title: Intimate partner sexual and physical violence among women in Togo, West Africa: prevalence, associated factors, and the specific role of HIV infection.
abstract: BACKGROUND
  A substantial proportion of newly diagnosed HIV infections in sub-Saharan Africa occur within serodiscordant cohabiting heterosexual couples. Intimate partner violence is a major concern for couple-oriented HIV preventive approaches. This study aimed at estimating the prevalence and associated factors of intimate partner physical and sexual violence among HIV-infected and -uninfected women in Togo. We also described the severity and consequences of this violence as well as care-seeking behaviors of women exposed to intimate partner violence.
  
  
  METHODS
  A cross-sectional survey was conducted between May and July 2011 within Sylvanus Olympio University Hospital in Lomé. HIV-infected women attending HIV care and uninfected women attending postnatal care and/or children immunization visits were interviewed. Intimate partner physical and sexual violence and controlling behaviors were assessed using an adapted version of the WHO Multi-country study on Women's Health and Life Events questionnaire.
  
  
  RESULTS
  Overall, 150 HIV-uninfected and 304 HIV-infected women accepted to be interviewed. The prevalence rates of lifetime physical and sexual violence among HIV-infected women were significantly higher than among uninfected women (63.1 vs. 39.3%, p<0.01 and 69.7 vs. 35.3%, p<0.01, respectively). Forty-two percent of the women reported having ever had physical injuries as a consequence of intimate partner violence. Among injured women, only one-third had ever disclosed real causes of injuries to medical staff and none of them had been referred to local organizations to receive appropriate psychological support. Regardless of HIV status and after adjustment on potential confounders, the risk of intimate partner physical and sexual violence was strongly and significantly associated with male partner multi-partnership and early start of sexual life. Among uninfected women, physical violence was significantly associated with gender submissive attitudes.
  
  
  CONCLUSIONS
  The prevalence rates of both lifetime physical and sexual violence were very high among HIV-uninfected women and even higher among HIV-infected women recruited in health facilities in this West African country. Screening for intimate partner violence should be systematic in health-care settings, and specifically within HIV care services. At a time of increased investments in couple-oriented HIV prevention interventions, further longitudinal research to better understanding of HIV-serodiscordant couple dynamics in terms of intimate partner violence is needed.
authors.affiliation: INSERM, Centre INSERM U897 'Epidémiologie et Biostatistique', Bordeaux, France; Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France; Juan.Burgos@isped.u-bordeaux2.fr.
authors.forename: Juan
authors.initials: J
authors.lastname: Burgos-Soto
authors.affiliation: INSERM, Centre INSERM U897 'Epidémiologie et Biostatistique', Bordeaux, France; Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.affiliation: COMPTRASEC, CNRS UMR 5114, Pessac, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Encrenaz
authors.affiliation: Service des maladies infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo.
authors.forename: Akouda
authors.initials: A
authors.lastname: Patassi
authors.affiliation: Département de Santé Publique, Faculté mixte de médecine et pharmacie, Lomé, Togo.
authors.forename: Aurore
authors.initials: A
authors.lastname: Woronowski
authors.affiliation: Département de Santé Publique, Faculté mixte de médecine et pharmacie, Lomé, Togo.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kariyiare
authors.affiliation: Service de pédiatrie, Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo.
authors.forename: Annette K
authors.initials: AK
authors.lastname: Lawson-Evi
authors.affiliation: INSERM, Centre INSERM U897 'Epidémiologie et Biostatistique', Bordeaux, France; Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France.
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.affiliation: INSERM, Centre INSERM U897 'Epidémiologie et Biostatistique', Bordeaux, France; Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: INSERM, Centre INSERM U897 'Epidémiologie et Biostatistique', Bordeaux, France; Département de Santé Publique, Faculté mixte de médecine et pharmacie, Lomé, Togo.
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: INSERM, Centre INSERM U897 'Epidémiologie et Biostatistique', Bordeaux, France; Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D018023:HIV Seronegativity; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015995:Prevalence; D011902:Rape / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014037:Togo / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology
keywords: Africa; HIV infection; gender; intimate partner violence