Naeemah Abrahams1,2, Shibe Mhlongo1, Kristin Dunkle1, Esnat Chirwa1, Carl Lombard3, Soraya Seedat4, Andre P Kengne5, Bronwyn Myers6,7, Nasheeta Peer5, Claudia Garcia-Moreno8, Rachel Jewkes1,9,10. 1. Gender and Health Research Unit, South African Medical Research Council. 2. Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town. 3. Biostatistics Unit, South African Medical Research Council, Cape Town. 4. Anxiety and Stress Disorder Unit, University of Stellenbosch, Stellenbosch. 5. Non-Communicable Diseases Research Unit, South African Medical Research Council. 6. Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council. 7. Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 8. Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. 9. Intramural Research Directorate, South African Medical Research Council, Cape Town. 10. Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
OBJECTIVE: To determine the incidence of HIV acquisition in women postrape compared with a cohort of women who had not been raped. DESIGN: A prospective cohort study. METHODS: The Rape Impact Cohort Evaluation study based in Durban, South Africa, enrolled women aged 16-40 years from postrape care services, and a control group of women from Primary Healthcare services. Women who were HIV negative at baseline (441 in the rape-exposed group and 578 in the control group) were followed for 12-36 months with assessments every 3 months in the first year and every 6 months thereafter. Multivariable Cox regression models adjusted for baseline and time varying covariates were used to investigate the effect of rape exposure on HIV incidence over follow-up. RESULTS: Eighty-six women acquired HIV during 1605.5 total person-years of follow-up, with an incident rate of 6.6 per 100 person-years [95% confidence interval (CI): 4.8-9.1] among the rape exposed group and 4.7 per 100 person-years (95% CI: 3.5-6.2) among control group. After controlling for confounders (age, previous trauma, social support, perceived stress, multiple partners and transactional sex with a casual partner), women exposed to rape had a 60% increased risk of acquiring HIV [adjusted hazard ratio: 1.59 (95% CI: 1.01-2.48)] compared with those not exposed. Survival analysis showed difference in HIV incident occurred after month 9. CONCLUSION: Rape is a long-term risk factor for HIV acquisition. Rape survivors need both immediate and long-term HIV prevention and care.
OBJECTIVE: To determine the incidence of HIV acquisition in women postrape compared with a cohort of women who had not been raped. DESIGN: A prospective cohort study. METHODS: The Rape Impact Cohort Evaluation study based in Durban, South Africa, enrolled women aged 16-40 years from postrape care services, and a control group of women from Primary Healthcare services. Women who were HIV negative at baseline (441 in the rape-exposed group and 578 in the control group) were followed for 12-36 months with assessments every 3 months in the first year and every 6 months thereafter. Multivariable Cox regression models adjusted for baseline and time varying covariates were used to investigate the effect of rape exposure on HIV incidence over follow-up. RESULTS: Eighty-six women acquired HIV during 1605.5 total person-years of follow-up, with an incident rate of 6.6 per 100 person-years [95% confidence interval (CI): 4.8-9.1] among the rape exposed group and 4.7 per 100 person-years (95% CI: 3.5-6.2) among control group. After controlling for confounders (age, previous trauma, social support, perceived stress, multiple partners and transactional sex with a casual partner), women exposed to rape had a 60% increased risk of acquiring HIV [adjusted hazard ratio: 1.59 (95% CI: 1.01-2.48)] compared with those not exposed. Survival analysis showed difference in HIV incident occurred after month 9. CONCLUSION: Rape is a long-term risk factor for HIV acquisition. Rape survivors need both immediate and long-term HIV prevention and care.
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