Background:
In Kenya, people who inject drugs (PWID) have a higher HIV burden compared to the general adult population. Violence and its related HIV risk behaviors and low HIV service uptake are also more common among PWID living with HIV, which may increase HIV transmission among PWID and their sexual and/or injecting partners. Understanding the nature and correlates of violence may inform population-specific public health interventions and policy recommendations.
Methods:
Using cross-sectional data from a prospective cohort study in Kenya, we identified the prevalence and correlates of violence among sexual and injecting partners of PWID living with HIV, whom we contacted through assisted partner services. Violence is defined as any physical harm (hit, slap, kick, physically hurt), threats with a weapon or mentally, or forced sexual acts inflicted on a person by anyone in the past year. We used a Chi-squared test and a two-sided Fisher’s exact test to identify the socio-demographic characteristics associated with violence. Using the Woolf test for homogeneity, we conducted a stratified analysis to test effect modification by gender and HIV status.
Results:
Among 3302 partners, 1439 (44%) experienced violence within the past year. Physical violence was the most common form of violence experienced (35%; 95% confidence interval [95%CI] 33.3%, 36.5%), followed by being threatened (23%; 95%CI 21.5%, 24.4%), and sexual violence (7%; 95%CI 6.2%,7.9%). Being male (Relative Risk [RR]=1.22; 95%CI 1.11, 1.33; p< 0.001), living in coastal Kenya (RR=1.53; 95%CI 1.41, 1.66; p< 0.001), having multiple sexual partners (RR=1.39; 95%CI 1.22, 1.6; p< 0.001), being divorced/ separated/ widowed (vs. single) (RR=1.24; 95%CI 1.13, 1.37; p< 0.001), not having stable housing (RR=1.14; 95%CI 1.03, 1.27; p=0.019), being both a sexual and injecting partner of a PWID (vs. injecting partner only) (RR=1.18; 95%CI 1.06, 1.32; p=0.005), being an active injection drug user not on methadone (vs. on methadone) (RR=1.53; 95%CI 1.04, 2.25; p=0.018), and, for men, having had sex with men (RR=1.36; 95%CI 1.21, 1.54; p< 0.001) were associated with experiencing violence. The stratified analysis identified that gender was an effect modifier while HIV status was not.
Conclusions:
Study results highlight PWID partners at increased risk for experiencing violence, which may help to formulate and tailor effective public health interventions and policy recommendations for increasing HIV-related services among key populations in Kenya.
Table: Stratified analysis by Gender on the association between some partner characteristics and experiencing violence