1. Council for the Advancement of Nursing Conference
Intimate partner violence and condom use among South African adolescents .
A.M. Teitelman1, J.B. Jemmott III2, L. Icard3, A. O'Leary4, G.A. Heeren2, Z. Ngwane5, S. J. Ratcliffe2, S. Bellamy2
1University of Pennsylvania, School of Nursing, Philadelphia, 2University of Pennsylvania, Perelman School of Medicine, Philadelphia, 3Temple University, Philadelphia, 4Centers for Disease Control & Prevention, Atlanta,, 5Haverford College, Haverford
Council for the Advancement of Nursing Conference
September 2012

2. Acknowledgements South African research team members:
University of Fort Hare's Centre for Health Promotion
—  Joanne Tyler, PhD
—  Pretty Ndyebi, MSW
—  Phelisa Mpulu, BHon
—  Craig Carty, MSc
Funding:
NIMH 1 R01 MH065867
NIMH 1K01MH A1
The Penn Center for AIDS Research AI
NIMH 1 R01 MH and NIMH 1K01MH A1 and the Penn Center for AIDS Research AI

3. Background
Intimate partner violence (IPV) has been tied to HIV/STI sexual risks among adolescent and adult women globally
In South Africa, this link is especially important because the prevalence of both HIV and intimate partner violence is high (Jewkes et al., 2002).

4. Background (cont’d)
IPV includes physical abuse; sexual coercion, threats, and emotional abuse and each type of IPV may be related to sexual risk
Little is known about gender comparisons of IPV and sexual risk among South African adolescents

5. Study Purpose Examine associations between IPV and condom use
Multiple types of IPV were examined:
physical
sexual
psychological
threats
combined measures of overall IPV
Determine if associations differ by gender

6. Methods
Sample:
702 sexually experienced adolescents in Eastern Cape, South Africa
Urban township
Rural settlement
During the 54-month follow-up of an HIV risk-reduction intervention trial
Paper and pencil self-report survey, collected by read aloud procedure

7. Methods- Measures Proportion of protected sex acts in prior 3 months
Outcome Measure
Proportion of protected sex acts in prior 3 months
Background Data -Demographic and health information
Age; lives with mother/father
Alcohol/drug use
Age of first sex, older sexual partner
Transactional sex; history of forced sex

8. Methods- Measures (cont’d)
Intimate Partner Violence Measure:
Total IPV (as victim) (adapted from Wolfe, 2001)
22 item scale,
alpha = .92
Comprised of 4 subscales
Physical violence (4 items)
Sexual violence (4 items)
Threatening behavior (4 items)
Psychological/Emotional Abuse (10 items)

9. Methods - Data Analysis:
Descriptive statistics:
Chi- Square tests were used to compare frequencies
t-tests were used to compare means as appropriate
Lowess plots were used to determine log- transformations needed to meet model assumptions
Logistic regression:
examined associations of condom use with IPV
Total IPV
4 types of IPV
and whether the associations differed by gender

10. Results - Descriptive Background data N= 702 (50% male; 50% female)
Mean age = 16.9 years

11. Demographics and Partner Experiences by Gender

12. Results - Descriptive Intimate Partner Violence
Girls more likely to experience
Physical violence
Psychological violence
Threats
Boys more likely to experience
Sexual violence

13. Results- Physical Violence by Gender

14. Results- Sexual Violence by Gender

15. Results- Psychological Abuse by Gender

16. Results- Threats by Gender

17. Results- Descriptive (con’t)
Proportion of protected sex acts in past 3 months
| Percent No
Yes

18. Results – Multivariate analysis
Threats, psychological and overall IPV were not associated with condom use
For both males and females physical IPV was significantly associated with the proportion of protected sex acts
(P= 0.002, P= respectively)
A gender x physical IPV interaction was significant (P = ), such that females reporting more IPV were less likely to use condoms and males reporting more IPV were more likely to use condoms.
Males reporting more sexual IPV were less likely to use condoms (P=0.009)

19. Multiple regression Odds of Having Protected Sex in Past 3 months
Correlate
Males Only
Females Only
Gender x Correlate Interaction
Odds Ratio
95% CI
p-value
Physical abuse
1.99
1.08, 3.68
0.028
0.65
0.47, 0.91
0.011
0.002
Sexual abuse
0.72
0.56, 0.92
0.009
0.84
0.66, 1.07
0.156
0.355

20. Results Gender by Physical IPV Interaction
For males:
> physical abuse
MORE condom use
For females:
physical abuse
LESS condom use
Highly significant (p<0.001) interaction of effect by gender.

21. Conclusion
Sexual risk consequences of IPV may differ by gender among adolescents in this region of South Africa.
For females, physical IPV may increase sexual risk through condom non-use
For males, physical IPV may occasion greater condom use, but sexual IPV may increase sexual risk through condom non-use
These findings highlight the importance of addressing multiple types of IPV in HIV prevention interventions for both males and females and tailoring by gender.