Silverman Jay G, Decker Michele R, Saggurti Niranjan, Balaiah Donta, Raj Anita
Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
JAMA. 2008 Aug 13;300(6):703-10. doi: 10.1001/jama.300.6.703.
Despite reductions in prevalence of human immunodeficiency virus (HIV) infection among the general population of India, women account for a rising percentage of all HIV cases with husbands' risk behavior described as the major source of women's infection. Intimate partner violence (IPV) has been described as being associated with heterosexual transmission of HIV to women in India and elsewhere.
To assess the relationship between experiencing IPV and the occurrence of HIV infection in a nationally representative sample of married Indian women tested for HIV.
DESIGN, SETTING, AND PARTICIPANTS: The Indian National Family Health Survey 3 was conducted across all Indian states in 2005 through 2006. The nationally representative sample included 124,385 married women; analyses conducted in 2007 and 2008 were limited to 28,139 married women who provided IPV data and HIV test results via systematic selection into respective subsamples.
Prevalence estimates of lifetime IPV and HIV infection were calculated and demographic differences assessed. Intimate partner violence was conceptualized as physical violence with or without sexual violence and then was further categorized as physical violence only vs physical and sexual violence. Regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for HIV infection among Indian women based on experiences of IPV after adjusting for demographics and women's HIV risk behaviors.
One-third of married Indian women (35.49%) reported experiencing physical IPV with or without sexual violence from their husbands; 7.68% reported both physical and sexual IPV, and 27.80% reported experiencing physical IPV in the absence of sexual violence. Approximately 1 in 450 women (0.22%) tested positive for HIV. In adjusted models, married Indian women experiencing both physical and sexual violence from husbands demonstrated elevated HIV infection prevalence vs those not experiencing IPV (0.73% vs 0.19%; adjusted OR, 3.92; 95% CI, 1.41-10.94; P = .01). Physical IPV alone was not associated with risk of HIV infection. Women's personal sexual risk behaviors were not associated with HIV infection.
Among married Indian women, physical violence combined with sexual violence from husbands was associated with an increased prevalence of HIV infection. Prevention of IPV may augment efforts to reduce the spread of HIV/AIDS.
尽管印度普通人群中人类免疫缺陷病毒（HIV）感染率有所下降，但在所有HIV病例中，女性所占比例却在上升，丈夫的危险行为被认为是女性感染的主要来源。在印度及其他地区，亲密伴侣暴力（IPV）被认为与HIV通过异性传播给女性有关。
在接受HIV检测的具有全国代表性的已婚印度女性样本中，评估遭受IPV与HIV感染发生之间的关系。
设计、背景和参与者：2005年至2006年在印度所有邦开展了第三次全国家庭健康调查。具有全国代表性的样本包括124385名已婚女性；2007年和2008年进行的分析仅限于28139名已婚女性，她们通过系统抽样分别进入各自的子样本，提供了IPV数据和HIV检测结果。
计算终身IPV和HIV感染的患病率估计值，并评估人口统计学差异。将亲密伴侣暴力概念化为有或没有性暴力的身体暴力，然后进一步分为仅身体暴力与身体和性暴力。在对人口统计学和女性HIV危险行为进行调整后，使用回归模型估计印度女性中基于IPV经历的HIV感染优势比（OR）和95%置信区间（CI）。
三分之一的已婚印度女性（35.49%）报告遭受过丈夫的有或没有性暴力的身体IPV；7.68%报告遭受过身体和性IPV，27.80%报告在没有性暴力的情况下遭受过身体IPV。大约每450名女性中有1名（0.22%）HIV检测呈阳性。在调整后的模型中，遭受丈夫身体和性暴力的已婚印度女性的HIV感染患病率高于未遭受IPV的女性（0.73%对0.19%；调整后的OR，3.92；95%CI，1.41 - 10.94；P = 0.01）。仅身体IPV与HIV感染风险无关。女性的个人性风险行为与HIV感染无关。
在已婚印度女性中，丈夫的身体暴力与性暴力相结合与HIV感染患病率增加有关。预防IPV可能会加强减少HIV/AIDS传播的努力。
