title: Intimate partner violence after disclosure of HIV test results among pregnant women in Harare, Zimbabwe.
abstract: BACKGROUND
  HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women.
  
  
  METHODS
  In this cross sectional study we interviewed 1951 postnatal women who tested positive and negative for HIV about IPV experiences following HIV test disclosure, using an adapted WHO questionnaire. Multivariate regression models assessed factors associated with IPV after disclosure and controlled for factors such as previous IPV and other known behavioural factors associated with IPV.
  
  
  RESULTS
  Over 93% (1817) disclosed the HIV results to their partners (96.5% HIV- vs. 89.3% HIV+, p<0.0001). Overall HIV prevalence was 15.3%, (95%CI:13.7-16.9), 35.2% among non-disclosers and 14.3% among disclosers. Overall 32.8% reported IPV (40.5% HIV+; 31.5% HIV- women, p = 0.004). HIV status was associated with IPV (partially adjusted 1.43: (95%CI:1.00-2.05 as well as reporting negative reactions by male partners immediately after disclosure (adjusted OR 5.83, 95%CI:4.31-7.80). Factors associated with IPV were gender inequity, past IPV, risky sexual behaviours and living with relatives. IPV after HIV disclosure in pregnancy is high but lower than and is strongly related with IPV before pregnancy (adjusted OR 6.18, 95%CI: 3.84-9.93).
  
  
  CONCLUSIONS
  The study demonstrates the interconnectedness of IPV, HIV status and its disclosure with IPV which was a common experience post disclosure of both an HIV positive and HIV negative result. Health services must give attention to the gendered nature and consequences of HIV disclosure such as enskilling women on how to determine and respond to the risks associated with disclosure. Efforts to involve men in antenatal care must also be strengthened.
authors.affiliation: Gender and Health Research Unit, Medical Research Council, Cape Town, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: Simukai
authors.initials: S
authors.lastname: Shamu
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa; University of Montreal Hospital Research Centre (CR-CHUM), Montreal, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Zarowsky
authors.affiliation: Women's and Gender Studies, University of the Western Cape, Cape Town, South Africa.
authors.forename: Tamara
authors.initials: T
authors.lastname: Shefer
authors.affiliation: International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Gender and Health Research Unit, Medical Research Council, Cape Town, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: Naeemah
authors.initials: N
authors.lastname: Abrahams
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D015995:Prevalence; D062486:Public Health Surveillance; D012747:Sexual Partners; D013179:Spouse Abuse; D011795:Surveys and Questionnaires; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology