title: A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya.
abstract: We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.
authors.affiliation: Department of Global Health, University of Washington, Seattle, 98104, USA. ksw@uw.edu.|Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.
authors.forename: Kate S
authors.initials: KS
authors.lastname: Wilson
authors.affiliation: Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
authors.forename: George
authors.initials: G
authors.lastname: Wanje
authors.affiliation: Department of Global Health, University of Washington, Seattle, 98104, USA.
authors.forename: Krista
authors.initials: K
authors.lastname: Yuhas
authors.affiliation: Department of Psychology, University of Washington, Seattle, USA.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Linnet
authors.initials: L
authors.lastname: Masese
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Vander Stoep
authors.affiliation: Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.affiliation: Department of Global Health, University of Washington, Seattle, 98104, USA.|Department of Biostatistics, University of Washington, Seattle, USA.
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.affiliation: Department of Global Health, University of Washington, Seattle, 98104, USA.|Department of Epidemiology, University of Washington, Seattle, USA.|Department of Medicine, University of Washington, Seattle, USA.|Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
authors.forename: R
authors.initials: R
authors.lastname: Scott McClelland
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D017144:Focus Groups; D006679:HIV Seropositivity / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D000066511:Intimate Partner Violence; D007630:Kenya; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D060386:Sex Workers / Q000523:psychology; D012725:Sexual Behavior / Q000523:psychology; D012747:Sexual Partners; D013179:Spouse Abuse; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Adherence; Africa; Female sex workers; Intimate partner violence; Plasma viral load