experienced by women following APN was emotional violence. This form of abuse is predominant among younger populations and men, a section that experience almost half of the IPV(Karakurt and Silver, 2013). Emotional abuse has been noted to be the main precursor of physical violence and many may resort to emotional abuse rather than physical abuse that is associated with crime and punishments(Karakurt and Silver, 2013).
The prevalence of IPV particularly in women is consistently high in many African countries(Wado et al., 2021). This is consistent with what was found in this study. However, the comparable level of IPV between women and men in this study is surprising considering the fact that women are vulnerable to gender based violence in Uganda and many other parts of Africa(Young et al., 2017). Higher prevalence of IPV in women compared to men have been reported in other studies(Arishaba et al., 2022).
In the current study, IPV was associated with notification being made by a healthcare provider. This may be associated with fear of opening up to a partner probably due to previous history of violence and many opt for assistance from health care providers. In Uganda, especially in western Uganda, partners prefer to be direct with each other and few external parties are involved in family decisions(Manyak and Katono, 2010), a change from the norm can therefore lead to violence, such as use of health workers to tell partners about the HIV status of their spouses. Despite use of health providers increasing the likelihood of experiencing IPV, partners who eventually turned out HIV positive were less likely to abuse their spouses. This may be due to the guilt experienced by the partners since extramarital affairs have been reported to be common among couples in Uganda(Kaggwa et al., 2021). Individuals who eventually turned out positive may already have suspicions of being positive and their nonviolent reaction is a normal reaction following guilt of bringing the infection into the family. This information is of importance to health workers who are involved in APN and may use this as a strategy to inform of less likelihood of violence to the index clients who have multiple sexual partners.
Literature has it that methods of APN differ by country or group of people. Alam et al. (2010) noted that approximately two-thirds (63.5%) of contacts were successfully notified using centralized Internet APN. This is a method that is not practically feasible in most rural parts of Uganda since most Ugandans cannot access reliable internet either due to poverty or connection problems. However, the telephone APN has also been successful in other parts of the world(Udeagu et al., 2014). This method can be used by counsellors to help guide partners of index clients into care and reduce the chances of violence. With partners of our study participants preferring self APN, such methods should be used to compliment APN in Uganda, where applicable. This study had limitations that should be taken into account while interpreting our findings. First, recall bias is a possibility since we recruited clients who tested positive within the last six months. However, violence causes significant physical, emotional, and psychological damage to individuals and such memories cannot easily be repressed. Secondly, we had few individuals who reported sexual violence, which may be a misinterpretation of sexual experience among married couples who culturally may consider such acts violence. In addition, our IPV tool had only one question to assess for sexual of violence. However, the tool has been used in many studies in Uganda. We therefore propose validation of the tool with other standardized tools for IPV. Our findings show that IPV is common among index clients upon disclosure of their positive HIV test results to this partners. This calls for integration of IPV screening into HIV testing services as well as care for those who are affected especially among those who are vulnerable such as women. We envisage this will increase uptake of HIV partner notification programs.
Figure 1.
Number of participants experiencing different forms of intimate partner violence.
Table 1:
The association between participants’ variables and intimate partner violence
| Variable | n = 327 (%) | No IPV n = 211 (64.5%) | IPV n = 116 (35.5%) | X2, p value |
|---|---|---|---|---|
| Age categories | ||||
| 18 – 30 | 95 (29.0) | 54 (56.8) | 41 (43.2) | 4,02 (0.260) |
| 31 – 40 | 88 (26.9) | 57 (64.8) | 31 (35.2) | |
| 41 – 50 | 87 (26.6) | 61 (70.1) | 26 (29.9) | |
| Above 50 | 57 (17.4) | 39 (68.4) | 18 (31.6) | |
| Gender | ||||
| Female | 208 (63.6) | 134 (64.4) | 74 (35.6) | 0 (0.956) |
| Male | 119 (36.4) | 77 (64.7) | 42 (35.3) | |
| Occupation | ||||
| Not formally employed | 87 (26.6) | 47 (54.0) | 40 (46.0) | 7.54 (0.057) |
| Formally employed | 20 (6.1) | 14 (70.0) | 6 (30.0) | |
| Informally employed | 216 (66.1) | 146 (67.6) | 70 (32.4) | |
| Retired | 4 (1.2) | 4 (100) | 0 | |
| Level of education | ||||
| No formal education | 120 (36.7) | 77 (64.2) | 43 (35.8) | 2.30 (0.682) |
| Completed PLE | 144 (44.0) | 97 (67.4) | 47 (32.6) | |
| Completed O’level | 44 (13.5) | 25 (56.8) | 19 (43.2) | |
| Completed A’level | 1 (0.3) | 1 (100) | 0 | |
| Completed tertiary level | 18 (5.5) | 11 (61.1) | 7 (38.9) | |
| History of substance of addiction use in the past one year | ||||
| No | 184 (56.3) | 118 (64.1) | 66 (35.9) | 0.03 (0.865) |
| Yes | 143 (43.7) | 93 (65.0) | 50 (35.0) | |
| Acceptance of the partner disclosure | ||||
| Declined partner to be notified | 4 (1.2) | 2 (50.0 | 2 (50.0) | 0.37 (0.541) |
| Accepted partner to be notified | 323 (98.8) | 209 (64.7) | 114 (35.3) | |
| Method of disclosure chosen | ||||
| Self-disclosure | 249 (76.4) | 170 (68.3) | 79 (31.7) | 7.16 (0.028) |
| Assisted disclosure | 10 (3.1) | 6 (60.0) | 4 (40.0) | |
| Health worker/provider disclosure | 67 (20.5) | 34 (50.7) | 33 (49.3) | |
Table 2:
The association between partners’ characteristics and IPV as reported by the participants
| Variable | n = 327 (%) | No IPV n = 211 (64.5%) | IPV n = 116 (35.5%) | X2, p value |
|---|---|---|---|---|
| Age | ||||
| 18 – 30 | 89 (27.2) | 55 (61.8) | 34 (38.2) | 2.04 (0.564) |
| 31 – 40 | 100 (30.6) | 61 (61.0) | 39 (39.0) | |
| 41 – 50 | 86 (26.3) | 60 (69.8) | 26 (30.2) | |
| Above 50 | 52 (15.9) | 35 (67.3) | 17 (32.7) | |
| Gender | ||||
| Female | 119 (36.4) | 76 (63.9) | 43 (36.1) | 1.12 (0.571) |
| Male | 206 (63.0) | 133 (64.6) | 73 (35.4) | |
| Preferred not to say | 2 (0.6) | 2 (100) | 0 | |
| Occupation | ||||
| Not formally employed | 90 (27.5) | 56 (62.2) | 34 (37.8) | 1.18 (0.758) |
| Formally employed | 26 (8.0) | 15 (57.7) | 11 (42.3) | |
| Informally employed | 207 (63.3) | 137 (66.2) | 70 (33.8) | |
| Retired | 4 (1.22) | 3 (75.0) | 1 (25.0) | |
| Level of education | ||||
| No formal education | 95 (29.2) | 61 (64.2) | 34 (35.8) | 2.10 (0.717) |
| Completed PLE | 151 (46.5) | 102 (67.5) | 49 (32.5) | |
| Completed O’level | 45 (13.8) | 26 (57.8) | 19 (42.2) | |
| Completed A’level | 11 (3.4) | 6 (54.5) | 5 (45.5) | |
| Completed tertiary level | 23 (7.1) | 14 (60.9) | 9 (39.1) | |
| History of substance of addiction use in the past one year | ||||
| No | 141 (43.1) | 96 (68.1) | 45 (31.9) | 1.37 (0.242) |
| Yes | 186 (56.9) | 115 (61.8) | 71 (38.2) | |
| Linkage outcomes | ||||
| Accepted HIV testing services | 310 (95.4) | 203 (65.5) | 107 (34.5) | 4.05 (0.044) |
| Declined HIV testing services | 15 (4.6) | 6 (40.0) | 9 (60.0) | |
| If accepted, duration taken to HIV testing services | ||||
| 1 – 3 weeks | 69 (21.1) | 42 (60.9) | 27 (39.1) | 4.33 (0.228) |
| 4 – 6 weeks | 73 (22.3) | 43 (58.9) | 30 (41.1) | |
| Above 6 weeks | 168 (51.8) | 117 (69.6) | 51 (30.4) | |
| Never | 17 (5.2) | 9 (52.9) | 8 (47.1) | |
| If accepted, HIV test results | ||||
| Negative | 70 (22.5) | 34 (48.6) | 36 (51.4) | 11.60 (0.001) |
| Positive | 241 (77.5) | 170 (65.6) | 107 (29.5) | |
| If HIV positive, linkage to ART | ||||
| No | 7 (2.9) | 4 (57.1) | 3 (42.9) | 0.63 (0.428) |
| Yes | 231 (97.1) | 164 (71.0) | 67 (29.0) | |
Table 3:
Factors associated with IPV experience among the study participants
| Variables associated | Intimate partner violence experience after linkage | |||||
|---|---|---|---|---|---|---|
| Crude odds ratio | 95% confidence interval | p-value | Adjusted odds ratio | 95% confidence interval | p-value | |
| Method of disclosure chosen | ||||||
| Self-disclosure | - | - | - | - | - | - |
| Assisted disclosure | 1.43 | 0.39, 5.23 | 0.584 | 2.32 | 0.55, 9.78 | 0.254 |
| Health worker/provider disclosure | 2.09 | 1.21, 3.61 | 0.008 | 2.19 | 1.23, 3.87 | 0.007 |
| Linkage outcomes | ||||||
| Accepted HIV testing services | - | - | - | - | - | - |
| Declined HIV testing services | 2.85 | 0.99, 8.21 | 0.053 | NA | NA | NA |
| If accepted, HIV test results | ||||||
| Negative | - | - | - | - | - | - |
| Positive | 0.39 | 0.23, 0.68 | 0.001 | 0.39 | 0.23, 0.69 | 0.001 |
Acknowledgment:
We are grateful to the HEPI-TUITAH MICRO-RESEARCH AWARD under Grant No: R25TW011210 for selecting us among the winning teams to be supported to conduct this study. We thank the facilitators of Micro research training for introducing us to research methods. In a special way we thank the facilitator of aim one for teaching about HIV/AIDS using Low Dose High Frequency approach, which has enabled us to appreciate the challenges around the care of HIV/AIDS patients where this study generated the gap for investigation.
Funding:
This research was supported by the Fogarty International Centre (U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy [S/GAC] and the President’s Emergency Plan for AIDS Relief [PEPFAR]) of the National Institutes of Health under Award Number R25TW011210. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health”.
Footnotes
Conflict of interest: The authors declare that they have no conflict of interest.
Ethical approval and consent of participants: The study was conducted in accordance with the Declaration of Helsinki. The study received ethics approval from research ethics committee of Mbarara University of Science and Technology (approval number: MUSTREC #01/12–20). All participants provided voluntary written informed consent at study enrollment.
Consent for publication: Participants consented to the publication of the information obtained from them.
Availability of data and materials:
The datasets used and/or analyzed during the current study are available from the corresponding author SM on reasonable request.
References
- ARISHABA A, KIDUUMA W, NIGHT G, ARINAITWE I, NIYONZIMA V & MUBANGIZI V 2022. Predictors and factors associated with counseling seeking behavior against intimate partner violence among HIV-positive women in southwestern Uganda. HIV/AIDS (Auckland, NZ), 14, 275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- COCHRAN WG 2007. Sampling techniques, John Wiley & Sons. [Google Scholar]
- KABWAMA SN, BUKENYA J, MATOVU JK, GWOKYALYA V, MAKUMBI F, BEYEZA-KASHESYA J, MUGERWA S, BWANIKA JB & WANYENZE RK 2019. Intimate partner violence among HIV positive women in care-results from a national survey, Uganda 2016. BMC women’s health, 19, 1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KAGGWA MM, NAMATANZI B, KULE M, NKOLA R, NAJJUKA SM & ASHABA S 2021. Intimate partner violence, spouse extramarital affairs, and depression among women in rural Uganda. [DOI] [PMC free article] [PubMed]
- KAMANGA G, BROWN L, JAWATI P, CHIWANDA D & NYIRENDA N 2015. Maximizing HIV partner notification opportunities for index patients and their sexual partners in Malawi. Malawi Medical Journal, 27, 140–144. [PMC free article] [PubMed] [Google Scholar]
- KARAKURT G & SILVER KE 2013. Emotional abuse in intimate relationships: The role of gender and age. Violence and victims, 28, 804–821. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KARIUKI RM, RITHAA GK, OYUGI EO & GACHATHI DM 2020. What is the level of uptake of partner notification services in HIV testing in selected health facilities in Gatanga Sub County, Muranga County–Kenya; a retrospective study. BMC infectious diseases, 20, 1–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KLABBERS RE, MUWONGE TR, AYIKOBUA E, IZIZINGA D, BASSETT IV, KAMBUGU A, TSAI AC, RAVICZ M, KLABBERS G & O’LAUGHLIN KN 2020. Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda. Journal of global health, 10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KLABBERS RE, MUWONGE TR, AYIKOBUA E, IZIZINGA D, BASSETT IV, KAMBUGU A, TSAI AC, RAVICZ M, KLABBERS G & O’LAUGHLIN KN 2021. Health worker perspectives on barriers and facilitators of assisted partner notification for HIV for refugees and ugandan nationals: A mixed methods study in West Nile Uganda. AIDS and Behavior, 1–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KOUYOUMDJIAN FG, CALZAVARA LM, BONDY SJ, O’CAMPO P, SERWADDA D, NALUGODA F, KAGAAYI J, KIGOZI G, WAWER M & GRAY R 2013. Intimate partner violence is associated with incident HIV infection in women in Uganda. Aids, 27, 1331–1338. [DOI] [PubMed] [Google Scholar]
- KYEGOMBE N, ABRAMSKY T, DEVRIES KM, MICHAU L, NAKUTI J, STARMANN E, MUSUYA T, HEISE L & WATTS C 2015. What is the potential for interventions designed to prevent violence against women to reduce children’s exposure to violence? Findings from the SASA! study, Kampala, Uganda. Child Abuse & Neglect, 50, 128–140. [DOI] [PubMed] [Google Scholar]
- MANYAK TG & KATONO IW 2010. Conflict management style in Uganda: a gender perspective. Gender in Management: An International Journal. [Google Scholar]
- MOH 2018. Assisted Partner Notification Training for Providers in Clinical Settings. Kampala Uganda. [Google Scholar]
- MOH 2019. Uganda population-based HIV impact assessment (UPHIA) 2016–2017. Ministry of Health, Uganda Kampala, Uganda. [Google Scholar]
- NAMIMBI F, AKUJU F, SSUUNA M, NASUUNA E, MWONDHA R & ALAMO S Assisted partner notification services in Kampala, Uganda. conference on retroviruses and opportunistic infections, 2020. [Google Scholar]
- OSINDE MO, KAYE DK & KAKAIRE O 2011. Intimate partner violence among women with HIV infection in rural Uganda: critical implications for policy and practice. BMC women’s health, 11, 1–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- REID RJ, BONOMI AE, RIVARA FP, ANDERSON ML, FISHMAN PA, CARRELL DS & THOMPSON RS 2008. Intimate partner violence among men: Prevalence, chronicity, and health effects. American Journal of Preventive Medicine, 34, 478–485. [DOI] [PubMed] [Google Scholar]
- SILEO KM, KINTU M & KIENE SM 2018. The intersection of intimate partner violence and HIV risk among women engaging in transactional sex in Ugandan fishing villages. AIDS care, 30, 444–452. [DOI] [PMC free article] [PubMed] [Google Scholar]
- STRAUS MA 2017. Measuring intrafamily conflict and violence: The conflict tactics (CT) scales, Routledge. [Google Scholar]
- TIH PM, TEMGBAIT CHIMOUN F, MBOH KHAN E, NSHOM E, NAMBU W, SHIELDS R, WAMUTI BM, GOLDEN MR & WELTY T 2019. Assisted HIV partner notification services in resource‐limited settings: experiences and achievements from Cameroon. Journal of the International AIDS Society, 22, e25310. [DOI] [PMC free article] [PubMed] [Google Scholar]
- UBOS I 2017. Uganda Demographic and Health Survey 2016 Key Indicators Report (March).
- UDEAGU C-CN, BOCOUR A, SHAH S, RAMOS Y, GUTIERREZ R & SHEPARD CW 2014. Bringing HIV partner services into the age of social media and mobile connectivity. Sexually transmitted diseases, 41, 631–636. [DOI] [PubMed] [Google Scholar]
- UDHS, I. 2011. Uganda demographic and health survey. Uganda Bureau of Statistics, Kampala Uganda. [Google Scholar]
- UNAIDS 2014. Fast-Track - Ending the AIDS epidemic by 2030. Geneva. [Google Scholar]
- WADO YD, MUTUA MK, MOHIDDIN A, IJADUNOLA MY, FAYE C, COLL CV, BARROS AJ & KABIRU CW 2021. Intimate partner violence against adolescents and young women in sub-Saharan Africa: who is most vulnerable? Reproductive health, 18, 1–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WAMUTI BM, ERDMAN LK, CHERUTICH P, GOLDEN M, DUNBAR M, BUKUSI D, RICHARDSON B, BARNABAS R, MUTITI PM & MACHARIA P 2015. Assisted partner notification services to augment HIV testing and linkage to care in Kenya: study protocol for a cluster randomized trial. Implementation Science, 10, 1–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WHO 2013. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines, World Health Organization. [PubMed] [Google Scholar]
- YOUNG CR, KAIDA A, KABAKYENGA J, MUYINDIKE W, MARTIN JN, HUNT PW, BANGSBERG DR, HABERER JE & MATTHEWS LT Prevalence and Risk Factors for Intimate Partner Violence in Women Living with HIV in Uganda. Open Forum Infectious Diseases, 2017. Oxford University Press; US, S663–S663. [Google Scholar]
- YOUNG CR, KAIDA A, KABAKYENGA J, MUYINDIKE W, MUSINGUZI N, MARTIN JN, HUNT PW, BANGSBERG DR, HABERER JE & MATTHEWS LT 2018. Prevalence and correlates of physical and sexual intimate partner violence among women living with HIV in Uganda. PloS one, 13, e0202992. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author SM on reasonable request.