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Jay G. Silverman, PhD; Michele R. Decker, ScD; Niranjan Saggurti, PhD; Donta Balaiah, PhD; Anita Raj, PhD

JAMA. 2008;300(6):703-710.

Context  Despite reductions in prevalence of human immunodeficiency virus (HIV) infection among the general population of India, women account for a rising percentage of all HIV cases with husbands' risk behavior described as the major source of women's infection. Intimate partner violence (IPV) has been described as being associated with heterosexual transmission of HIV to women in India and elsewhere.

Objective  To assess the relationship between experiencing IPV and the occurrence of HIV infection in a nationally representative sample of married Indian women tested for HIV.

Design, Setting, and Participants  The Indian National Family Health Survey 3 was conducted across all Indian states in 2005 through 2006. The nationally representative sample included 124 385 married women; analyses conducted in 2007 and 2008 were limited to 28 139 married women who provided IPV data and HIV test results via systematic selection into respective subsamples.

Main Outcome Measures  Prevalence estimates of lifetime IPV and HIV infection were calculated and demographic differences assessed. Intimate partner violence was conceptualized as physical violence with or without sexual violence and then was further categorized as physical violence only vs physical and sexual violence. Regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for HIV infection among Indian women based on experiences of IPV after adjusting for demographics and women's HIV risk behaviors.

Results  One-third of married Indian women (35.49%) reported experiencing physical IPV with or without sexual violence from their husbands; 7.68% reported both physical and sexual IPV, and 27.80% reported experiencing physical IPV in the absence of sexual violence. Approximately 1 in 450 women (0.22%) tested positive for HIV. In adjusted models, married Indian women experiencing both physical and sexual violence from husbands demonstrated elevated HIV infection prevalence vs those not experiencing IPV (0.73% vs 0.19%; adjusted OR, 3.92; 95% CI, 1.41-10.94; P = .01). Physical IPV alone was not associated with risk of HIV infection. Women's personal sexual risk behaviors were not associated with HIV infection.

Conclusions  Among married Indian women, physical violence combined with sexual violence from husbands was associated with an increased prevalence of HIV infection. Prevention of IPV may augment efforts to reduce the spread of HIV/AIDS.

Author Affiliations: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts (Drs Silverman and Decker); Population Council, New Delhi, India (Dr Saggurti); National Institute for Research in Reproductive Health, Indian Council for Medical Research, Mumbai, India (Dr Balaiah); and Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston (Dr Raj).

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