Evidence of perpetration of intimate partner violence among HIV-positive couples: a systematic scoping review protocol

Intimacy issues in relationships are normally very sensitive and secretive especially when they are related to human immunodeficiency virus (HIV) disclosure. Although a lot of work has been done to either minimize it or eliminate it completely as much as possible, fear, ignorance and discrimination regarding HIV continue to exact profound human costs like abusive treatment and violence [4, 16, 18]. Spangenberg et al. identified that 46% of mothers of sick newborns in Ghana reported some form of violence. Women who are HIV positive are at risk of experiencing the same forms of violence as other women in the population but in a severe form because of their status [17].

There is increasing evidence suggesting that HIV-positive women and probably men in many African countries may be at increased risk of experiencing intimate partner violence (IPV) following disclosure of their status to their partners [3, 12, 14]. These problems relating to IPV are, however, more likely to be exacerbated in resource-poor settings like Ghana, where discrimination and stigmatization are high [2, 3]. HIV-positive couples in such areas are at risk of being ostracized, denied some essential services, criticized, thrown out of their homes, divorced and/or blamed for bringing disease into the family or into the community [15]. Shamu et al. further reported that 40.5% of HIV-positive pregnant women in Zimbabwe experienced IPV after disclosure of their HIV-positive status to their partners. HIV-positive women are at increased risk of experiencing IPV following disclosure of the partner’s status to each other [1, 10]. The fear of IPV (physical, sexual, psychological and spiritual abuse) may decrease HIV-prevention behaviours [5, 8, 15] such as disclosure of seropositive status to partners, which may lead to the spread of the infection. It may also prevent HIV-positive couples from staying on lifelong antiretroviral treatment and prevention of mother-to-child transmission [6, 7, 13]. Violence against HIV-positive women also has a consequential influence on status disclosure, which is vital to HIV prevention and partner support in accessing preventive services [8, 9].

Intimate partner violence by men against their partners is one of the most glaring indicators of women’s lack of empowerment [3, 10]. There is often the need for the collection of both victimization and offending data that question both partners. This would allow for an examination of the association between status compatibilities and intimate partner violence and victimization and perpetration, as well as mutually combative behaviour between intimate partners [11].

There is scarcity of evidence on the most effective ways of reducing IPV and abuse among persons living with HIV (PLWHIV) in most sub-Saharan African countries [14] which are low- and middle-income countries. Therefore, the need to review studies on HIV-positive couples with intimate partner violence to establish gaps and identify where primary research is necessary. Hence, this study will explore evidence of experiences of HIV-positive couples with IPV and the types of violence experiences by HIV-positive couples.

This study protocol was registered and published with the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42017062190.

This study will generate evidence that will help to describe experiences of human immunodeficiency virus (HIV)-positive individuals/couples with intimate partner violence. Recent improvements in antiretroviral therapy, coupled with nutritional supplementation, have contributed to longevity of life of persons living with HIV (PLWHIV). Mortality and morbidity are now low in HIV populations in low- and middle-income countries while campaigns have further slowed the spread of the virus. However, these efforts are being hindered by non-disclosure of HIV-seropositive status by some couples for fear of being victims of intimate partner violence. Good intimate partner relationship can improve the quality of life of HIV-positive couples and increase their life expectancy. IPV prevention can contribute immensely on the prevention of HIV/AIDs.

We are not aware if there are any empirical studies or reviews that have been done in sub-Saharan African countries that answer the research questions outlined in this protocol. Therefore, this study will include all studies from anywhere in the world that address the population of interest, intervention and any/or all the outcomes listed in Table 1.

Findings from this study will contribute to the body of knowledge on intimate partner violence among HIV-positive individual/couples which will have a positive impact on research, practice and policy. Reduction or elimination of intimate partner violence should help improve the quality of life of HIV-positive couples and increase their life expectancy. The findings from the study will provide an insight on the possible means of reducing IPV and abuse among PLWHIV.

The proposed systematic scoping review results will generate findings that will describe the experiences of HIV-positive couples with partner violence, and the types of violence these populations experienced. The findings from this study will help in identifying gaps in literature on the care of the HIV-positive couples with partner violence. It will also enhance HIV prevention that can be used in education, clinical practice and in making public health policies on HIV and AIDS prevention. The gaps identified will help outline areas for preventive strategies to stimulate cordial coexistence among couples in the low- and middle-income countries. However, there is no data on intimate partner violence among HIV-positive couples in low- and middle-income countries. A number of studies have been on HIV and stigmatization among both men and women.