Exploring Social-Ecological Factors that Contribute to Intimate Partner Violence among People Living with HIV in Kayonza District, Rwanda.

Background:
Intimate partner violence (IPV) represents a significant global health challenge, affecting one in four women worldwide. This critical issue is associated with physical, psychological, and socioeconomic consequences particularly in Sub-Saharan Africa (SSA). The intersection of IPV with HIV/AIDS further increases vulnerability as PLHIV are at heightened risk of experiencing IPV. Rwanda records a high prevalence of both IPV and HIV, however, little is known about factors influencing the intersection of these phenomena. This study sought to address this gap by exploring the factors that contribute to IPV among a diverse group of PLHIV in Kayonza district, Rwanda.

Method:
An exploratory qualitative study was conducted between May and June 2024. A total of ten semi-structured interviews were conducted with PLHIV who have experienced IPV, and two FGDs were conducted with service providers who worked with PLHIV and survivors of IPV for over one year at the time of the study. This study explored the range of factors related to IPV in a diverse group of PLHIV. Purposive sampling and snowball sampling were used to recruit PLHIV and service providers, respectively. Key themes were drawn from semi-structured interviews and FGD transcripts using thematic analysis guided by the social-ecological model.

Results:
The findings highlighted four themes that exemplified the factors related to IPV among people living with HIV: 1) experiences of IPV in PLHIV are caused by general factors and by triggers directly related to their HIV status; 2) HIV-related stigma of various types is intimately tied to experiences of IPV and coping strategies; 3) traditional culture and gender norms shape PLHIV’s definitions and perceptions of IPV; 4) complex contextual factors regarding IPV reporting and fragmented service provision influence decisions regarding IPV-related coping strategies employed by PLHIV. Factors such as controlling behaviors, discordant HIV status, HIV-related stigma, gender norms, and barriers to coping strategies were identified as key factors related to experiences and perceptions of IPV in PLHIV. Women were thought to be more vulnerable to IPV by participants in connection to traditional gender norms, but men were also recognized as survivors of IPV. Coping strategies were dependent upon one’s social context and varied from silence and confiding in family and friends to reporting incidents to local authorities and law enforcement. The findings of this study may be used to improve interventions that address IPV among diverse groups of PLHIV in Rwanda.

Conclusion:
The study findings indicate gaps in the IPV reporting system and weaknesses in the provision of prevention efforts and services addressing IPV among PLHIV in Kayonza district. However, the findings also present the opportunity to implement effective interventions to improve existing reporting channels and interventions against IPV to reduce violence against PLHIV. Efforts to mitigate HIV-related stigma and misconceptions, address traditional gender norms, improve IPV reporting channels, and enhance the empowerment of marginalized groups have the potential to improve IPV among PLHIV with diverse identities.