The synergy between intimate partner violence and HIV: Baseline findings from the SASA! study, a cluster randomized controlled community trial in Kampala, Uganda

Background. Despite evidence of the synergy between intimate partner violence (IPV) and the human immunodeficiency virus (HIV), recent research on the synergy among men and women in countries of interest and concern, such as Uganda, is lacking. Rigorous research on the role of gender inequalities and power dynamics in the linkage is also deficient. This dissertation explores the synergy between IPV and HIV in greater depth among women and men participating in a cluster randomized controlled community trial of SASA!, an intervention to prevent IPV and HIV in Kampala, Uganda.;Methods. A quantitative household survey was conducted in eight study communities with 1,583 individuals (717 women and 866 men). Qualitative semi-structured interviews were carried out with 46 married (unmatched) individuals (22 women and 24 men) who completed the survey and were selected based on experiences with violence, concurrency, and polygamy.;Results. A significant association was found among men between perpetration of IPV and having multiple partners (adjusted odds ratio (AOR) = 1.85, [95% confidence interval (CI), 1.22--2.79]), having concurrent partners (AOR = 2.53, [1.73--3.69]), and reporting being HIV positive (AOR = 2.70, [1.08--6.71]). Having multiple partners and concurrent partners were both strongly significantly associated with reported HIV status. A significant association was also found among women between their partners' concurrency and their own experiences of IPV (AOR = 2.49, [1.92--3.23]). Data revealed that victims of violence tended to seek support from informal versus formal contacts, and a significant relationship between support seeking and injuries. Both women and men revealed how rigid gender norms continue to perpetuate gender inequality and imbalance of power, both of which contribute to the IPV and HIV epidemics. Positive deviants provided critical input on the enablers and pathways toward more balanced power dynamics in this setting.;Conclusions. Study results indicate that interventions may be more effective if IPV and HIV are addressed in tandem given that gender norms and relationship power dynamics play a substantial role in driving both epidemics. Qualitative findings suggest the importance of community-based social-level interventions that embody ecological and structural approaches to shift ingrained gender norms and inequalities.