Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
J Glob Health. 2020 Dec;10(2):020440. doi: 10.7189/jogh.10.020440.
BACKGROUND: Assisted partner notification (APN) for HIV was introduced in refugee settlements in West Nile Uganda in 2018 to facilitate testing of sexual partners. While APN is an effective strategy recommended by the World Health Organization, its safety has not been evaluated in a refugee settlement context in which participants have high prior exposure to interpersonal violence. The extent to which interpersonal violence influences APN utilization and the frequency with which post-APN interpersonal violence occurs remains unknown. METHODS: To explore the relationship between APN and interpersonal violence, a cross-sectional mixed-methods study was conducted at 11 health centers in refugee settlements in West Nile Uganda. Routinely collected index client and sexual partner data were extracted from APN registers and semi-structured interviews were conducted with health workers. RESULTS: Through APN, 1126 partners of 882 distinct index clients were identified. For 8% (75/958) of partners, index clients reported a history of intimate partner violence (IPV). For 20% (226/1126) of partners, index clients were screened for post-APN IPV; 8 cases were reported of which 88% (7/8) concerned partners with whom index clients reported prior history of IPV. In qualitative interviews (N = 32), health workers reported HIV disclosure-related physical, sexual and psychological violence and deprivation or neglect. Incidents of disclosure-related violence against health workers and dependents of index clients were also reported. Fear of disclosure-related violence was identified as a major barrier to APN that prevents index clients from listing sexual partners. CONCLUSIONS: Incidents of interpersonal violence have been reported following HIV-disclosure and fear of interpersonal violence strongly influences APN participation. Addressing HIV perception and stigma may contribute to APN uptake and program safety. Prospective research on interpersonal violence involving index clients and sexual partners in refugee settlements is needed to facilitate safe engagement in APN for this vulnerable population.
背景：2018 年，乌干达西部尼罗河地区的难民营引入了辅助性伴侣通知（APN），以促进性伴侣的检测。虽然 APN 是世界卫生组织推荐的一种有效策略，但在难民定居点中，参与者先前曾高度暴露于人际暴力之中，其安全性尚未得到评估。人际暴力对 APN 使用的影响程度以及发生 APN 后人际暴力的频率尚不清楚。
方法：为了探索 APN 与人际暴力之间的关系，在乌干达西部尼罗河地区的 11 个难民定居点的 11 个卫生中心进行了一项横断面混合方法研究。从 APN 登记册中提取了常规收集的索引客户和性伴侣数据，并对卫生工作者进行了半结构式访谈。
结果：通过 APN，确定了 882 名不同索引客户的 1126 名伴侣。对于 8%（75/958）的伴侣，索引客户报告了亲密伴侣暴力（IPV）的历史。对于 20%（226/1126）的伴侣，对其进行了 APN 后 IPV 筛查；报告了 8 例，其中 88%（7/8）涉及与索引客户报告有先前 IPV 史的伴侣。在定性访谈（N=32）中，卫生工作者报告了与 HIV 披露相关的身体、性和心理暴力以及剥夺或忽视。还报告了针对卫生工作者和索引客户家属的与披露相关的暴力事件。由于担心与披露相关的暴力，艾滋病毒感染者被认为是 APN 的主要障碍，这阻止了他们列出性伴侣。
结论：报告了 HIV 披露后发生人际暴力事件，对人际暴力的恐惧强烈影响了 APN 的参与度。解决对 HIV 的认知和耻辱感可能有助于增加 APN 的参与度和计划的安全性。需要对难民定居点中涉及索引客户和性伴侣的人际暴力进行前瞻性研究，以促进这一弱势群体安全参与 APN。
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