'They can't report abuse, they can't move out. They are at the mercy of these men': exploring connections between intimate partner violence, gender and HIV in South African clinical settings.
This qualitative study captured South African female health provider perspectives of intimate partner violence in female patients, gender norms and consequences for patients' health. Findings indicated female patients' health behaviours were predicated on sociocultural norms of submission to men's authority and economic dependence on their partners. Respondents described how men's preferences and health decision-making in clinics affected their patients' health. Adverse gender norms and gender inequalities affected women's opportunities to be healthy, contributing to HIV risk and undermining effective HIV management in this context. Some providers, seeking to deliver a standard of quality healthcare to their female patients, demonstrated a willingness to challenge patriarchal gender relations. Findings enhance understanding of how socially-sanctioned gender norms, intimate partner violence and HIV are synergistic, also reaffirming the need for integrated HIV-intimate partner violence responses in multi-sector national strategic plans. Health providers' intimate knowledge of the lived experiences of female patients with intimate partner violence and/or HIV deepens understanding of how adverse gender norms generate health risks for women in ways that may inform policy and clinical practice in South Africa and other high-HIV prevalence settings.
a Department of Conflict Resolution, Human Security & Global Governance , McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston , USA.|b Department of Nursing , College of Nursing and Health Sciences, University of Massachusetts Boston , Boston , USA.|c Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Hillbrow Johannesburg , South Africa.
Courtenay
C
Sprague
c Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Hillbrow Johannesburg , South Africa.|d Bixby Center for Global Reproductive Health , University of California San Francisco , San Francisco , USA.
Abigail M
AM
Hatcher
c Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Hillbrow Johannesburg , South Africa.
Nataly
N
Woollett
a Department of Conflict Resolution, Human Security & Global Governance , McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston , USA.
Theresa
T
Sommers
c Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Hillbrow Johannesburg , South Africa.
Vivian
V
Black
D000328:Adult; D044383:Black People; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D036301:Qualitative Research; D012725:Sexual Behavior / Q000523:psychology*; D066262:Social Norms; D013019:South Africa / Q000453:epidemiology; D013179:Spouse Abuse / Q000191:economics / Q000523:psychology*; D016387:Women's Health / Q000208:ethnology
HIV; Intimate partner violence; South Africa; gender norms; health systems; qualitative; sub-Saharan Africa