Prospective Study of the Mental Health Consequences of Sexual Violence Among Women Living With HIV in Rural Uganda
Open accessAbstract
The association between sexual violence and depression is well known, but the temporal aspects of the association have not been well established. We analyzed data from a cohort of 173 HIV-positive women in rural Uganda who were interviewed every 3 months for a median of 1.8 years of follow-up. The method of generalized estimating equations (GEE) was used to model the marginal expectation of depression symptom severity (Hopkins Symptom Checklist for Depression), mental health–related quality of life (MOS-HIV Mental Health Summary), and heavy drinking (Alcohol Use Disorders Identification Test) as a function of self-reported forced-sex victimization in the 3 months prior to interview. Estimates were adjusted for variables known to confound the association between victimization and mental health status. To assess any potential reciprocal relationships, we reversed the temporal ordering of the exposures and outcomes and refitted similar GEE models. In multivariable analyses, victimization was associated with greater depression symptom severity ( b = 0.17; 95% CI = [0.02, 0.33]) and lower mental health–related quality of life ( b = −5.65; 95% CI = [−9.34, −1.96]), as well as increased risks for probable depression (adjusted relative risk [ARR] = 1.58; 95% CI = [1.01, 2.49) and heavy drinking (ARR = 3.99; 95% CI = [1.84, 8.63]). We did not find strong evidence of a reciprocal relationship. Our findings suggest that forced sex is associated with adverse mental health outcomes among HIV-positive women in rural Uganda. Given the substantial mental health–related impacts of victimization, effective health sector responses are needed.
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The forced sex measure's construct validity is supported by a Ugandan study showing that forced sex predicts later psychological distress without a reciprocal association.
“While not specifically validated for use in the study setting, its construct validity is supported by a recent study from Uganda showing a longitudinal relationship between forced sex and subsequent development of psychological distress (and no reciprocal association between psychological distress and subsequent victimization) [45].”
From Relationship power and sexual violence among HIV-positive women in rural Uganda (2016) · cites this paper as [45]
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- Authors
- Tsai, A. C., Wolfe, W. R., Kumbakumba, E., Kawuma, A., Hunt, P. W., Martin, J. N., Bangsberg, D. R., & Weiser, S. D.
- Affiliations
- Harvard University (US)
- University of California, San Francisco (US)
- Mbarara University of Science and Technology (UG)
- Corresponding author
- Tsai, Alexander C.
- ORCID
- Venue
- Journal of Interpersonal Violence
- Publisher
- SAGE Publications
- Published
- 2015-01-13
- Volume
- 31
- Issue
- 8
- Pages
- 1531-1553
- ISSN
- 0886-2605 (ISSN-L)
- 1552-6518
- PMC
- PMC4500676
- OpenAlex
- W1975218082
- Cited by
- 50
- References
- 120
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 7 · 2017: 3 · 2016: 4 · 2015: 6
- FWCI
- 15.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Interpersonal Violence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (5k23mh079713-05, P30A1027763)
- U.S. Public Health Service (P30A1027763)
- National Institute of Mental Health (K23 MH-079713, R01MH054907, K23MH096620, K24MH087227, P30MH062246)
- National Institute of Allergy and Infectious Diseases (P30AI027763)
- Topics
- Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
- Social Sciences › Health › Intimate Partner and Family Violence
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- sexual violence, forced sex, women living with HIV, depression, mental health-related quality of life, heavy drinking, reciprocal effects, temporal association, rural Uganda, victimization
- MeSH terms
- Adult, Depressive Disorder, Female, Health Status, Humans, Mental Health, Mental Status Schedule, Prospective Studies, Rape, Rural Population, Uganda, HIV Infections, Crime Victims, Self Report
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