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. 2025 Jul 9;25:2421. doi: 10.1186/s12889-025-23609-z

Intimate partner violence among women living with HIV in East Africa: a systematic review and meta-analysis

Gossa Fetene Abebe 1,✉, Melsew Setegn Alie 1, Amanuel Adugna 1, Nigusie Shifera 2, Wubetu Agegnehu 2, Tewodros Yosef 2,3, Desalegn Girma 1
PMCID: PMC12239382  PMID: 40634913

Abstract

Background

Intimate partner violence (IPV) is a widespread yet often unrecognized problem that affects millions of women worldwide. It is prevalent among marginalized individuals, such as women living with HIV. However, there is a dearth of available evidence concerning this matter among women living with HIV in East Africa.

Objective

We systematically reviewed and analyzed the existing evidence on the prevalence of IPV and its associated factors among women living with HIV in East Africa.

Methods

We included all primary cross-sectional studies published before 20th June/2024. PubMed, HINARI, Web of Science, African Journal Online, ScienceDirect, and Google Scholar were searched. To appraise the included studies, the Joanna Briggs Institute checklist was used. We used the I2 test to determine the heterogeneity of the included studies. Publication bias was assessed using funnel plot and Egger’s test. Lastly, the IPV among women living with HIV and its associated factors were presented using pooled proportion and odds ratio with a 95% confidence interval.

Results

Eighteen cross-sectional studies involving 11,168 individuals were included. The pooled prevalence of intimate partner violence among women living with HIV in East Africa was 54.6% (95% CI, 44.1-65.1%). The odds of IPV among women living with HIV in East Africa were high for those with low monthly income (OR: 2.96, 95% CI: 1.32–6.68), alcohol-drinking partners (OR: 2.24, 95% CI: 1.54–3.28), multiple sexual partners (OR: 2.29, 95% CI: 1.52–3.43), experiences of controlling behavior by an intimate partner (OR: 4.65, 95% CI: 2.79–7.73), and favorable attitudes towards wife-beating (OR: 2.56, 95% CI: 1.87–3.51).

Conclusion

In East Africa, the prevalence of IPV among women living with HIV was found to be high. As a result, it is crucial to implement focused and targeted interventions that promote behavioral change. Also, the findings emphasize the necessity of establishing and organizing support networks to address IPV among women living with HIV.

Trial registration

Registered in PROSPERO with ID: CRD42024565464.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-23609-z.

Keywords: Intimate partner violence, Women living with HIV, East Africa, Systematic Review

Introduction

Intimate partner violence (IPV) is defined as a behavior by an intimate partner or ex-partner that leads to physical, sexual, or psychological harm [1]. It’s recognized as a threat to human rights, and deprivation of individual liberty and freedom [2], and has prompted serious global public health problems, and an impediment to sustainable development [3].

Globally, one in three ever-partnered women have experienced IPV in their lifetime [4]. The burden of IPV disproportionately affects women in low-income and middle-income countries than high-income countries, for example, 32% in central Africa and 24% in eastern Sub-Saharan Africa, 19% in South Asia, and 4–6% in Europe and North America [5]. Another study noted that the low-income countries share the highest burden, at a prevalence of 48·1%, followed by 29·6% in upper-middle-income countries, and 24·6% in low-middle-income countries [6].

IPV is both a cause and effect of HIV in women [7], for instance, women who experience IPV may have limited ability to negotiate safe sex practice, increasing their vulnerability to HIV infection [8]. Women living with HIV (WLHIV) faces a higher risk of experiencing IPV compared to HIV-negative women due to stigma and discrimination, dependency, power imbalance, HIV-related vulnerabilities, fear of disclosure, and lack of social support [8–11].

IPV is a major public health problem strongly associated with WLHIV in East Africa [12, 13]. The IPV experienced by WLHIV has been shown to impact their engagement in HIV care and treatment [14], decrease adherence to antiretroviral therapy [14, 15], and reduce the likelihood of achieving viral suppression [14, 16, 17]. IPV also can have major short-term and long-term negative health consequences, for instance, injuries, depression, anxiety, unwanted pregnancies, sexually transmitted infections including HIV/AIDS, and death [18–21]. In addition, IPV has significant financial implications for individuals, families, and society as a whole [22–24].

IPV and HIV/AIDS are two pandemics that require integrated and collaborative interventions [7, 25]. To address these global pandemics, the Sustainable Development Goals (SDGs) has called for member countries to end the HIV epidemic (target 3.2) and eliminate all forms of violence against women (target 5.2) by 2030 [26]. And the UNAIDS 10-10-10 targets also calling to reduce less than 10% of PLHIV, including women, children, and key populations, experience violence [27, 28]. However, in East Africa, the proportion of IPV among WLHIV is prevalent as the primary studies was conducted in different places in the region [29–35]. Previous studies in East Africa countries have reported varying rates of IPV among WLWHA, ranging from 14.6 to 100% [34, 36] and several factors have been identified as risk factors for experiencing IPV among WLHIV [29–33, 35–42].

These primary studies were done in a fragmented manner across different East Africa countries, and the pooled prevalence of IPV among WLHIV has not been determined in East Africa countries. Therefore, in this systematic review and meta-analysis, we aimed to synthesize the available evidence on the pooled prevalence of IPV and its associated factors among WLHIV in East Africa countries. The findings will provide valuable insights into the burden of IPV in this population, inform the development of effective interventions, and contribute to the achievement of SDGs ending all form of IPV.

Methods

Study setting and period

We included studies conducted among countries listed in the East Africa region [43]; Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Mauritius, Rwanda, Seychelles, Somalia, South Sudan, Sudan, Tanzania, and Uganda. We searched all databases started from 1 st May/2024 to 20th June/2024.

Search strategies

This systematic review has adhered to the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guideline and checklist [44]. PubMed, African Journals Online, HINARI, ScienceDirect, Google Scholar, and direct Google were searched for relevant studies on IPV among WLHIV in East Africa. To account for the missed studies in the database, all reference lists of eligible studies were retrieved. All primary cross-sectional studies published before 20th June, 2024 were included. The search was done using keywords such as intimate partner violence, or gender-based violence, or physical violence, or sexual violence, or emotional violence and HIV-positive women, or women living HIV, or WLHIV, and associated factors, or determinants, or predictors, and countries found in East Africa. We used combinations of Boolean operators (AND, OR), free keywords, and MeSH terms in the search process (Additional file 1).

Eligibility criteria

We used the following inclusion criteria; (1) studies employed in East Africa countries, (2) all cross-sectional studies, (3) studies reporting the prevalence of IPV among WLHIV and/or associated or determinant factors or predictors, and (4) studies published as full-length articles in English. Conference papers or abstracts, articles lacking full texts, anonymous reports, editorial reports, and qualitative studies were excluded from the study.

Data extraction

Four researchers extracted the data from all the included studies using Microsoft Excel spreadsheet. In case of any discrepancies between the data extractors, discussions were held and resolved by the three different researchers. The information extracted from each study included the author’s name, publication year, number of WLHIV experiencing IPV, prevalence of IPV among WLHIV, name of country, study design, and associated factors such as odds ratios.

Quality assessment/critical appraisal

The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies was used to assess the quality of the study [45]. Two researchers independently assessed the quality of each article using a critical appraisal checklist adapted from JBI (Additional file 2). During the critical appraisal process, if any disagreement happened, the reviewers held discussions to address and resolve the issues.

Statistical analysis

Data entry was performed using the Microsoft excel database, and the entered data was imported into R software version 4.1.3 for further analysis utilizing the Meta-package. The I2 index was used to assessed the heterogeneity between studies [46], where values of 25%, 50%, and 75% noted low, medium, and high heterogeneity, respectively [47]. Publication bias was evaluated by visually inspecting the symmetry of the funnel plot and conducting the Egger test. In the Egger test, the presence of publication bias was determined by observing a p-value of less than 0.05. By considering the sample size and year of publication, a univariate meta-regression analysis was employed to identify potential sources of heterogeneity. Moreover, a leave-one-out sensitivity analysis was performed, systematically removing one study at a time to assess the impact of each individual study on the overall estimate [48]. Furthermore, a trim-and-fill analysis was conducted to assess the extent of distortion in the pooled prevalence of IPV among WLHIV caused by publication bias. The results are presented in a forest plot, displaying a point estimate along with 95% confidence intervals. All analyses were performed using R software version 4.1.3.

Results

Characteristics of the studies included in the meta-analysis and systematic review

We identified a total of 3,154 articles through different search strategies. Then, a total of 2,124 records due to duplication, 993 articles due to inappropriate titles and abstracts, and 19 articles due to noncompliance with inclusion criteria were eliminated. Lastly, we included 18 articles that met the eligibility criteria (Fig. 1).

Fig. 1.

Fig. 1

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PRISMA flow chart showing the process of search and selection of studies included in the systematic review and meta-analysis

A total of 11,168 individual participants participated, with sample sizes ranging from 162 in Rwanda [33] to 5,198 in Uganda [13] (Table 1).

Table 1.

Characteristics of the studies included in the meta-analysis and systematic review

Authors Country Study design N WLHIV experiencing IPV Prevalence
Mathania, M. et al., 2023 [29] Tanzania Cross-sectional study 411 270 65.7%
Biranu, S. et al., 2023 [30] Ethiopia Cross-sectional study 412 175 41.7%
Alemie, A. et al., 2023 [31] Ethiopia Cross-sectional study 626 402 64.2%
Kaggiah, A. et al., 2022 [32] Kenya Cross-sectional study 159 47 29.6%
Hatoum, S. et al., 2022 [33] Rwanda Cross-sectional study 162 44 27%
Bloom, B. et al., 2022 [37] Uganda Cross-sectional study 168 114 68%
Arishaba, A. et al., 2022 [35] Uganda Cross-sectional study 296 196 66.2%
Hatcher, A. et al., 2021 [38] Kenya Cross-sectional study 396 228 57.6%
Aloyce, Z. et al., 2021 [40] Tanzania Cross-sectional study 327 279 85.3%
Biomndo, B. et al., 2021 [39] Kenya Cross-sectional study 408 310 76%
Ogbonnaya, I. et al., 2020 [41] Uganda Cross-sectional study 216 156 72.2%
Goyomsa, G. et al., 2020 [42] Ethiopia Cross-sectional study 396 128 32.3%
Meskele, M. et al., 2019 [49] Ethiopia Cross-sectional study 408 250 61.3%
Kabwama, S. et al., 2019 [13] Uganda Cross-sectional study 5198 2290 44.2%
Brooks, R. et al., 2019 [34] Kenya Cross-sectional study 600 600 100%
Wilson, K. et al., 2016 [36] Kenya Cross-sectional study 357 52 14.6%
Deribe, L. et al., 2016 [50] Ethiopia Cross-sectional study 311 143 46%
Osinde, M. et al., 2011 [51] Uganda Cross-sectional study 317 93 29.3%
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Key: N = Total number of participants

Pooled prevalence of intimate partner violence among WLHIV in East Africa

The pooled prevalence of intimate partner violence among WLHIV in East Africa was 54.6% (95% CI, 44.1-65.1%) (Fig. 2). The highest prevalence was reported from Tanzania, 75.5%, while the lowest was reported from Rwanda, 27.2% (Fig. 3).

Fig. 2.

Fig. 2

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Forest plot showing the pooled prevalence of IPV among women living with HIV in East Africa

Fig. 3.

Fig. 3

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Forest plot shows the subgroup analysis of the pooled prevalence of IVP among women living with HIV in East Africa

Assessment of publication bias

Our findings revealed that the funnel plot displayed an asymmetrical distribution of studies in the line of effect (Fig. 4). The Egger’s test also noted a significant value for publication bias (P = 0.002). A trim-and-fill analysis noted that ten studies were filled and the pooled prevalence of IPV among WLHIV became 55.38% (95% CI: 43.76, 75.43) (Fig. 5).

Fig. 4.

Fig. 4

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Funnel plot showing evaluation of publication bias among included studies in the pooled proportion of IVP among women living with HIV in East Africa

Fig. 5.

Fig. 5

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Funnel plot shows the trim and fill analysis for the pooled prevalence of IVP among women living with HIV in East Africa

Meta-regression and sensitivity analysis

The meta-regression analysis showed that none of the study characteristics, such as publication year and sample size, showed any association with the pooled estimates (P > 0.05) (Table 2).

Table 2.

Meta regression analysis of factors affecting between study heterogeneity

Variables Coefficients P-value
Publication years 0.0252 (−0.009, 0.059) 0.15
Sample size 0.0000 (−0.0001, 0.0001) 0.77
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The sensitivity analysis results showed that almost all studies made comparable contributions to the overall prevalence of IPV among WLHIV in East Africa. When each study was omitted from the analysis, the pooled prevalence of IPV ranged from 51.9 to 57% (Fig. 6).

Fig. 6.

Fig. 6

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Forest plot showing sensitivity analysis for the pooled prevalence of IPV among women living with HIV in East Africa

Factors associated with IPV among WLHIV in East Africa

In this meta-analysis, we found significant factors associated with IPV among HIV-positive women in East Africa. The odds of IPV among WLHIV were high for those with low monthly income, alcohol-drinking partners, multiple sexual partners, experiences of controlling behavior by an intimate partner, and favorable attitudes towards wife beating.

Three studies [31, 34, 49], involving a total of 1,634 participants, examined the association between low monthly income and IPV among WLHIV. The random effect model analysis revealed a significant association between low monthly income and experiencing IPV among WLHIV. Thus, the odds of experiencing IPV among WLHIV were three times higher among those low monthly income WLHIV compared to their counterparts (OR: 2.96, 95% CI: 1.32–6.68) (Fig. 7).

Fig. 7.

Fig. 7

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Forest plot showing the association between low monthly income and IPV among women living with HIV in East Africa

Two studies [31, 49], including a total of 1,034 individuals, assessed the association between partner drinking alcohol and IPV among WLHIV. The random effect model analysis identified a significant association between partner drinking alcohol and experiencing IPV among WLHIV. Thus, the odds of experiencing IPV among WLHIV were two times higher than those not having alcohol drinking partner (OR: 2.24, 95% CI: 1.54–3.28) (Fig. 8).

Fig. 8.

Fig. 8

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Forest plot showing the association between partner drinking alcohol and IPV among women living with HIV in East Africa

Two studies [42, 49], incorporating a total of 804 participants, investigated the association between having multiple sexual partners and IPV among WLHIV. The random effect model analysis showed a significant association between having multiple sexual partners and experiencing IPV among WLHIV. Having multiple sexual partners had two times higher odds of experiencing IPV among WLHIV as compared to women having single sexual partner (OR: 2.29, 95% CI: 1.52–3.43) (Fig. 9).

Fig. 9.

Fig. 9

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Forest plot showing the association between having multiple sexual partners and IPV among women living with HIV in East Africa

Five studies [30, 32, 36, 49, 50], involving a total of 1,647 individual participants, examined the association between experiencing controlling behavior by intimate partner and IPV among WLHIV. The random effect model analysis noted a significant association between experiences of controlling behavior by an intimate partner and IPV among WLHIV. WLHIV who reported controlling behavior by an intimate partner were five times higher odds of experiencing IPV as compared to their counterparts (OR: 4.65, 95% CI: 2.79–7.73) (Fig. 10).

Fig. 10.

Fig. 10

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Forest plot showing the association between experiencing controlling behaviour by an intimate partner and IPV among women living with HIV in East Africa

Four studies [30, 42, 49, 50], including a total of 1,527 participants, assessed the association between women have favorable attitudes towards wife-beating and IPV among WLHIV in East Africa. The random effect model analysis depicted a significant association between women who had favorable attitude that justifies wife-beating were nearly 2.6 times higher odds of experiencing IPV among WLHIV as compared to their counterparts (OR: 2.56, 95% CI: 1.87–3.51) (Fig. 11).

Fig. 11.

Fig. 11

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Forest plot showing the association between women having a favourable attitude about wife beating and IPV among women living with HIV in East Africa

Discussion

The pooled prevalence of IPV among WLHIV in East Africa was found to be 54.6% (95% CI, 44.1-65.1%). This finding is consistent with studies done in Democratic Republic of Congo (51%) [52], and UK (51.8%) [53]. However, this result is higher than studies done in Southwest Nigeria (23.6%) [54], South Africa (21%) [55], Coastal City of South India (19.2%) [56], and southern Alberta (40.4%) [57]. This variation might be attributed to differences in their different cultures, study periods and source populations.

In the current study, we identified the factors associated with IPV among WLHIV in East Africa. Accordingly, the odds of experiencing IPV is higher among low monthly income WLHIV as compared to their counterparts. This finding is supported with studies done in Nigeria [58] and England [59]. The possible explanation could be that low monthly income often leads to financial dependence and limited resources, making it harder for these women to leave abusive relationships. Also, low-income WLHIV may face additional power imbalances due to their socioeconomic status and health condition, making them more vulnerable to abuse.

Consistent with studies done in China [60], Nigeria [61], and Sub-Saharan Africa [62], the odds of experiencing IPV among WLHIV who had alcohol drinking partners were higher than those whose partner did not drinking alcohol. This could be because alcohol use can contribute to increased aggression and impaired judgment, which may lead to violent behavior. Moreover, alcohol use can affect communication and conflict resolution skills, further exacerbating the risk of violence within a relationship.

In line with study done in Nigeria [61], having multiple sexual partners were higher odds of experiencing IPV among WLHIV as compared to their counterparts. The possible reason could be the fact that engaging in sexual relationships with multiple partners can increase the risk of jealousy, conflict, and power imbalances within relationships. As a result, the likelihood of experiencing IPV is increased.

In agreement with studies conducted in Vietnam [63], and Sub-Saharan Africa [64], WLHIV who experienced partner controlling behavior were higher odds of having IPV as compared to their counterparts. This could be attributed to the fact that controlling behavior can exacerbate their vulnerability and limit their ability to assert their rights and seek support. Furthermore, WLHIV who are subjected to control may face additional barriers in seeking help due to the fear of disclosure, stigma, and the potential consequences of leaving the relationship. This can further perpetuate the cycle of abuse and hinder their ability to protect themselves.

Lastly, we found a significant association between women who hold favorable attitudes that justify wife-beating and a higher likelihood of experiencing IPV among WLHIV compared to their counterparts. This finding is supported by studies done in Togo [65], Pakistan [66], and Sub-Saharan Africa [62]. The possible justification could be that justifying wife-beating can undermine efforts to address and prevent IPV, as it sends a message that violence is an acceptable response to disagreement, rather than promoting healthier alternatives such as communication, negotiation, and respect.

The clinical and public health implication

This study significantly contributes to the existing body of knowledge by providing insights into the pooled prevalence and persistent factors associated with IPV among WLHIV. Policymakers and planners must now prioritize these identified determinants to reduce the burden of IPV. The Minister of Health in the East Africa countries, in collaboration with non-governmental organizations, should place special emphasis on IPV among WLHIV with low monthly income, having alcohol-drinking partners, multiple sexual partners, experiencing of controlling behavior by an intimate partner, and favorable attitudes towards wife beating. Addressing these factors will reduce the burden of IPV, contributing for the successful completion of the SDGs. To reduce the burden of IPV and contribute to the successful achievement of the SDGs, we must take action, for instance, integrating educational initiatives that focus on healthy relationships, consent, and gender equality topics into school curricula can empower young people to recognize and reject abusive behaviors.

Strength and limitation

This systematic review has several strengths. Firstly, we searched multiple databases to include all studies. Secondly, our study shed light on the pooled prevalence estimates of IPV among WLHIV in East Africa. Also, we identified the factors associated with the IPV in WLHIV, which is crucial for preventive public health efforts. However, this review does have certain limitations. Firstly, we only included articles published in English. Secondly, the cross-sectional design of the included studies may limit our ability to establish a causal association between IPV among WLHIV and the associated factors. Thirdly, some factors were only reported in a single study, preventing the calculation of a pooled effect size. Lastly, some of the sample sizes for countries were small; and WLHIV had variations in populations, for instance, pregnant women, married women, or women who are commercial sex worker.

Conclusion

The pooled prevalence of IPV among WLHIV in East Africa was found to be high. Low monthly income, alcohol-drinking partners, multiple sexual partners, experiences of controlling behavior by an intimate partner, and favorable attitudes towards wife-beating were the factors associated with IPV among WLHIV. It underscores the need to implement targeted behavioral change interventions, like increasing community and women’s awareness of the severe consequences of violence, the detrimental effects of alcohol consumption, and the need for women’s economic empowerment. Both governmental and non-governmental organizations working in the area of women’s health should give due emphasis to the identified modifiable factors and develop and implement effective strategies to address them. The literature on the prevalence of IPV among WLHIV in East Africa is limited, and more longitudinal studies are required to examine the causal connections of IPV among WLHIV.

Supplementary Information

12889_2025_23609_MOESM1_ESM.docx (15.2KB, docx)

Additional file 1: Search terms summary.

12889_2025_23609_MOESM2_ESM.docx (19.6KB, docx)

Additional file 2: Critical appraisal of studies included in the systematic review and meta-analysis for pooled prevalence of IPV among HIV-positive women in East Africa.

Acknowledgements

Not applicable.

Authors’ contributions

GA was initiated the conception of the study. All authors (GA, MA, AA, NS, WA, TY, and DG) participated in the data extraction, analysis, interpretation of the result, and drafting of the article. All authors engaged fully in revising the article, agreed on the journal to which the article will be sent for publication, gave final approval of the version to be published, and agreed to take responsibility for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, or publication.

Data availability

All relevant data are within the manuscript and its supporting information file.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

12889_2025_23609_MOESM1_ESM.docx (15.2KB, docx)

Additional file 1: Search terms summary.

12889_2025_23609_MOESM2_ESM.docx (19.6KB, docx)

Additional file 2: Critical appraisal of studies included in the systematic review and meta-analysis for pooled prevalence of IPV among HIV-positive women in East Africa.

Data Availability Statement

All relevant data are within the manuscript and its supporting information file.

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