Gillings Health Behavior Researchers Study HIV Testing, Intimate Partner Violence in Tanzania

March 23, 2016

Marta Mulawa

HIV testing and intimate partner violence are the public health issues that Marta Mulawa, a doctoral candidate of health behavior at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, targeted in two recently published papers.

Mulawa based both articles on data from a Tanzania-based study led by her adviser Suzanne Maman, associate professor of health behavior at the Gillings School.

“These two papers are examples of what a great student can produce when given access to data and support,” Maman says. “Marta came up with the ideas and led the analysis and writing of both papers. I just played a supporting role in encouraging her when she came to me with the ideas, and as she worked through the analysis and writing.”

The two researchers also worked with co-author Peter Balvanz, a research project coordinator in their department.

The first paper, titled “Perpetration and Victimization of Intimate Partner Violence Among Young Men and Women in Dar es Salaam, Tanzania,” was published online Jan. 21 by the Journal of Interpersonal Violence.

In the article, the co-authors compare the baseline rates of victimization and perpetration related to three forms of intimate partner violence – psychological, physical and sexual – among sexually active men and women enrolled in an HIV and gender-based violence prevention trial in Dar es Salaam, Tanzania.

Over a yearlong period, 34.8 percent of men and 35.8 percent of women reported experiencing some form of intimate partner violence victimization. Men were almost twice as likely as women to report perpetrating intimate partner violence, however.

Suzanne Maman

Suzanne Maman

Overall, the researchers found high rates of co-occurrence of victimization and perpetration, with 69.7 percent of male perpetrators and 81.8 percent of female perpetrators reporting that they also had been victimized during the last year.

The finding that there is substantial overlap between intimate partner violence victimization and perpetration, which reveals that violence is often bidirectional within relationships, has important implications for future public health interventions.

“Not many studies in sub-Saharan Africa measure experiences of violence from both men and women,” explains Mulawa. “In this paper, we had the opportunity to compare those reports by gender. I was surprised to see how many men, on par with the proportion of women, reported being victimized within the last year. The degree to which victimization and perpetration was overlapping was also really striking.”

The research team’s second paper, titled “Comparing Perceptions with Actual Reports of Close Friend’s HIV Testing Behavior Among Urban Tanzanian Men,” was published online Feb. 15 by AIDS and Behavior.

In sub-Saharan Africa, men have lower rates of HIV testing and higher rates of AIDS-related mortality than women. To evaluate whether there is an opportunity to increase men’s uptake of testing by correcting misperceptions about testing norms, Mulawa and Maman asked about men’s perceptions of their closest friend’s HIV testing behavior, then compared those perceptions with the friend’s actual, self-reported behavior.

The study also compared the perceptions of men who had tested for HIV with those of men who had never tested. Neither group differed in the overall accuracy of their perceptions, but non-testers were much more likely to assume that their closest friend had never tested, either. This result lends support to a social norms approach to correct non-testers’ misconceptions about HIV testing.

“These papers both fill gaps in the literature and have important intervention implications,” says Maman. “The second paper leveraged the unique social network data available through our study to provide important insight into how men are influenced by what they think their peers are doing with regard to HIV testing. Together, these two articles suggest that engaging men’s social networks to change norms and behaviors related to both intimate partner violence and HIV is an important public health approach.”