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

Introduction

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.

Methods

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.

Findings

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.

Discussion

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.

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

Table 2

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

Explanatory Variables	Sexual IPV OR (95% CI)	Physical IPV OR (95% CI)	Physical & Sexual IPVOR (95% CI)
Age
20–24 years	1.00	1.00	1.00
16–19 years	0.9 (0.4–1.9)	1.0 (0.4–2.7)	0.5 (0.2–1.6)
Poverty status
Non-poor	1.00	1.00	1.00
Poor	1.1 (0.5–2.1)	0.7 (0.3–1.9)	1.00
Abjectly poor	1.0 (0.4–2.3)	0.5 (0.1–1.5)	1.2 (0.3–3.6)
School Status
Out of School	1.00	1.00	1.00
In School	0.5 (0.2–1.2)	0.6 (0.2–1.8)	0.7 (0.2–2.3)
Age mixing in the past 3 months
No	1.00	***	***
Yes	1.7 (1.00–3.1)
Transactional sex for money with the most recent casual partner
No	1.00	***	1.00
Yes	2.1 (1.1–3.8)		1.8 (1.0–3.2)
Sexual Debut
≥15 years	***	1.00	***
<15 years		1.2 (0.5–2.9)
Relationship power inequity
Low	***	1.00	***
High		0.9 (0.4–2.1)
Number of casual partners in the past 3 months
≤4 casual partners	***	***	1.00
≥5 casual partners			0.4 (0.2–0.9)
Condom use with casual partners in the past 3 months
Consistent	***	1.00	1.00
Inconsistent		0.4 (0.2–1.1)	0.4 (0.2–0.9)
Condom use with main partner in the past 3 months
Consistent	***	***	1.00
Inconsistent			4.0 (0.4–34.1)
Condom use with one night stand at last sex
No	***	1.00	***
Yes		1.1 (0.5–2.7)
Male Partner fidelity
No	***	1.00	1.00
Yes		0.9 (0.4–2.1)	0.6 (0.2–1.7)

*** Predictor variables where p >0.25 in the bivariate analyses were excluded from the final multivariate logistic regression models

Full article at:  http://goo.gl/xqHPPr

By:  Yanga Z. Zembe,1,2,* Loraine Townsend,1 Anna Thorson,2 Margrethe Silberschmidt,3 and Anna Mia Ekstrom2

Paula Braitstein, Editor

¹Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa

²Department of Public Health Sciences /Global health, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

³Department of Public Health, University of Copenhagen, Copenhagen, Denmark

University of Toronto Dalla Lana School of Public Health, CANADA

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: YZ LT AT AME. Performed the experiments: YZ. Analyzed the data: YZ LT MS. Contributed reagents/materials/analysis tools: YZ LT AT MS AME. Wrote the paper: YZ LT AT MS AME.

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