Polyvictimization and HIV Testing Behavior in Malawi Open Access

Abstract

Over half of all children in the world are victims of violence every year (1). This violence can be physical, sexual, or emotional in nature, with varying severities and consequences. These forms of violence can co-occur and impact children throughout their life span, resulting in polyvictimization. Violence against children has been shown to increase risk for HIV through various behavioral pathways (3-6). Thus far, there is little empirical research exploring multiple forms of violence exposures and HIV testing uptake. We hypothesize that while children exposed to violence are at higher risk for contracting HIV, they will be less likely to be tested for HIV due to violence’s impact on self-efficacy. We also hypothesize that as individuals are exposed to more forms of violence, the association will strengthen in a graded fashion. Multivariable logistic regression was performed to assess the relationship between different violence exposure types and ever having been tested for HIV, with separate models for males and females. Females exposed to physical and emotional violence combined were more likely to have ever been tested for HIV in comparison to those who did not experience any form of violence (aOR= 2.559; [1.020, 6.418]). Females exposed to sexual and emotional violence combined were less likely to have ever been tested for HIV than females not exposed to any form of violence (aOR=0.058; [0.005, 0.654]).  Regardless of exposure category, males exposed to violence were no more or less likely to have ever been tested for HIV than males who reported no exposure to violence. This study demonstrates that among individuals aged 13-24 years living in Malawi, different combinations of violence have varying associations with testing behavior and these associations differ by sex. 

Table of Contents

Table of Contents

Literature Review……………………………………………………………..…………1

            Intersections of HIV and Violence………………………………………….....…1

            Barriers and Facilitators for HIV Testing and Counseling………………...…...1

            Malawi Context…………………………………………………………….……..3

            Gaps in the Literature………………………………………………………..…...4

Introduction……………………………………………………………………………....5

Methods…………………………………………………………………………………...8

            Study Design……………………………………………………………….……...8

            Data Analysis…………………………………………………………………......9

Results…………………………………………………………………………………...14

            Background Characteristics………………..…………………………………...14

            Exposure Prevalence……………………………………………………….……15

            Bivariate Associations……………………………………………………….…..15

            Modeling………………………………………………………………………....16

Discussion…………………………………………………………………………….....20

Conclusion…………...………………………………………………………………….26

Public Health Implications and Future Directions…………………………………...27

References……………………………………………………………………………….28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Testing Behavior Child Maltreatment Malawi HIV Emotional Violence Sexual Violence Physical Violence Sex-Differences Polyvictimization
Committee Chair / Thesis Advisor	Suglia, Shakira, Emory University
Partnering Agencies	CDC

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