Research Article :
Domestic violence cuts cross all
age groups and globally, between 10% and 69% of women report of having been
physically assaulted by their sexual partner at least once in their life.
Furthermore, between 6% and 47% of adult women report of having been sexually
assaulted by their sexual partners while between 7% and 48% of girls and young
women at least reported their first sexual episode to have been forced.
Understanding of domestic violence issues and integrating them in the current
treatment regimens is critical for success of treatment regimens of the above
50 years PLWH as domestic violence is blamed to hamper adherence to ARVS and
ART, condom use among others. Hence the main objective of the study was to find
out factors associated with domestic violence among the 50 years and above
population living with HIV/AIDS, making a case study of Mukono hospital
patients. Specifically the study intended to establish the
individual/background factors associated with domestic violence among the above
50 years population living with HIV/AIDS, define the socio-economic factors
associated with domestic violence and find the influence of substance abuse
associated with domestic violence among the 50 years and above population
living with HIV/AIDS. The study adopted a descriptive
cross sectional survey that employed both qualitative and quantitative data
collection techniques that was supported by both primary and secondary data.
Primary data was collected from the 50 years and above PLWH attending CoU
Mukono hospital and from CoU Mukono hospital selected key informants, while
secondary data was captured from CoU Mukono hospital records. The study used
focus group discussions to capture qualitative data were different focus group
discussions for male and female respondents were organized. Quantitative data
was captured through use of questionnaires which were interviewer administered.
The study targeted a sample of 263 respondents which was calculated using a
Kish and Leslie formula and generated by use of simple random numbers that were
assigned to study units following the inclusion and exclusion criteria that
held that study participants had to be above 50 years, on ART and able to speak
Luganda or English fluently. Only 196 respondents were studied as 67
questionnaires had errors. Domestic violence was measured on
a standard HITS scale and a score greater than 10 was positive and indicated
domestic violence while a score less than 10 was negative and indicated that a
participant had not suffered domestic violence hence domestic violence was
measured as a binary outcome. The study held domestic violence as a dependent
variable and predictors of domestic violence like individual/ background
factors, social economic factors like occupation and alcohol abuse as
independent factors. A binary logistic regression was fitted against variables
to test for their associations with domestic violence at both bivariate and
multivariate level that a backward elimination method was used to determine
variables that were significantly associated with domestic violence at
multivariate level using a 95% CI. The study found that alcohol consumption was
a risk factor to domestic violence and findings are in line with Canadian Panel
on violence against women, 1993. Study findings associate domestic violence
with having arguments over sex which is in line with Rani et al., 2004; Worlds
women and Girls data sheet 2011. The study recommended that there is need to
promote interventions that limit alcohol consumption among patients as heavy
alcohol consumption is associated with domestic violence that affects the
treatment regimens of the 50 years and above. Women
comprise nearly half of the 40 million people living with HIV/AIDS
and constitute the majority of the group with new HIV
infection in the world [1-4]. The interrelationship between domestic violence
and spread of HIV/AIDS significantly explains the paradigm as an issue of public
health concern in the control of HIV/AIDS [5,6]. Although men also
experience domestic violence women have been found to suffer effects of
domestic violence pertaining to health more than men as biologically domestic
violence has been found to exacerbate HIV transmission in women than men due to
the larger surface mucus membrane exposed by women during sex than men, higher
transfer of fluids from men to women and the higher viral load in male fluids
[7,8]. Different studied paradigms explain the link between intimate partner
violence (IPV) and HIV/AIDS and this can be examined in 3 ways: through forced
sex with an infected partner; or compromised negotiation for safe sex and or
increased risk for sexual
risk behaviors [4]. The
1992 British crime survey established that less than 4% of women over 60 years
of age reported any form of physical violence in their relationships compared
to 17% from their counterparts between 18-24 years. This is in line with the
Scottish police which reported 1.2% cases of domestic
violence from an old person above 60 years. However data from the British
crime report 2001 showed that the 50 years and above are more likely to
recognize domestic violence as abusive compared to the age group 16-24 years
hence revoking the view that the 50 years and above old were more likely to
accept domestic violence for failure to recognize it as abusive [9]. In
Uganda studies on domestic violence have provided the estimates of domestic
violence among the age group 15-49 years. Koening [10] found that 70% of men
and 90% of respondents justified wife beating to burnt food, if the spouse left
house without consent from the husband, neglect of children or refused to have
sex. It seems hard for the 50 years and above olds to seek help when faced with
domestic violence as services available do not meet their needs and care givers
seem to neglect their needs. Domestic violence is blamed for exacerbating
HIV/AIDS spread as it compromises women to make decisions on safe
sex practices [4]. The
Ugandan government has recognized domestic violence as abusive and exploitative
and to curb domestic violence the government of Uganda has adopted the Domestic
Violence Act 2010 that allows the incidence of domestic violence to be
prosecuted under the general penal code as assault or homicide. In addition a
revised law has been drafted by government that handles issues of domestic
violence, marriage and divorce that a person in a domestic relationship who
engages in domestic violence commits an offence and is liable on conviction or
to a fine not exceeding forty eight currency points or imprisonment not
exceeding two years or both and the court may, in addition to imposing a fine
or imprisonment,
order the offender in a case of domestic violence to pay compensation to the
victim of an amount deemed fit by court. However
the 50 years and above PLWH have different needs from the age group 15-49 years
were most of the research on domestic violence has been centered [11].
Understanding of domestic violence issues and integrating them in the current
treatment regimens is critical for success of treatment regimens of the 50
years and above old PLWH as domestic violence is blamed for hampering adherence
to ARVS and ART, condom use among others [7]. Church of Uganda Mukono hospital
is offering HIV/AIDS programmes that target 50 years and above old. However
understanding factors associated with domestic violence among the 50 years and
above PLWH and integrating them in their treatment is a critical component in
the success of interventions which include: offering of ARVS, screening, testing
and diagnosis
and home based care. However no research has been done in regard to factors
associated with domestic violence among the 50 years and above PLWH. The
general objective of the study was to identify the factors associated with
domestic violence among the 50 years and above old population living with
HIV/AIDS. What individual/background factors
associated with domestic violence among the 50 years and above of age
population living with HIV/AIDS? What are the socio-economic factors
associated with domestic violence among the 50 years and above of age
population living with HIV/AIDS? What is the influence of substance abuse
associated with domestic violence among the 50 years and above of age
population living with HIV/AIDS? The
study is expected to be used by CoU to design appropriate policies that can
curb domestic violence among the 50 years and above of age and hence limit its
drive of HIV/AIDS. The study is expected to be used by policy makers to design
policies that can combat the level of domestic violence among the 50 years and
above of age PLWH so as to curb its effect on the current treatment regimens.
The study is an informative report that is expected to be used by gender
activists to advocate for the integration of variables associated with domestic
violence in the planning and designing of treatment regimens of the 50 years
and above PLWH. The study is expected to be used by the above 50 years PLWH to
reflect on their relationships and hence improve them to combat domestic
violence and HIV/AIDS. In
the conceptual frame work above, individual or background and economic
factors interplay with intermediate factors to cause the outcome (domestic
violence) though background and economic factors can act independently of
intermediate factors to cause domestic violence. Intermediate factors like
alcohol consumption are risk
factors of domestic violence however the older the person the less likely
that they are to get involved in heavy alcohol consumption which is likely to
lessen episodes of domestic violence. Despite the fact that domestic violence is
blamed to exacerbate HIV/AIDS [5], present research on domestic violence has
been centred among the age group 15- 49 years and hence has not unearthed
factors associated with domestic violence among the 50 years and above of age
PLWH. However domestic violence affects the treatment regimens of the above 50
years of age PLWH through compromised decisions for women on safe sex practices
and adherence failure to ARVS [4]. Hence it is critical
to establish factors associated with domestic violence among the above 50 years
PLWH so as to address domestic violence issues that affect the treatment
regimens of the 50 years and above of age PLWH. Literature Review There
is no single variable that can independently explain the cause of domestic
violence and research has advanced an interrelatedness of factors to aid
understanding of domestic violence in context of specific societies and
communities. Several cultural and institutionalized cultural factors account
for domestic violence in cultural and institutional specific areas and thus
cultural, economic, legal and political factors significantly cannot for
domestic violence which is stirred by the unequal power relationships [3].
Furthermore factors responsible for the unequal relationships include social
economic factors and dynamics, fear and control over female sexuality,
family institution and structure where power relations are enforced as
patriarchal, belief in male superiority over female and male inheritance,
legislations and cultural barriers and sanctions that bar women from legal
recognition and status for instance owning land and property and k that
deprive women from economic independence. Heise
argues that the link between lack of economic resources and domestic violence
is circular and operates in an endless chain that resource stricken women
accept low paying employment, fail to secure employment and settle for home
exploitative work that deprive them of economic independence that keeps them in
violent and abusive relationships. However high violence levels are found in
relationships of economically independent women as men use sex
violence to subdue women in order to assert their manhood and authority
over economically independent women, men use sex violence as a weapon to subdue
women and this is specifically true when the male partner is unemployed and
feels that his power is threatened in the household. Cultural
factors provide justification for wife beating in some circumstances as in
developing countries culture places men as family heads and household decision
makers which is an irony that subdues women as subordinates to men that denies
them property rights and making them dependent. Traditional culture ranks women
as inferior to men that a man is justified to divorce and remarry while it is
abominable for a woman to divorce her husband even when faced with violence a
tradition that compels women to be submissive to men [12]. In
addition women are ranked inferior to men that concur with Uganda Demographic
Health Survey 201, that found that 44% of men compared to 58% of women
justified wife beating where the most reported justification for wife beating
was wife neglecting children that was reported at 45% compared to 56% in 2006. Other
causes of domestic violence reported by the survey were wife going out without
consent from her husband although the percentage of women who justify wife
beating when a woman denied her husband sex fell to 22% in 2011 from 31% in
2006 while of women who justify wife beating when a wife prepared food badly
declined to 17% in 2011 from 23% in 2006. Wife beating remains profound from
African societies and stems from the cultural orientation which ranks men above
women and that regards women as inferior to men and hence required to seek
consent from their husbands before going anywhere. Women are required to look
after children, prepare food and sexually serve their husbands against their
consent [13]. Findings
from the UDHS [14] indicate that wife beating is highly justified and
legitimate among women with primary education than their counterparts with
post-secondary education and among households with low income levels which
concurs with Rani et al. [13] who in analyses of data sets of Demographic
Health Surveys from seven countries including Uganda, Malawi, Benin, Ethiopia,
Rwanda, Zimbabwe and Mali used a multivariate analysis to identify factors that
where significantly associated with wife beating and found that the likelihood
of support for wife beating was low among women with post-secondary education
across the seven countries than women without formal education . The
Uganda Demographic Health survey 2011 highlighted that wife beating is
justified when a woman declines to offer sex to her husband that was reported
at 22% in 2011 compared to 33% UDHS, [15] survey findings which is still high
which affirmed that women are not in full control of their bodies.
Decisions on sex are highly dictated by men were refusal to offer a
husband sex provokes an episode of domestic violence according to Worlds
women and Girls data sheet 2011 which reported that 31% of Ugandan women
compared to 19% of Ugandan men having condoned wife beating when a wife refused
to give her husband sex. However, understanding attitudes and beliefs between
women and men behind wife beating and domestic violence is a critical component
in investing domestic violence as it determines acceptability and reporting. Perception
of a male partners HIV/AIDS status is a predisposing factor that exacerbates
domestic violence. Koening et al. [10] who found that women who were somewhat
likely to perceive their male partners as HIV positive had OR= 1.84, 95% CI=
1.45-2.33, P= 0.000 to experience domestic violence while women who perceived
that their male partners were very likely to have been exposed to HIV/AIDS had
OR=3.72, 95% CI= 2.81- 4.92, P= 0.000 compared to women who did not know the
HIV status of their husbands who recorded OR=1.05,95% CI= 0.85- 1.29, P= 0.675
thus the perception of a male partners HIV status is a significant predisposing
factor for domestic violence. Koening
et al. established an inverse relationship between odds for domestic violence
and period of current relationship where short relationship periods were
associated with higher odds of domestic violence compared to longer
relationship periods which were associated with relatively lower odds for
domestic violence. Hence as relationship period increases the odds for domestic
violence decrease this means that orientation about the
relationship changes. Koening
et alin the same survey established that in relationships where women are in a
wife - husband relationship the odds for domestic violence were 1 compared to a
relationship were it is consensual OR=1.32, 95% CI=1.05-1.67, P= 0.020
and OR= 0.41, 95% CI= 0.30-0.56, P= 0.000 where a relationship was
a boyfriend relationship. Thus odds decrease with recognition of a husband -
wife relationship and this can be partly attributed to the nature of the
husband - wife relationship hence understanding the attitudes and nature of the
relationship is critical in explaining the limited violence in the
relationship. However, Koening in his study focused on the age group 15-49
years and neglected the above 50 years who have different needs compared to the
age group 15-49 years. Koening
et alfound that women with 0-1 child had 1 odd to experience domestic violence
compared to women who had 2-3 living children who had OR=0.85(95% CI 0.68-1.07)
P= 0.161 compared to women who had 4-5 living children who had OR=0.87 (95% CI
0.65-1.16) P= 0.344 and compared to women
who had at least 6 living children who had OR=0.64,95% CI= 0.45-0.91,P= 0.012.
Hence odds of living in violent relationships decreased with increase in number
of children living . Koening
et alestablished that a womans age at first intercourse significantly predicted
domestic violence as women who had their first sexual intercourse before 15
years had OR=1.93 95% CI=1.47-2.52, P= 0.000. Women who had their
first sexual intercourse between 15-17 years had OR=1.58, 95% CI= 1.24-2.03, P=
0.000 odds for living in violent relationships as compared to odds of women
who had their first sexual intercourse at least at 18 years who had 1 odd
for living in violent relationships. However Koenig did his study in Rakai
district which is rural thus the sample size having different attitudes,
knowledge, education
and exposure compared to the urban setting were this study is centered. However
the Rakai study was done in Rakai which is a village setting where people have
different knowledge and attitudes from people in the urban setting. Koening
et al established that a womans consumption of alcohol significantly predicts
domestic violence at OR= 1.22, 95% CI= 3.44-6.21, P= 0.042 compared to those
who did not consume alcohol. In addition alcohol and illicit drugs like
marijuana and Viagra arouse sexual urge that under the influence of illicit
drugs, users lose conscience and may not know that they are committing
violence against their partners which drives sexual violence against women. In
Canada an examination of perpetrators of gender based violence almost found
that 40% had consumed multiple substances like cocaine, marijuana and gamma
hydroxybutyrate which induce men to sexually abuse their partners Canadian
Panel on violence against women, 1993. Childhood
sexual abuse is an act of violation of childrens rights through domination and
use of power over children. The abuser uses his position of power and authority
over the child to subdue the child to sexual
violence. The abusers position and knowledge is higher than that of
the child as the child depends on the adult for affection. Thus the abuser
exploits the power difference to subject the child to sexual violence. This can
be through coercion hence any time a child is sexually abused there is coercion
[16]. This
builds in the child that he recognizes violence as legitimate that he does it
in adulthood. A child who was exposed to sexual violence or witnessed his
mother or relatives being exposed to sexual violence is likely to subject
violence to others in adulthood
as revenge or because of the feeling that women have no right to refuse sexual
acts [17]. This justifies that the above 50 years are not free from sexual
violence though research has mainly focused on the age group above 15-49 years. Domestic
violence is prevalent in both low, middle income and developed nations of the
world. It happens that the rates of domestic violence in Europe and Eurasia are
synonymous to those recorded in other parts of the world. A systemic review on
worldwide prevalence by the WHO [18] reported that women having experienced
domestic violence from a romantic partner in Philippines and Paraguay ranged
from 10% to 67% in Papua New Guinea and Nicaragua. 1.3-3% in United States and
Canada. However it is imperative to note that concern could be taken when
reporting prevalence of domestic violence as evidence has shown that there is
underreporting of episodes of domestic violence due to stigma, fear of more
possible episodes of domestic violence from the perpetrator and at times fear
of rejection from family members and the community [19,20]. Level
of domestic violence may vary between regions due to the differences in
methodologies employed; the way people perceive violence and their willingness
to disclose violence and abusive actions to researchers and hence caution could
be taken when interpreting low rates of domestic violence in a particular
region. Population surveys have documented that a very small population of
women survivors of domestic violence come to the attention of authorities and
service providers [20,21]. This
concurs with survey findings from the Europe and Eurasia on domestic violence
which found that only 1-20% of survivors of domestic violence reported to
police or social health workers. Thus estimates of domestic violence do not
give realistic approximation rates of the phenomenon as many women suffer in
silence due to fear of stigma however domestic violence has been reported at 5%
in New Zealand to 81% in Egypt [3]. In Bucharest 28% of women hospitalized
women were being beaten by their romantic partners [22]. However under reporting
is synonymous as many survivors were found not to seek assistance from
authorities due to fear of potential violence from the perpetrator. Studies
on domestic violence try to quantify the prevalence of domestic violence among
the abused and statistics have found that women who are subjected to domestic
violence experience a range of abuses including physical, emotional, financial
and sexual abuses. However it was found that women fail to report the frequent
abuses they suffer on a regular basis [23,24]. Studies in Uganda concur with
global trends on the burden of domestic violence, a study in Uganda found out
that 68% of ever married women aged between 15 and 49 years experienced
domestic abuse from an intimate partner [15]. However, in Uganda there is
under reporting as a number of cases of domestic violence are not reported due
to fear of prosecution of the perpetrator as victims could be depending on the
perpetrator [25]. At
the global arena domestic violence came to the limelight during the first
Womens conference Decade (1975-1985) and in the nineties it turned into a major
focus at the international fora. The Vienna conference on human rights in 1993
identified that even though domestic violence manifests in the family domain it
is an abuse of human
rights and this was developed by the Belem do para Convention of the
organization of American states in 1994 which gave birth to the designation of
the Inter American courts for survivors of domestic violence. These treaties
and codes have developed mechanisms, policies and frameworks that help to
define domestic violence cases and how to deal with cases to hinder subsequent
occurrences however confusion and loopholes are still manifested in the way
populations perceive and interpret domestic violence in South America, analysis
on institutional feedback has given contradicting results, in Venezuela for
instance, domestic violence is only considered when there is a stable
relationship. In Brazil domestic violence is not considered when it is between
concubines and unmarried spouses. Controversies manifest on to which call
points to use to address domestic violence as counselors are used to counsel
perpetrators and survivors to prevent further occurrence instead of seeking
medical and support from legal authorities. This is adopted to minimize legal
costs that would be incurred by the perpetrators. In numerous cities societal
approaches had been used to help out battered women as temporary shelters would
be constructed where they would get help [26]. Categorically this would just
exacerbate the problem as it was a short term remedy that not a sustainable
solution. Hence
the controversies in perceptions, definition and recognition of domestic
violence vary from region to region and contribute to reporting level of rates
of domestic violence which in turn affects the prevalence estimates of the
burden of domestic violence. However violence is perceived as a means of
solving differences and is highly appreciated as a tool of socializing children
[27]. The Uruguayan survey found that 40% of households had a record of
previous violence and 80% of households had a record of present violence. Studies
on sexual violence have unearthed that sexual violence can occur at any age in
ones life [28,29]. They add that victims of reported rape at childhood stand
chances of suffering sexual violence even in adulthood thus confirming that the
old are prey to sexual and physical
violence unlike the common school of thought that exonerated them from
sexual abuse [30-32]. However
many cases of sexual violence are not reported to authorities for fear of
stigma and fear for further violence from the perpetrator hence prevalence
rates of sexual violence are significantly affected by under reporting. About
10.4% (11.7 million) men in the United States revealed to have had a partner
who insisted on getting pregnant without their consent and 8.7% reported to
have had an intimate partner who insisted to get pregnant though they never
wanted while 3.8% reported to have had an a romantic partner who declined to
use a condom. These
significantly determine the constructs in which people perceive and define
abuse. Cultural and gender dynamics vary from society to society and determine
what entails abuse that determines the reporting rates for domestic violence in
a given society as it justifies it or condemns it [24].A study in Macedonia
found that women declined to allow researchers to code slapping as physical
violence because they felt that this was something casual and normal as it was
frequently happening in many household [33].Contradictions in defining domestic
violence were found in a study in Macedonia where men classified physical
violence as only when aggression is associated with injury while women reported
physical violence even when physical violence was not associated with injury
[34]. It
was found that in Australia 25% of women in 1996 experienced domestic violence
[11]. However even in the developed world like Australia old
people live in a world where domestic violence is not talked about and have
to follow the footprints of their mothers who yielded into abuse. This is
because society and norms are designed to think that the above 50 years do not
experience abusive acts from their intimate partners. Hence Australian
olden women have hardly been exposed and brought to the limelight of the
influence of women empowering movement than the young women. Research on
domestic violence among the above 50 years has been low because realities of
the old people are lost when age is seen as the only factor exacerbating the
abuse [35]. Hence the plight of the old is abused and their voices are hardly
hard at the interface of domestic violence. Unlike
the common school of thought that domestic violence is manifested among young,
the above 50 years are also vulnerable to the problem, a survey conducted among
the above 50 years in Argentina found that 51% of the above 50 years had been
subjected to emotional violence and 11% mainly women had been subjected to
physical violence on part of family members and no significant difference was established
between economic level [36]. IPV
hampers intimate partner communication and decision on safe sex practices for
instance use of condom, HIV status disclosure and sexual faithfulness. Kalichman
et al. established that women with abusive partners were more likely to decline
negotiating condom use thinking that her persistence may be viewed as
manifesting unfaithfulness or untrustworthiness of either partner. Further
studies have shown that a womans fear and anticipation of potential violence
from the perpetrator in suggesting condom use hampers negotiation for safe sex
practices and is a critical component that exacerbates HIV transmission
[37,38]. Subsequently the fear of violence determines whether a woman takes
voluntary counseling and testing services. Methodology
of the study, the study design, study population, sample size calculation, data
collection tools and techniques, plan for data analysis and ethical
considerations among others. The methodology is derived from the problem
statement and study objectives. The
study took a descriptive cross sectional survey. It employed both qualitative
and quantitative data. The design was adopted to capture an in depth understanding
of the burden of domestic violence among the 50 years and above old PLWH
attending CoU hospital Mukono. The study used focus group discussions to
capture an in depth narrative about the study variables and different focus
group discussions for male and female respondents were organized. The use of
two different data collection methods enhanced data triangulation and validity.
The
study used both primary and secondary data. Primary data was collected from the
50 years and above old PLWH attending CoU Mukono and from CoU Mukono
hospital, selected key informants, while secondary data was captured from CoU
Mukono hospital records like patient registers which reflected participant
serial numbers, date of birth, place of residence and language of communication
among other variables. Both primary and secondary data was used to aid data
triangulation to ensure validity. The
study population constituted 196 adults 50 years and above old PLWH attending
CoU hospital Mukono. Also 6 selected key informants were selected from CoU
hospital Mukono. The 50 years and above old PLWH were captured from CoU Mukono
data base following the inclusion and exclusion criteria. Study participants
were on ART and proficient at either Luganda or English. Inclusion
criteria Selected participants had to be 50 years and above of age The
study targeted all the 6 key informants attending to the 50 years and above
PLWH, Sample
size calculation: Using the sample size calculation formula. However
the study studied a sample of 196 respondents as 67 questionnaires had errors
and never conformed to study standards and required procedures during data
processing and editing for instance some questionnaires never conformed to
prescribed age cut offs. Register sheets containing all the 50 years and above PLWH attending CoU
Mukono hospital were used to generate the sampling frame in that the data base
was controlled for the 50 years and above PLWH that random numbers were
assigned to study units. A study sample of 263 was generated using simple
random numbers that had been assigned to study units following the inclusion
and exclusion criteria. Simple random sampling was used to generate the study
sample of 263 respondents. This is being probabilistic minimizes study bias.
However 196 respondents were studied as 67 questionnaires had errors. The
method was also used because it increases generalizability among the target
population. All the 6 key informants were selected for the focus group
discussions and 30 respondents were selected for the
focus group discussion through quota sampling. Two focus group discussions of
females and males with each constituting of 15 participants were held to aid
comparison of responses. Level
of domestic violence was the outcome variable that a scale running from 0-20
was used to determine if a participant lived in a violent relationship or a
violent free relationship. Independent
Variable Independent
variables included the individual/background factors for instance gender, age,
education, marital status, religion and HIV/AIDS. Socio-economic
factors which included income and occupation among others and substance
abuse like alcohol consumption. Covariates
associated with domestic violence among above 50 years PLWH were used to
predict the dependent variable and were coded as 1. The
study is holding level of domestic violence as a dependent variable and holds
covariates predicting domestic violence as independent variables among the
above 50 years PLWH. Clinical
Research and Methods The
domestic violence scale tool in Table 1, was used to measure domestic violence
which was the outcome variable. Each item was scored from 1-5, thus, scores for
this inventory range from 4-20. A score greater than 10 was considered positive
and indicates that a participant has suffered domestic violence while a score
less than 10 was negative and indicated that a participant had not suffered
domestic violence. Domestic violence was measured as a
binary outcome and a binary logistic regression was used to test for
significant predictors at both bivariate and multivariable levels. Table 1: Domestic
violence Screening (Measuring) Tool. The
study used questionnaires which captured the objectives of the study that were
interviewer administered for purposes of quality Control and compliance to the
WHO ethical guidelines with selected respondents [39]. Questionnaires were
translated to Luganda language in which they were administered and then
translated to English during data entry to maintain content validity.
Questionnaires were administered by trained field researchers in domestic
violence. Focus
Group discussions were held with selected key informants and respondents to
capture qualitative data about the study variables. Female interviewers held
focus group discussions with a group of 15 female participants and male
interviewers held a focus group discussion with a group of 15 male
participants. These groups where separated to aid comparison in the collected
data between the groups. Data
was collected, edited, coded, sorted and analyzed using the STATA software and
it was tabulated and presented in tables. A Pearson chi-square statistic was
used at bivariate level to analyze the association between a given predictor
variable and domestic violence and given the association it was analyzed at
bivariate and at multivariate level using the binary logistic regression. A
fitted logistic regression was used to analyze and identify predictors that
statistically significantly explain domestic violence among the above 50 years
PLWH attending CoU Mukono. At
a bivariate level, the Chi square statistic was used to obtain significance
levels of predictor variables which were tested using the logistic regression.
Significance was determined using the probability value cut off of 0.05 and
variables with a probability value of less than 0.05 were determined
significant at bivariate and multivariable level. Chi square analysis relied on
the following equation. Where;
j=1,2,…, =
k
I=1,2,…= r Oij
is the observed frequency Eij
is the expected frequency k
is the number of categories of the dependent variable r
is the number of categories of the independent variable At
a multivariate level the logistic regression was fitted using all variables
through a backward elimination method using the following method Where; Pi
is the probability of occurrence of the dependent variable domestic violence 1-pi
is the probability that the dependent variable will not occur
(pi + 1-pi =1) Xs
are the independent variables used to predict the dependent variable bo
is the intercept of the slope and is a constant bj
are the regression parameter estimates A
fitted Binary logistic regression was used to test the significance of
variables at the multivariate level using ORS and the probability values.
Significant variables were identified which were deemed to significantly
explain domestic violence among the above 50 years PLWH attending CoU hospital
Mukono. Qualitative
data was analyzed through thematic analyses of themes from focus group
discussions from key informants and selected participants and qualitative data
was presented in themes. Field
researchers were trained in researching violence among the above 50 years PLWH
and results of a pilot study were analyzed and compared with study results. Questionnaires where transcribed to Luganda in which they
were administered and then transcribed to English during data entry to maintain
content validity. Questionnaires were administered by trained field researchers
in domestic violence. Findings
were compiled into a report and presented to the Institute of Health Policy and
Management at International Health Sciences University Kampala. A copy of the
dissertation will be submitted to the Belgian Technical Cooperation Kampala and
Raising Voices. Female
researchers interviewed female respondents and similarly male field researchers
interviewed male respondents. This was adopted to maximize privacy and
confidentiality. It is one of the guidelines in conducting research on domestic
violence. Respect
of autonomy: participation in the study was voluntary that only respondents
who gave an informed consent were interviewed. Respondents had a right to
consent to the study or to opt out of it without any threats or intimidation. Principle
of Beneficence: the study maximized benefits and minimized risks to study
participants and a thorough explanation about the benefits and risks of the
study to participants was read and explained to respondents for them to choose
whether or not to participate in the study. They were explained the purpose,
objective and goal of the study and how it benefits them. Participants were
assured of confidentiality and privacy that all data would be used for only
study purposes and no names of participants would appear in the final report. Principle
of Harm: The harm principle was observed where all respondents were assured
of confidentiality and privacy of all their responses that all the information
would be stored and kept safely to avoid external viewing so that it is only
used for study purposes. During presentation of results no information will
show its source or particular respondents who gave specific pieces of
information as this can provoke more episodes of violence from the perpetrator.
Participants where offered mobile numbers of counselors who would counsel them
in case of emotional discomfort caused by some of the questions. Respect
of persons: Respondents had a right to autonomy that participants with
diminished or impaired autonomy where excluded from the study as the study
never employed joint confidentiality for privacy. Selected participants had a
right to halt the interview at any time in case of any interruption and
interviews were scheduled at the respondents convenience. Respondents fixed
appointments for interviews and determined interview
spots. The
study targeted the above 50 years PLWH as it is aimed at curbing domestic
violence issues that affect their treatment regimens. Hence the burden of
research was only felt by the above 50 PLWH and on ART that it never targeted
suspects of HIV or people below 50 years as benefits of the study would not
accrue to them. The
study used a sample of the 50 years and above PLWH from Mukono which cannot be
generalized to other 50 years and above PLWH in other areas. The
study lacks statistical power to be generalized to external areas and hence findings
exclusively define domestic violence among the 50 years and above PLWH though
they give a snap shot of the problem and can be based on to conduct an
extensive study. This
is descriptive cross sectional study hence it suffers weaknesses of a cross sectional
study for that it cannot test for causation. Data
on both independent and dependent variables was collected at the same point in
time hence it can hardly test causation as it mainly depends on previous data
to explain the dependent variable which is subject to memory and recall bias.
However to minimize memory and error biases the very 50 years and above for
instance above 95 years were eliminated from the study and data on possible
confounders was collected. Study
findings which are tabulated in percentages, frequencies to show the level of
domestic violence and presented in χ2 and Odds ratios to test for associations
between study variables and domestic violence the outcome variable and to
identify significant variables at both bivariate and at multivariable level. Table
2 presents demographic characteristics of the studied respondents who attend
CoU Mukono hospital which are presented in percentages scores. A descriptive
analysis of demographic variables is tabulated to aid interpretation of the
study sample and to aid analysis of results in relation to study objectives
(Table 2). To view Table 2 click below Table 2: Socio Demographics of respondents. Of
the 196 respondents studied 76.53% (150) were between 50-79 years and 23.43%
(46) were above 79 years. According to Table 3, age showed a χ2=
9.55, P = 0.002 which is a significant association. This means that
age was associated with domestic violence hence interventions to curb
domestic violence so as to improve treatment regimens of the 50 years and
above PLWH should meet the domestic
violence related issues of different age groups. Percentage
scores reported on religious affiliation indicated that 17.86% (35) were
Protestants, 25% (49) Catholics, 20.92% (41) Muslims, 19.39% (38) Pentecostal
and 16.84% (33) from other religions hence Catholics were the majority and
those from other religious denominations were the least in the study sample.
Hence according to the table 3 below, religion was not associated with domestic
violence with a χ2= 8.8678, P =0.064 thus interventions to curb domestic
violence among the 50 years and above PLWH should not target religion as
religion is not associated with domestic violence. The
study findings established that 25.51% (50) had no formal education, 25 % (49)
had primary education, 17.86 % (35) had secondary education, 13.78% (27) had
university education and 17.86% (35) had tertiary education which implies that
50.51% had utmost primary education. According to table 3 below, education is
not associated with domestic violence as a χ2= 2.03, P=0.729 was obtained
thus interventions to curb domestic violence in order to improve treatment
regimens among the 50 years and above PLWH should not target education levels
as education level is not associated with domestic violence. Of
the 196 respondents studied 22.96% (45) were married compared to the 77.04%
(151) who were unmarried though with regular sexual partners which gave a χ2
=28.66, P = 0.000 which is a significant association as seen in table 3 below.
Hence marital status is associated with domestic violence and therefore
interventions to curb domestic violence in order to improve the treatment
regimens of the 50 years and above PLWH should target domestic violence issues
of different marital statuses of patients. Of
the 196 respondents studied females constituted 37.24% compared to the males
who constituted 62.75% which according to Table 3 below, gave χ2= 2.16, P =
0.14 which shows that domestic violence is not associated with gender. Hence
interventions to curb domestic violence should not target gender as gender
difference is not associated with domestic violence but should focus at
associated factors with domestic violence for instance marital status of
patients. Among
the 196 respondents studied 21.94% were involved in professional works
including teaching, medical work and other professional works, 13.27% were taxi
drivers working directly as taxi drivers or owning taxis, 9.69% worked as motor
riders or owned motor bikes, 11.73% worked in bakery business, 10.20% owned
saloons or were employed in saloons as hair dressers while others worked as
barbers, 13.27% worked as shoe repairers and 19.90% were employed in other
occupations. According
to table 3 below, this gave χ2=3.15, P=0.789 which is not a significant
association implying that there is no association between domestic violence and
occupation. Therefore interventions to curb domestic violence in order to
improve the treatment regimens of the 50 years and above PLWH should not target
occupations as domestic violence is not associated with occupation but should
focus at associated factors with domestic violence as seen in Table 3. Table
3 presents χ2 results of significant factors associated with
domestic violence and are interpreted using a 95% CI, P=0.05. Interpretation of
results is related to study objectives and policy implications are given to
contribute to policy formulations in order to curb domestic violence and
identify areas of further research (Table 3). To view Table 3 click below Domestic violence across age: According to the Table 3, age is significantly associated
with domestic violence with a χ2 = 9.55, P= 0.002. Hence interventions to curb
domestic violence should meet the domestic violence issues of different age
groups in order to improve the treatment regimens of the above 50 years PLWH as
age is associated with domestic violence. Domestic violence across marital status: According
to Table 3 above, domestic violence is associated with marital status with a
χ2= 28.66, P = 0.000. Hence interventions to curb domestic violence in order to
improve the treatment regimens of the above 50 years PLWH should meet the
domestic violence issues related to marital status of patients. Domestic
Violence across partners who had partners who lived with other partners as if
married: According
to the Table 3, domestic violence is associated with a partner having other
partners as if married with a χ2= 35.41, P = 0.000. Hence interventions
to curb domestic violence in order to improve the treatment regimens of the
above 50 years PLWH should discourage patients from having other partners as if
married as having another partner as if married is a risk factor to domestic
violence Domestic
across ever initiated a discussion about condom: According
to Table 3, domestic violence is statistically associated with having
discussions about condom use with a χ2= 39.07, P = 0.000. Hence
interventions to curb domestic violence so as to improve the treatment regimens
of the above 50 years PLWH should integrate mechanisms that hamper violence
accruing due to discussion about condom use among patients. Domestic
Violence across partner ever initiated a discussion about condom use: According
to Table 3, domestic violence is associated with a partner having ever
initiated a discussion about condom use with a χ2 = 20.04, P = 0.000. Hence
interventions to curb domestic violence in order to improve the treatment
regimens of the above 50 years PLWH should integrate issues of promotion of
violent of discussions about condom use to promote positive discussions about
condom use to avoid violence. Domestic
Violence across ever had an argument over sex in the last 12 months: According
to Table 3, domestic violence is associated with having an argument over sex
with a χ2 = 114.82, P = 0.000. Hence interventions to curb domestic
violence in order to improve the treatment regimens of the above 50 years PLWH
should address issues of containing arguments over sex as having arguments over
sex is a risk factor to domestic violence. Domestic violence across always used a condom in the
last 12 month with regular partner: According
to Table 3, domestic violence is associated with frequent condom use with a χ2=
100.14, P = 0.000. Hence efforts to curb domestic violence in order to improve
the treatment regimens of the 50 years and above PLWH should integrate issues
of designing safe mechanisms for negotiation of condom use among patients. Domestic
violence across partner having had a sexual relationship with another partner: According
to Table 3, domestic violence is associated with a partner having had sexual
relationships with another partner in the last 12 months before the study with
a χ2= 71.29, P=0.000. Hence interventions to curb domestic violence in order to
improve the treatment regimens of the above 50 years PLWH should integrate
issues of containing partners from having sexual relationships with other
partners in their design. Domestic
violence across having had a sexual relationship with another partner in the
last 12 months: According
to Table 3, domestic violence is associated with having had a sexual
relationship with another partner in the last 12 months before the study with a
χ2= 58.4532, P= 0.000 which is a significant association.
Thus efforts to curb domestic violence in order to improve the treatment
regimens of the above 50 years PLWH should discourage patients from having
sexual relationships with other partners. Domestic violence across ever seen partner drunk in the
last 12 months: According
to the Table 3, domestic violence is associated with having ever seen a partner
drunk with a χ2= 57.0659, P=0.000 which is a significant association. Hence
interventions to curb domestic violence in order to
improve the treatment regimens of the above 50 years PLWH should integrate
issues of containing alcohol consumption among patients. Domestic
violence across respondents who had ever been drunk: According
to Table 3, domestic violence is associated with a respondent ever have been
drunk with a χ2= 49.29, P=0.000 which is a significant association. Hence
efforts to curb domestic violence in order to improve the treatment regimens of
the above 50 years PLWH should integrate issues of
containing alcohol consumption as alcohol consumption is associated with
domestic violence. Domestic
violence across respondents who had been often drunk: According
to the Table 3, domestic violence is associated with a patient being often
drunk with a χ2= 39.80, P=0.000 which is a significant association. Hence
interventions to curb domestic violence in order to improve the treatment
regimens of the above 50 years PLWH should integrate issues of retraining alcoholism
in design and programming as alcoholism is associated with domestic violence. Domestic
violence across respondents who saw their partners often drunk in the last 12
months: According
to the Table 3, domestic violence is associated with a respondent having seen
his partner drunk with χ2= 38.6313, P=0.000. Hence interventions to curb
domestic violence in order to improve the treatment regimens of the above 50
years PLWH should focus at encouraging patients to refrain from being often
drunk as a patients seeing his partner often drunk is significantly associated
with domestic violence. Presentation of results of the bivariate logistic
regression: The
table 4 presents results of the binary logistic regression and presents
variables that are associated with domestic violence at bivariate level which
are computed at a 95% CI, P=0.05. Interpretation of results is related to study
objectives and policy implications are given to contribute to policy
formulations in order to curb domestic violence so as to improve the treatment
regimens of the above 50 years PLWH and identify areas of further research
(Table 4). To view Table 4 click below Table 4:
Binary logistic Regression. Age Marital
status Partner lives with other partners as if married Ever
initiated a discussion about condom use According
to Table 4, domestic violence is significantly associated with initiation of
condom use with OR =.102, 95% C.I= .0470 - .2256, P= 0.000. Hence
respondents who ever initiated a discussion about condom use had 0.898 odds
less of living in violent relationships as compared to odds of respondents who
never initiated a discussion about condom use. Thus interventions to curb domestic violence should be mainly geared towards patients
less than 79 years as they are 65% times more likely to live in violent
relationships as compared to those above 79 years. However the above 79 years
old lived in less violent relationships as compared to the age group less than
79 years old as it was hard for them to start new relationships. Marital status of respondents: According to Table 4 there is a
significant relationship between domestic violence and marital status with OR=
6.60 95 CI= 3.15 - 13.80 P= 0.000. Respondents who were unmarried had 7 odds
more of living in violent relationships as compared to odds of respondents who
were married. This is in agreement with Koening who established that the
married lived in less violent relationships as compared to the unmarried.
Therefore interventions to combat domestic violence should be mainly targeted
at unmarried patients and should clearly address domestic violence issues
affecting the unmarried in order to improve the treatment regimens of the above
50 years However the married lived in less violent relationships because of the
respect they had for each other as compared to the unmarried who thought they
could always get a new partner. Partner lives with other partners as if
married: According to Table 4 domestic violence is associated with partners
living with other partners as if married with OR= 8.320 95% C.I = 3.904 -17.732
P= 0.000. Hence respondents who lived with other partners as if married had 8.3
odds more of living in violent relationships as compared to odds of respondents
who never lived with other partners as if married. This is in line with AI that
established a strong correlation between domestic violence and sexual
unfaithfulness. Ever initiated a discussion about condom use: According to Table 4
domestic violence is associated with having a discussion about condom use with
OR =.102 95% C.I= .047 - .225 P= 0.000. This implies that respondents who ever
initiated a discussion about condom use had 0.9 odds less of living in violent
relationships as compared to odds of respondents who never initiated such a
discussion. This is in line with Kalichman et al and hence interventions and
programmes aimed at combating domestic violence should involve mechanisms that
promote condom use among patients in order to curb domestic violence so as to
improve the treatment regimens of the above 5 HIV/AIDS,
Domestic Violence, AlcoholFactors Associated With Domestic Violence among the 50 Years and above Living with Hiv-Aids - A Case Study of Mukono Hospital Patients
Abstract
Full-Text
Introduction and Background of the Study
Statement of the problem
General objective
Specific objectives
Research Questions
Significance of
the study
Conceptual framework
Justification for the study
Predisposing factors for domestic violence
Economic factors
Cultural factors
Education of women
Denying a husband sex
Perception of a male partners HIV/AIDS status
Length of current relationship
Relationship to most recent partner
Number of living children
Womans age at first intercourse (Years)
Consumption of alcohol
Childhood history, experience and witness of
domestic violence
Level of domestic violence among adults above 50
years of age
Understanding of domestic violence at the
international level
Sexual violence against the above 50 years
populations
Cultural and gender dynamics in defining violence
Level of domestic violence among the above 50 years
Effect of intimate partner violence on domestic
violence
Methodology
Study Design
Sources of Data
Study population
Selected participants had to be able to speak Luganda or English fluently.
Participants who did not speak English or Luganda fluently
Participants who were suspects of HIV/AIDS for instance on PEP. This
information could be obtained from the data set as it included patients on
ART and patients on post exposure prophylaxis.Sample Selection
Study Variables
Dependent Variable
Domestic violence Screening Tool (HITS Instrument)
Data collection techniques
Questionnaires
Plan for Data analysis
Quality Control Issues
Plan for dissemination of data
Ethical issues
Principles of justice
Limitations of the study
Results of the Study
Introduction
Socio Demographic Characteristics of Respondents
Domestic violence and significant conceptualized
predictors
According
to Table 4, domestic violence is significantly associated with age with OR=.35, 95% CI=.17 - .69, P= 0.002. Hence respondents
above 79 years have 0.65 odds less of living in violent relationships as
compared to their counterparts below 79 years. This is in line with table 3
results that established a significant association between domestic violence
and age. Thus interventions to curb domestic violence should be mainly geared
towards patients less than 79 years as they are 65% times more likely to live
in violent relationships as compared to those above 79 years.
According
to Table 4, there is a significant relationship between domestic violence and
marital status with OR= 6.60, 95 CI= 3.15 - 13.80, P= 0.000. Respondents who
were unmarried had 7 odds more of living in violent relationships as compared
to odds of respondents who were married. This means that interventions to
combat domestic violence should be mainly targeted at unmarried patients so as
to curb domestic violence in order to improve the treatment regimens of the
above 50 years PLWH.
According
to Table 4, domestic violence is significantly associated with living with
another partner as if married with OR= 8.32, 95% C.I = 3.90 -17.732, P=
0.000.This implies that respondents who lived with other partners as if married
had 8 odds more of living in violent relationships as compared to odds of
respondents who never lived with other partners as if married. Hence odds of
domestic violence increase with sexual unfaithfulness thus interventions to
curb domestic violence should promote sexual faithfulness in order to improve
the treatment regimens of the above 50 years PLWH. Keywords
