Reviewer's report
Title:Intimate partner violence among women with HIV infection in rural Uganda:
critical implications for policy and practice
Version: 2Date:19 July 2011
Reviewer: Rachel Jewkes
Reviewer's report:
Thank you for inviting me to re-review this paper. It has been greatly improved
but still needs to be revised in important ways before publication.
I want to suggest that the authors gain clarity on what major contribution this
study can make and they sharpen the focus further on this. To my mind, the
finding of the high IPV prevalence among women with HIV is important and their
conclusions on ART and IPV are also important (whatever these are, see below).
I would suggest focusing thus.
The most important problem is that I am uncertain from the paper what the main
finding is. There is considerable discussion about the association between IPV
and ART use and mention of unadjusted and adjusted ORs which show a greater
likelihood of ART use by those women who have experienced IPV. However
Table 2 shows that women who have experienced IPV in the last 12 months are
less likely to be now on ART and (albeit with very small cell sizes) possibly to
have had more problems on ART. These findings need to be reconciled as the
most important contribution of the paper lies in its ability to shed light on this
area.
I would suggest removing all the paaragraphs from the discussion that related to
IPV and HIV connections (these are well discussed in the introduction) as the
paper doesn't shed light on these as it doesn't have any HIV- study participants.
This p. 10 para starting "our findings", p.11 para starting "one explanation, and
p.12 para starting "in the south african study" are all redundant.
Other specific changes:
p.2 - 4 lines before end should be "education level and physical..."
p.3 - conclusion - last 2 sentences should provide interpretation (implications for
practice - why are the findings important??) not a results summary
p.4 - 6 lines before end - sentence starting "secondly" - I think this should be
qualified as men's socialisation isn't universal, but such ideals are particularly
well described for African men
p.4 the next sentence - its true for some women but when women do follos
socially accepted norms and behaviour in Africa these most often require
acquiescence with men's control of them and their relationships and acceptance
of men's sexually risky behaviour and this acceptance is very risky for women.
Table 2 - I find the presentation of 'ever abuse" and "history of SIPV in the last 12
m" very confusing here. They don't contribute anything and I want to suggest that
this table only looks at ART. If there are important differences in relationship
between current ART use and different IPV measures its necessary to present
additional columns showing these in this table. Given the importance of ARV in
the paper and the role of this variable in the model in Table 3 I think its a good
idea to present the table 3 IPV exposures
There is a n problem - n=12 women with IPV have changed ARV regimen and
n=99 without IPV, whereas only n=11 and n=98 women are now on ARV (what is
the root of this difference?)
Table 3 - this is complicated because of the model used and I want to suggest
that you remove from the model and don't present variables that are not
associated with IPV of any type. You can rather footnote that they were tested (or
mention this in the data analysis description). I would also not present the
unadjusted ORs here. the title for the table should be simplified to "Multinomial
regression model of factors associated with different types of IPV" and mention
the reference group in a footnote to the table
p.8 last sentence - leaving aside my confusion about what the ARV/IPV finding
is, a p=0.078 is not significant so women who report IPV are NOT more likely to
be on ART.
Level of interest: An article whose findings are important to those with closely
related research interests
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