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Partner Violence and Elevated HIV Viral Load in South African Women

Significant progress has been made towards treating and preventing the transmission of HIV. For instance, antiretroviral therapy during pregnancy supports maternal health and reduces or eliminates HIV transmission to the infant. Yet, many women across global settings cannot adhere to treatment after giving birth, often due to social and structural barriers. Intimate partner violence (IPV) is one of those barriers—and, according to a new study published in AIDS, IPV adversely impacts HIV outcomes in the postpartum period.

In secondary data analyses funded by the National Institute of Mental Health, a team of international researchers led by Abigail M. Hatcher, Ph.D., of the University of North Carolina (UNC), aimed to explore IPV and its impact on HIV viral response at delivery and postpartum in South Africa. The initial study, supported by the National Institute of Child Health and Human Development, enrolled 471 pregnant women who were 18 years or older, living with HIV, and started ART during their current pregnancy.

The researchers followed the progress of this South African cohort from their first antenatal visit up to 18 months postpartum for a total of up to ten study visits. Measures included questionnaires (with a behaviorally specific assessment of IPV), bloodwork to assess HIV viral loads, as well as clinical data from medical records.

Across the cohort, rates of viral suppression declined over the postpartum period. While 84% of the women were virally suppressed at 6 weeks postpartum, only 67% were suppressed at 12 months postpartum, and 63% at 18 months postpartum. Over the course of the study period, one-third of the women reported IPV exposure. IPV at baseline was associated with reduced odds of viral suppression at 12 months postpartum, controlling for factors such as age, marital status, pregnancy intention, problem drinking, and duration of time on ART.

In longitudinal analyses, IPV predicted viral load at subsequent timepoints. Using a relatively newer technique called “dynamic panel modeling,” the researchers found a greater intensity of IPV was associated with higher viral loads 3 to 6 months later. Importantly, this is among the first longitudinal studies linking IPV to later HIV outcomes.

Overall, the findings suggest a longitudinal association between IPV and elevated viral loads among postpartum women, which has health implications for the mother and the infant. According to the researchers, efforts to address IPV could help eliminate infant HIV infections and secure health and well-being for women of childbearing age.

Reference

Hatcher, A. M., Brittain, K., Phillips, T. K., Zerbe, A., Abrams, E. J., & Myer, L. (2021). Longitudinal association between intimate partner violence and viral suppression during pregnancy and postpartum in South African women. AIDS, 35(5), 791-799. doi: 10.1097/QAD.0000000000002796.

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HD074558, HD080465, MH121185.