Papas Rebecca K, Gakinya Benson N, Mwaniki Michael M, Lee Hana, Kiarie Stella W, Martino Steve, Loxley Michelle P, Keter Alfred K, Klein Debra A, Sidle John E, Baliddawa Joyce B, Maisto Stephen A
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.
AIDS Behav. 2017 Aug;21(8):2243-2252. doi: 10.1007/s10461-017-1684-y.
Victimization from physical and sexual violence presents global health challenges. Partner violence is higher in Kenya than Africa. Violence against drinkers and HIV-infected individuals is typically elevated, so dual vulnerabilities may further augment risk. Understanding violence risks can improve interventions. Participants were 614 HIV-infected outpatient drinkers in western Kenya enrolled in a randomized trial to reduce alcohol use. At baseline, past 90-day partner physical and sexual violence were examined descriptively and in gender-stratified regression models. We hypothesized higher reported violence against women than men, and positive violence association with HIV stigma and alcohol use across gender. Women reported significantly more current sexual (26.3 vs. 5.7%) and physical (38.9 vs. 24.8%) victimization than men. Rates were generally higher than Kenyan lifetime national averages. In both regression models, HIV stigma and alcohol-related sexual expectations were significantly associated with violence while alcohol use was not. For women, higher violence risk was also conferred by childhood violence, past-year transactional sex, and younger age. HIV-infected Kenyan drinkers, particularly women, endorse high current violence due to multiple risk factors. Findings have implications for HIV interventions. Longitudinal research is needed to understand development of risk.
身体暴力和性暴力造成的伤害构成了全球性的健康挑战。肯尼亚的伴侣暴力情况比非洲其他地区更为严重。针对饮酒者和艾滋病毒感染者的暴力行为通常更为高发，因此双重脆弱性可能会进一步增加风险。了解暴力风险有助于改进干预措施。研究参与者为肯尼亚西部614名感染艾滋病毒的门诊饮酒者，他们参与了一项旨在减少酒精使用的随机试验。在基线时，对过去90天内伴侣的身体暴力和性暴力情况进行了描述性分析，并纳入了按性别分层的回归模型。我们假设报告的针对女性的暴力行为比男性更多，并且在不同性别中，暴力行为与艾滋病毒污名化及酒精使用呈正相关。女性报告的当前性暴力（26.3% 对 5.7%）和身体暴力（38.9% 对 24.8%）受害率显著高于男性。这些比率总体上高于肯尼亚全国终身平均水平。在两个回归模型中，艾滋病毒污名化和与酒精相关的性期望与暴力行为显著相关，而酒精使用则不然。对于女性而言，童年暴力、过去一年的交易性行为和较年轻的年龄也会带来更高的暴力风险。感染艾滋病毒的肯尼亚饮酒者，尤其是女性，由于多种风险因素而承受着较高的当前暴力风险。研究结果对艾滋病毒干预措施具有启示意义。需要进行纵向研究以了解风险的发展情况。
