title: Non-consensual sex and association with incident HIV infection among women: a cohort study in rural Uganda, 1990-2008.
abstract: Non-consensual sex is associated with HIV infection in Africa, but there is little longitudinal data on this association. We describe reported non-consensual sex among women over two decades in southwest Uganda, including associations with incident HIV infection. Between 1990 and 2008, individuals in a population cohort who recently seroconverted to HIV were enrolled into a clinical cohort, along with randomly selected HIV-negative controls. Participants were invited to the study clinic every 3 months, and females asked about recent experiences of sex against their will. Associations of non-consensual sex with HIV status were analyzed prospectively using conditional logistic regression, adjusting for age and year of interview, allowing for within-woman correlation. 476 women aged 14-81 enrolled and attended 10,475 visits over 19 years. The results show high levels of repeated non-consensual sex, often long after HIV infection. There was more reporting among women living with HIV compared to HIV-negative women (22 vs 9 %; OR = 2.29, 95 %CI 1.03-5.09), with the strongest associations among married participants. HIV programmes should address repeated sexual coercion before and subsequent to HIV infection.
authors.affiliation: Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. Isolde.Birdthistle@lshtm.ac.uk
authors.forename: Isolde
authors.initials: I
authors.lastname: Birdthistle
authors.forename: Billy N
authors.initials: BN
authors.lastname: Mayanja
authors.forename: Dermot
authors.initials: D
authors.lastname: Maher
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003068:Coercion; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission*; D006679:HIV Seropositivity / Q000453:epidemiology / Q000523:psychology / Q000635:transmission; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data* / Q000639:trends; D013179:Spouse Abuse / Q000523:psychology / Q000706:statistics & numerical data; D014454:Uganda; D055815:Young Adult