Association between intimate partner violence and STI/HIV-related risk behaviors: Findings from the Nepal Demographic Health Survey

Background: Intimate partner violence (IPV) is a significant global health issue and has been associated with increased sexually transmitted infection (STI)/HIV-related risk behaviors and vulnerability to STIs/HIV. While IPV exists across all strata of Nepali society, its link to STI/HIV-related risk behaviors has not been explored in this region. This study was designed to examine the potential relationship between physical- and sexual-IPV and STI/HIV-related risk behaviors among women in Nepal.

Methods: We used data from the nationally representative Nepal Demographic Health Survey-2011, which employed a two-stage complex design for data-collection. We limited our analyses to 3,084 currently married-women, aged 15-49 years, who completed questionnaires on demographic-characteristics, physical- and sexual-IPV, and sexual behaviors in the past year. We used multivariate logistic-models, adjusted for age, educational and employment status, cohabitation-duration, and husband’s drinking behavior, to assess the association between IPV and STI/HIV-related risk behaviors.

Results: Over one-fourth (28%) of women reported having experienced some type of IPV during their lifetime, including physical-IPV (23%) and sexual-IPV (14%). Lower educational status, educational-disparity between women and her husband, higher economic-status and problematic alcohol-use were significantly associated with an increased physical- and/or sexual-IPV risk among women. Women who reported physical-IPV were significantly more likely to report history-of-STIs (aOR:1.74; 95%CI:1.37–2.22), multiple-sex-partner (aOR:2.31; 95%CI:1.56–3.43), inconsistent condom-use (aOR:1.88; 95%CI:1.03–2.85), husband with known HIV-related risk behaviors (aOR:1.75; 95%CI:1.04–2.94), and inability to negotiate safer-sex (aOR:1.44; 95% CI:1.17–1.78). Whereas, women experiencing sexual-IPV were significantly more likely to report history-of-STIs (aOR:1.52; 95%CI:1.15–2.00), being unable-to-refuse sex (aOR:2.56; 95%CI:1.69–3.84), and inability to negotiate-safer-sex (aOR:1.63; 95%CI:1.28–2.12).  

Conclusions: These findings reinforce the growing evidence globally that women who experience IPV from their intimate partner are more likely to exhibit STI/HIV-related risk behaviors. This highlights a need to develop effective interventions aimed at eliminating IPV to decrease the disproportionate burden of adverse health outcomes including STIs/HIV among women.