Reviewer's report
Title:Intimate partner violence among women with HIV infection in rural Uganda:
critical implications for policy and practice
Version: 4Date:30 August 2011
Reviewer: Joseph Ntaganira
Reviewer's report:
Reviewer's report
Title: Intimate partner violence among women with HIV infection in rural Uganda:
critical implications for policy and practice
Version: 2 Date: 30 August 2011
Reviewer: Joseph Ntaganira
Reviewer's report:
This manuscript has been improved but it still needs to be seriously revised
especially in the methodology, results and discussion sections.
P.5 – last paragraph – “In addition, intimate partner may be a consequence of
HIV care.” I would recommend adding a sentence on couple counseling as a
measure to promote HIV prevention and reduce IPV risks.
P.6 – first paragraph – “…in South Africa, a strong association was found
between gender-based violence and HIV infection…” and 5 lines below:
…Studies in South Africa and Nigeria found….” I would recommend keeping one
sentence and having several citations.
P.7 – Data analysis – Before the sentence on Multivariate logistic regression, I
would suggest to add a sentence on the bivariate analysis that were conducted
and which test was used.
P.7 - Results – 2 lines before the end – “…The respondents who reported history
of IPV were comparable to those who did not (p>0.005) except ….” – I would
suggest adding a footnote at table1.
P.7 – Results – “Table 1 shows the socio-demographic characteristics of the
respondents stratified by presence of IPV.” Please specify whether it is IPV in the
preceding 12 months or lifetime. This should also be clear on Table 1.
P.7 – Table 1: n of history of IPV is 55. Please specify which IPV (physical,
sexual…) and whether it is IPV in the preceding 12 months or lifetime.
P.8 – Sentences on prevalence of IPV are not part of Table 2: “…Lifetime
prevalence of IPV…” up to the first 2 lines of p.9. All this section should be
removed and placed before table 2. This section would describe the distribution
of types of IPV in your study population. As there is no table for these figures, it
should be mentioned that data are not shown.
P.8 – 4 lines before the end – “…This is in comparison to 12 women (21%) who
reported physical violence only, implying…” What is the difference with the
physical violence reported by 55 women (17.3%), 3 lines before? What is your
denominator?
P.8 – 3 lines before the end – “…implying higher association between
psychological and sexual violence, as compared to physical violence.” Which test
have you applied? Please provide the p-value.
P.8 – 2 lines before the end – “Women who reported IPV at any time in their
lifetime were nearly twice as likely to be currently on antiretroviral therapy (Odds
ration 1.9, 95% CI 0.93-3.93, p-value = 0.078), but…”. It should be point out that
this relationship is not significant and therefore women who reported IPV are not
more likely to be on ARVst!!
P.8 – Table 2 is a very confusing. What is the interest of combining “ever
abused” and “IPV in the last 12 months”? Also, numbers presented for “history of
IPV” are very small and do not lead to any serious conclusion. The table should
show where the p-values are significant.
There is a n problem – women who are not currently on ARVs, 4+164= 168 and
not 202; participants who have ever changed ARV treatment, 4+71 = 75 and not
77; among women with no history of IPV, 27 have changed ARV but those who
reported reasons are 28.
P.9 – Table 3 – The title should precise “…factors associated with different types
of IPV in the preceding 12 months” and provide the n.
Results in table 3 are confusing: AOR for Use of ARVs 2.56 (0.98-7.32) among
victims of physical violence is not significant because it includes the value 1;
AOR for age of respondents 0.93 (0.87-1.08) among victims of sexual and
psychological violence is not significant for the same reason;
In table 3, use of ARVs and IPV (preceding 12 months) is significant while it was
not significant in their lifetime (p.8). Please explain why this difference. The mean
duration on ARVs was 3.3 months; is there any difference between new patients
on ARVs and old patients (more than 6 months) when looking to participants on
ARVs and IPV? Have you looked at potential biases? For example, is the
relationship due to disclosure of HIV status and not ARVs because your patients
were put on ARVs very recently? What is the proportion of discordant couples
among your population?
P.9 – AOR presented in the middle of the page are different from those shown in
table 3 for physical violence: 0.50 (0.31-0.82) vs. 0.56 (0.39-0.80).
P.10 – 1st paragraph – The content is discussed in the introduction section and
should be removed here.
P.11- 2nd paragraph – Because this study has several limitations, especially a
poor study design and a very small sample, it is very difficult to conclude on the
level of IPV among the study population (only HIV women). We have no idea on
the magnitude of IPV among HIV negative women. It is therefore unclear to me
what the contribution of the study is.
P.12 – 2nd paragraph – “…Though their generalisability is doubtful, we
recommend that qualitative studies…” I would also recommend a quantitative
study with a sufficient sample comprising HIV+ and HIV- women.
P.12 – Conclusion – I feel uncomfortable on what are the main findings. The
prevalence of IPV is apparently high in that study population of HIV+ women but
we ignore its level in the general population or among HIV- women. Education
level of women and spouses seems the only factor negatively associated to IPV.
Although authors describe taking ARVs as a risk factor for IPV, results are
confusing and need to be reviewed.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.