1. Intimate partner physical and sexual violence are associated with perceived and actual HIV risk among hospital outpatients in rural Uganda Susan M. Kiene, PhD Rhoda Wanyenze, Moses Bateganya, Haruna Lule, Harriet Nantaba, Michael Stein The Salawo Research Collaboration The Warren Alpert Medical School of Brown University, USA Makerere University School of Public Health, Uganda University of Washington, USA Gombe Hospital, Uganda

2. Background  HIV and intimate partner violence (IPV) are intertwined epidemics in many parts of the world  Violence is a risk factor for HIV  In Uganda, where HIV prevalence is 6.5% (UNAIDS, 2010), 48% of women and 20% of men report IPV, ever (DHS, 2006)

3. Objectives  Understand the prevalence of the experience of IPV among both women and men in an outpatient population in rural Uganda  Explore the mechanisms by which IPV may increase risk for HIV infection  Lack of access to testing  Increased risk from unprotected sex

4. Setting  Outpatient clinic in a 100 bed comprehensive public hospital in rural Butambala District, Uganda  Hospital serves a population > 300,000  Provider-initiated routine HIV-counseling and testing (PITC) offered to all outpatients regardless of presenting symptoms  Free care and antiretroviral treatment

5. Procedures and Measures Procedures  Interviewed before receiving provider-initiated HIV- counseling and testing Measures  prior HIV testing  perceived likelihood of testing HIV positive  history of physical (e.g., hitting, slapping) and sexual (forced sex) violence and emotional abuse (belittling, threats of violence) with current partner  sexual risk behavior

6. Participants  160 (82 female, 78 male) outpatients receiving provider-initiated routine HIV- counseling and testing  87% married  age M=34.0 (range 20-59)

7. Results Prevalence of Violence/Abuse

8. Emotional Abuse: Perceived % chance they would test HIV positive Difference: Women: Χ 2 19.14, p<.001, Men: Χ 2 28.8, p<.001

9. IPV: Tested for HIV in prior year NS difference

10. IPV: Perceived % chance they would test HIV positive Difference: Women: Χ 2 11.14, p<.001, Men: Χ 2 9.00, p<.01

11. IPV: Percent who tested HIV-positive Difference: Women: Χ 2 3.81, p<.05, Men: Χ 2 3.95, p<.05

12. IPV: Number of unprotected sex acts in prior 3 months Difference: Women: OR 1.06, CI (1.04-1.09), Men: OR 1.13, CI (1.02-1.24)

13. Summary  IPV is prevalent in this community  Women and men who experienced IPV were more likely to:  Think they would test HIV positive  Test HIV positive  Engage in more unprotected sex  No difference in prior access to HIV testing

14. Conclusions  The effect of IPV on increasing HIV risk is likely explained by the risk posed from unprotected sex not from lack of access to HIV testing  Interventions are needed to reduce the risk from unprotected sex among both women and men who experience IPV

15. Acknowledgements Participants Gombe Hospital Staff Research Assistants Ruth Namuleme Nalongo Kijje Hajara Kagulire Farouk Kimbowa Funding NIH K01 MH083536 Contact: susankiene@gmail.com