Intimate Partner Violence after Disclosure of HIV Test Results among Pregnant Women in Harare, Zimbabwe

Background: HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women. Methods: In this cross sectional study we interviewed 1951 postnatal women who tested positive and negative for HIV about IPV experiences following HIV test disclosure, using an adapted WHO questionnaire. Multivariate regression models assessed factors associated with IPV after disclosure and controlled for factors such as previous IPV and other known behavioural factors associated with IPV. Results: Over 93% (1817) disclosed the HIV results to their partners (96.5% HIV- vs. 89.3% HIV+, p<0.0001). Overall HIV prevalence was 15.3%, (95% CI: 13.7-16.9), 35.2% among non-disclosers and 14.3% among disclosers. Overall 32.8% reported IPV (40.5% HIV+; 31.5% HIV- women, p = 0.004). HIV status was associated with IPV (partially adjusted 1.43: (95%CI: 1.00-2.05 as well as reporting negative reactions by male partners immediately after disclosure (adjusted OR 5.83, 95%CI: 4.31-7.80). Factors associated with IPV were gender inequity, past IPV, risky sexual behaviours and living with relatives. IPV after HIV disclosure in pregnancy is high but lower than and is strongly related with IPV before pregnancy (adjusted OR 6.18, 95%CI: 3.84-9.93). Conclusion: The study demonstrates the interconnectedness of IPV, HIV status and its disclosure with IPV which was a common experience post disclosure of both an HIV positive and HIV negative result. Health services must give attention to the gendered nature and consequences of HIV disclosure such as enskilling women on how to determine and respond to the risks associated with disclosure. Efforts to involve men in antenatal care must also be strengthened.