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Ringwald, Beate (2022) Power, poverty, and participation: HIV and intimate partner violence in an informal settlement in Nairobi, Kenya, Thesis (Doctoral), Liverpool School of Tropical Medicine.
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Abstract
Background: People in informal urban settlements face numerous inequalities and social problems, including human immunodeficiency virus (HIV) and intimate partner violence (IPV). Despite evidence suggesting multiple intersections between IPV and HIV, research tends to investigate HIV or IPV in isolation. Studies commonly target single populations and focus on individual behaviour. Although the benefits of community participation are known, stakeholders are often insufficiently involved in decision-making processes related to health research.
Research aim: This thesis is to explore and expand understanding of the intersections of HIV and IPV in an informal settlement in Nairobi, Kenya in order to strengthen IPV and HIV prevention and response in the community. For this purpose, I conducted a researcher-led collaborative intersectionality study with a mixed-methods design, involving a secondary data analysis, focus group discussions, and key informant interviews.
Quantitative strand: This study compared current female and male IPV rates by urban residence (informal and formal settlements). Data from the 2014 Kenya Demographic and Health Survey, consisting of an ever-married sample of 1,613 women (age 15-49 years) and 1,321 men (age 15-54), were analysed. Multilevel logistic regression was applied to female and male data separately to quantify associations between residence and any current IPV. Results indicate gendered and spatial patterns, with women in informal urban settlements reporting highest rates of current IPV. Unadjusted analyses suggest residing in informal settlements is associated with any current IPV against women, but not men. However, this correlation is not statistically significant when adjusting for women’s education level, marital status, having witnessed parental IPV, current use of physical violence against partner, and partner’s alcohol use, all of which are statistically significantly correlated with male-to-female IPV in multivariate analysis.
Qualitative strand: This study explored power dynamics that influence IPV and HIV intersections among different groups of women and men in an informal settlement in Nairobi, Kenya. I formed a study team of researchers (n=4) and lay investigators (n=11) from the informal settlement. We facilitated focus group discussions with 56 women and 32 men and interviews with 10 key informants, and analysed data together. Findings illustrate how gender power imbalance intersects with other axes of power to shape complex dynamics of power, poverty, marginalisation, and gatekeeping in the informal settlement, which together create a web of unequal power relations that are conducive to IPV perpetration and HIV transmission. In addition, critical reflection and lessons on power in this study suggest involving community members as co-researchers in collaborative reflection and action was key to power-sharing; created opportunities for learning, change, and empowerment; and strengthened research process and findings.
Conclusions: IPV and HIV prevention interventions should be embedded within a community empowerment approach, involve people from all social ecological levels (including but not limited to individual, relationship, family, community, facilities) utilise multiple strategies (including individual economic and social empowerment, integration of services, and implementation of laws), and operate across sectors (including health, justice, housing, education, labour, transport). Research and programmes should create opportunities for the meaningful and continuous involvement of communities in decision-making and implementation.
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