ARISE Hub, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK; Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Soc Sci Med. 2023 Nov;336:116247. doi: 10.1016/j.socscimed.2023.116247. Epub 2023 Sep 20.
People in informal urban settlements in Kenya face multiple inequalities, yet researchers investigate issues such as HIV or intimate partner violence (IPV) in isolation, targeting single populations and focusing on individual behaviour, without involving informal settlement dwellers. We formed a study team of researchers (n = 4) and lay investigators (n = 11) from an informal settlement in Nairobi, Kenya to understand the power dynamics in the informal urban settlement that influence vulnerability to IPV and HIV among women and men from key populations in this context. We facilitated participatory workshops with 56 women and 32 men from different marginalised groups and interviewed 10 key informants. We used a participatory data analysis approach. Our findings suggest the IPV and HIV nexus is rooted in the daily struggle for cash and survival in the informal urban settlement where lucrative livelihoods are scarce and a few gatekeepers regulate access to opportunities. Power is gendered and used to exercise control over people and resources. Common coping strategies applied to mitigate against the effects of poverty and powerlessness amplify vulnerabilities to HIV and IPV. These complex power relations create and sustain an environment conducive to IPV and HIV. Prevention interventions thus need to address underlying structural drivers, uphold human rights, create safe environments, and promote participation to maximise and sustain the positive effects of biomedical, behavioural, and empowerment strategies.
肯尼亚非正规城市住区的居民面临着多种不平等，然而研究人员在研究艾滋病毒或亲密伴侣暴力（IPV）等问题时，往往是孤立地进行，针对单一人群，关注个人行为，而不涉及非正规住区居民。我们成立了一个由研究人员（n=4）和非专业调查员（n=11）组成的研究小组，他们来自肯尼亚内罗毕的一个非正规住区，旨在了解影响该背景下关键人群中妇女和男子易感染 IPV 和艾滋病毒的非正式城市住区中的权力动态。我们与来自不同边缘群体的 56 名妇女和 32 名男子一起举办了参与式研讨会，并采访了 10 名关键信息提供者。我们使用了参与式数据分析方法。我们的研究结果表明，IPV 和 HIV 之间存在联系，其根源在于非正规城市住区中为现金和生存而进行的日常斗争，在这个住区中，有利可图的生计很少，少数把关人控制着获得机会的途径。权力具有性别特征，用于对人和资源行使控制。为了减轻贫困和无力感的影响而采用的常见应对策略会加剧感染艾滋病毒和 IPV 的脆弱性。这些复杂的权力关系创造和维持了有利于 IPV 和 HIV 的环境。因此，预防干预措施需要解决潜在的结构性驱动因素，维护人权，创造安全环境，并促进参与，以最大限度地提高和维持生物医学、行为和赋权战略的积极影响。
