Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16-24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks.Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence.86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0-3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1-3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power.Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence

Open Access

“Money talks, bullshit walks ” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquir

Predictors of inconsistent condom use among a hard to reach population of young women with multiple sexual partners in peri-urban South Africa.

BackgroundEvidence suggests that multiple concurrent sexual partnering may be a key driver of the high HIV prevalence among young women in South Africa. However, little is known about whether and to what extent women who have multiple sexual partners also engage in other high risk sexual behaviors such as inconsistent condom use. And yet, multiple concurrent sexual partnering is of little epidemiological relevance if all partners in these sexual networks use condoms consistently. This study assesses the prevalence of sexual risk behaviors and HIV, and predictors of inconsistent condom use among women aged 16-24 with multiple sexual partners in a peri-urban setting in South Africa.MethodsWe used Respondent Driven Sampling, a sampling strategy for hard-to-reach populations to recruit 259 women aged 16-24 in a bio-behavioral cross-sectional survey in the Western Cape province. Estimates of population proportions and 95% confidence intervals (CIs) were calculated using the Respondent-Driven Sampling Analysis Tool 5.6 (RDSAT). The primary outcome was inconsistent condom use in the past three months.ResultsYoung women reported an average of 7 partners in the past 3 months and a high prevalence of sexual risk behaviors: concurrency (87%), transactional sex (91%) and age mixing (59%). Having >5 sexual partners in the last 3 months doubled the risk of unprotected sex (OR 2.43, CI 1.39-4.25). HIV prevalence was 4% among 16-19 year olds, increasing threefold (12%) at age 20-24.DiscussionMultiple sexual partnering, where a high number of partners are acquired in a short space of time, is a fertile context for unprotected and risky sexual behavior. The young women featured in this survey present with a constellation of high-risk sexual behaviors that cluster to form a risk syndrome. Carefully tailored repeat bio-behavioral surveillance surveys are recommended for this sub-population

Multivariate logistic regression models showing predictors of inconsistent condom use and no condom use.

***<p>Predictor variables where p>0.25 in the bivariate analyses were excluded from the multivariate logistic regression model.</p

x axis: Types of intimate partner violence; y axis: Prevalence of each type of intimate partner violence.

<p>x axis: Types of intimate partner violence; y axis: Prevalence of each type of intimate partner violence.</p

Relationship power equity sample & population proportions among women who have multiple sexual partners.

<p>Relationship power equity sample & population proportions among women who have multiple sexual partners.</p

Intimate partner violence and associated sexual risk behaviours among women who have multiple sexual partners.

<p><b>***</b> Predictor variables where p >0.25 in the bivariate analyses were excluded from the final multivariate logistic regression models</p><p>Intimate partner violence and associated sexual risk behaviours among women who have multiple sexual partners.</p