Prevalence and Predictors of Gender-based Violence and Unintended Pregnancy among Adolescent Women Living with HIV in Zimbabwe

Background
In Harare, Zimbabwe, women aged ≤19 are 2.2 times more likely to present with unplanned pregnancy. Women experiencing gender-based violence (GBV) have a higher rate of unintended pregnancies, unsafe abortions, and are more likely to become pregnant as adolescents. We examined prevalence and predictors of GBV and unintended pregnancy among 710 adolescent women living with HIV in Zimbabwe.

Methods
History of GBV and unintended pregnancy were analyzed as a binary outcomes. Risk factors exhibiting association with outcomes at p<0.10 in univariate analyses were advanced into multivariable models to control for confounding and to estimate independent impacts.

Results
At enrolment, median age was 18, median CD4 count was 343, 81% had lost one parent and 96% were out-of-school. At least one type of abuse was reported among 34% of participants: 28% physical; 13% sexual; 7% forced sex. 40%(n=291) had previously been pregnant, of which 75% were reportedly unintended. In adjusted models, food insecurity (RR:1.35[95%CI: 1.10,1.65]); multiple sex partners (RR:1.35[95%CI:1.09,1.70]); and unprotected sex (RR:1.41[95%CI:1.15,1.74]) were significantly associated with experiences of GBV. Experience of GBV was predictive of unintended pregnancy (RR:1.28[95% CI:1.05,1.57]), as was being married/living with a partner (RR:3.00[95%CI: 2.45, 3.68]); food insecurity (RR:1.68[95% CI:1.51,2.30]); multiple sex partners (RR:2.94[95% CI:2.38, 3.63]) and unprotected sex (RR:1.83[95%CI: 1.48, 2.26]).

Conclusions
Inter-related factors such as having economic need and engaging in risky sex were related to GBV experiences and unintended pregnancies. Multi-faceted programs that address issues of poverty, abuse and gender inequalities are urgently required to support the health and well-being of adolescent women living with HIV.