Magnitude of intimate partner violence and its associated factors among HIV-positive women attending health facilities in Ethiopia: a systematic review and meta-analysis – BMC Public Health

Report on Intimate Partner Violence Among HIV-Positive Women in Ethiopia in the Context of Sustainable Development Goals

1.0 Study Identification and Selection Process

This report summarizes a systematic meta-analysis focused on Intimate Partner Violence (IPV) among HIV-positive women in Ethiopia, a critical issue that directly impacts the achievement of several Sustainable Development Goals (SDGs), notably SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality). The selection process for relevant studies was conducted as follows:

1. An initial search across all databases yielded 1,151 publications.
2. A total of 761 duplicate studies were eliminated from the initial pool.
3. Following a review of titles and abstracts, 369 studies were excluded as they did not align with the review’s objectives.
4. The full texts of the remaining 21 studies were assessed, leading to the omission of 14 papers that did not meet the predefined eligibility criteria.
5. Ultimately, seven publications were identified as fully meeting the requirements for inclusion in this meta-analysis.

2.0 Characteristics of Included Studies

The seven studies included in this review provide essential data for monitoring progress towards SDG 5.2, which aims to eliminate all forms of violence against women. These studies, published between 2019 and 2023, collectively contribute to a deeper understanding of health and gender inequalities, aligning with SDG 10 (Reduced Inequalities).

• Total Participants: The analysis included a total of 2,704 HIV-positive women.
• Sample Size Variation: The smallest study comprised 128 participants in Addis Ababa, while the largest included 630 participants in Gondar city, Amhara region.
• Study Design: Six of the seven studies utilized a cross-sectional design, with one employing a case-control research design.
• Geographic Scope: The studies were conducted across various regions of Ethiopia, including Oromia, Amhara, SNNP, Sidama, and the capital, Addis Ababa, providing a broad geographical representation.

3.0 Prevalence of Intimate Partner Violence and SDG Implications

The findings reveal a high prevalence of IPV, representing a significant obstacle to ensuring the health, safety, and empowerment of women as mandated by the SDGs.

3.1 Pooled Prevalence of IPV

Using a random-effects model due to high heterogeneity (I² = 93.33%), the analysis determined the pooled prevalence of IPV among women living with HIV to be 51.45% (95% CI 44.05, 58.85). This alarming figure underscores the urgent need for targeted interventions to protect vulnerable populations and advance SDG 3 and SDG 5.

3.2 Subgroup Analysis and Regional Disparities

Subgroup analysis was performed to identify sources of heterogeneity, providing insights crucial for tailoring policies to meet SDG 10 by addressing regional inequalities.

• Regional Variation: The prevalence of IPV was highest in the Amhara region (Gondar city) at 64.20% and lowest in the Sidama region (Hawassa city) at 41.90%. Studies conducted in the Oromia region showed a prevalence of 47%, while other regions combined (Amhara, SNNR, and Sidama) showed a prevalence of 51%.
• Temporal Variation: The prevalence rate was comparable in studies conducted between 2014-2019 (51%) and those conducted between 2020-2023 (52%), indicating a persistent challenge.

3.3 Methodological Analysis

A meta-regression confirmed that sample size was a statistically significant predictor of variations in effect sizes. While a funnel plot appeared symmetrical, Egger’s test (p=0.009) indicated publication bias, which was addressed through a nonparametric trim-and-fill analysis. A leave-one-out sensitivity analysis confirmed that no single study disproportionately influenced the overall findings.

4.0 Factors Associated with IPV: Barriers to SDGs 5 and 16

Identifying the drivers of IPV is fundamental to creating effective programs that support SDG 5 (Gender Equality) and SDG 16 (Peace, Justice and Strong Institutions), which calls for the reduction of all forms of violence.

4.1 Key Associated Factors

The meta-analysis identified several statistically significant factors associated with a higher likelihood of experiencing IPV:

• Partner’s Controlling Behavior: Women whose partners exhibited controlling behaviors were 5.95 times more likely to experience IPV. This highlights the role of harmful gender norms, a direct target of SDG 5.
• Partner’s Alcohol Consumption: A partner’s alcohol use was associated with a 2.23 times higher likelihood of IPV, linking a public health challenge relevant to SDG 3 with increased violence against women.
• Partner’s Involvement in Physical Fights: Women whose partners engaged in physical altercations with other men were 2.02 times more likely to experience IPV, indicating a broader pattern of violence that undermines SDG 16.
• Women Having Multiple Partners: Women with multiple sexual partners were 2.12 times more likely to be affected by IPV compared to those with a single partner.

Conversely, the analysis found no statistically significant association between male multi-partnership and the prevalence of IPV (OR = 1.59, 95% CI 0.81, 2.38).

Analysis of Sustainable Development Goals in the Article

SDG 3: Good Health and Well-being

• The article directly relates to SDG 3 by focusing on the health and well-being of a specific, vulnerable population: HIV-positive women in Ethiopia.
• It investigates Intimate Partner Violence (IPV), a significant public health issue with severe physical and mental health consequences.
• The study also examines associated health-related risk factors, such as the harmful use of alcohol by partners, which connects to substance abuse prevention and treatment aspects of this goal.

SDG 5: Gender Equality

• The core subject of the article, Intimate Partner Violence (IPV) against women, is a primary focus of SDG 5.
• The research quantifies the prevalence of violence against women and explores factors that contribute to it, such as controlling behaviors by partners. This aligns with the goal of eliminating all forms of violence against women and girls.
• By studying the specific context of HIV-positive women, the article highlights an intersection of vulnerabilities related to gender and health status.

Identified SDG Targets

Target 3.3: End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases

• The article’s focus is exclusively on “women living with HIV positive.” Understanding the social and health challenges faced by this group, such as the high prevalence of IPV, is critical for designing effective health interventions and support systems necessary to manage and ultimately end the AIDS epidemic.

Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

• The article identifies a partner’s alcohol consumption as a significant factor associated with IPV. It states, “Women partners who drank alcohol were 2.23 times more likely to have experienced IPV.” This finding underscores the link between the harmful use of alcohol and its negative health and social consequences, reinforcing the importance of this target.

Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres

• This target is central to the article. The study’s primary objective is to measure the “prevalence of intimate partner violence among women living with HIV positive” and identify its associated factors. The entire research is a direct examination of the problem described in Target 5.2.

Mentioned or Implied Indicators

Indicator for Target 5.2 (Indicator 5.2.1): Proportion of ever-partnered women and girls subjected to physical, sexual or psychological violence by a current or former intimate partner.

• The article provides a direct measurement for this indicator within its specific study population. It explicitly states, “the pooled prevalence of IPV was 51.45% (95% CI 44.05, 58.85)” among HIV-positive women in Ethiopia. This quantifies the proportion of women in this group who have experienced IPV.

Implied Indicator for Target 3.5: Prevalence of risk factors associated with the harmful use of alcohol.

• While the article does not use the official SDG indicator for alcohol consumption (per capita consumption), it measures a related and crucial factor: the association between a partner’s alcohol use and violence. The finding that partners who drink alcohol are 2.23 times more likely to perpetrate IPV serves as a powerful, context-specific indicator of the harmful effects of alcohol, which this target aims to address.

Implied Indicator for Target 5.2: Prevalence of controlling behaviors by partners.

• The article identifies and measures the impact of controlling behavior as a key factor associated with IPV. It finds that “women whose partner showed controlling behavior were 5.95 times more likely to have experienced IPV.” This measurement of a specific form of psychological and emotional abuse provides a detailed indicator for understanding the dynamics of violence against women.

SDGs, Targets and Indicators Analysis

Source: bmcpublichealth.biomedcentral.com