Male victims of sexual violence in rural Malawi: the overlooked association with HIV infection.

In sub-Saharan Africa, research on intimate partner violence (IPV) has largely failed to consider men's experiences as victims by female perpetrators - particularly within ongoing heterosexual relationships such as marriage. The objectives of this study were to document the prevalence of sexual coercion among men, to describe the characteristics of male victims, and to test for an association between sexual coercion and HIV positivity. In 2010, cross-sectional data on HIV risk behaviors, HIV status, and IPV were collected from a sample of 684 mostly married men in rural Malawi. Bivariate analyses were used to examine differences in HIV risk characteristics between victims and nonvictims of sexual coercion. Multivariate logistic regression was used to determine the association between sexual coercion and HIV positivity. Over one-tenth (10.4%) of men reported being a victim of sexual coercion. Male victims of sexual coercion were more likely to be married (p < 0.05), older than 24 years (p < 0.05), physically abused by a female partner (p < 0.001), believed their partners were at higher risk for HIV (p < 0.05), and had consumed alcohol in the past month (p < 0.01). After controlling for potential confounders, the odds of being HIV positive were 7.2 times higher among men who had experienced sexual coercion (p < 0.000). In sub-Saharan Africa, research on men's experience of violence as victims is long overdue. More formative research is needed to understand the mechanisms through which men experience violence and how to appropriately measure IPV among male victims. While the data are cross-sectional and cannot evaluate causality, the strength of the association with HIV positivity merits further attention.