Prevalence and correlates of physical, sexual, and threatened violence among partners of people who inject drugs living with HIV in Kenya

Abstract

Background: People who inject drugs (PWID) have a higher HIV burden compared to the general adult population in Kenya. Violence among PWID is also common and associated with increased HIV risk and decreased HIV service uptake. Understanding the nature, distribution, and correlates of violence among PWID in Kenya may inform population-specific public health interventions and policy recommendations. Methods: Using a cross-sectional study, we identified the prevalence and correlates of different types of violence experienced by sexual and injecting partners of HIV-positive PWID in Kenya, who were contacted through assisted partner services. We used a Chi-squared test to estimate the risk of violence and conducted a pairwise comparison and two-sided Fisher’s exact test to identify the socio-demographic characteristics associated with violence. Using the Woolf test for homogeneity, we conducted a stratified analysis and tested for effect modification by gender and HIV status. Results: Among 3302 participants, 1439 (44%) had experienced some form of violence within the past one year. Physical violence was the most common form of violence experienced (35%; 95%CI 33.3%, 36.5%), followed by being threatened (23%; 21.5%, 24.4%), and sexual violence (7%; 95% CI 6.2%, 7.9%). Being male (Relative risk [RR]=1.22; 95% confidence interval [CI] 1.11, 1.33; p<0.001), living in coastal Kenya (RR=1.53; 95%CI 1.41, 1.66; p<0.001), having multiple sexual partners (vs. single) (RR=1.39; 95%CI 1.22, 1.6; p<0.001), being divorced/ separated or widowed (vs. single) (RR=1.24; 95%CI 1.13, 1.37; p<0.001), not having a stable place to live (RR=1.14; 95%CI 1.03, 1.27; p=0.019), being both a sexual and injecting partner (vs. sexual partner only) (RR=1.16; 95%CI 1.01, 1.33; p=0.041), being an active injection drug user not on methadone (vs. non-active injection drug users taking methadone) (RR=1.53; 95%CI 1.04, 2.25; p=0.018), and identifying as a man who has sex with men or man who have sex with both men and women (MSM/MSMW) (vs. man who has sex with women) (RR=1.36; 95%CI 1.21, 1.54; p<0.001) were associated with experiencing violence. The stratified analysis revealed that gender was an effect modifier on the association between partner characteristics (region, employment, partner type) and experiencing violence while HIV status was not. Conclusion: The study identified that the prevalence of violence among partners of PWID in Kenya differs for different genders and regions, and physical violence was the most frequent form of violence reported. There was strong evidence of an association between several partner characteristics and experiencing violence and it was modified by different Genders. This information will be useful to formulate and tailor effective public health interventions, and policy recommendations to increase HIV-related services among key populations in Kenya.