Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of global health
Abstract
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 or near refugee settlements serving refugee and
national populations 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.
Description
Keywords
Violence, HIV, Refugee settlements
Citation
Klabbers, R. E., Muwonge, T. R., Ayikobua, E., Izizinga, D., Bassett, I. V., Kambugu, A., ... & O’Laughlin, K. N. (2020). Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda. Journal of global health, 10(2). doi: 10.7189/jogh.10.020440