Coercive sex in rural Uganda: Prevalence and associated risk factors

• Published in: Social science & medicine (1982) 2004-02, Vol.58 (4), p.787-798
• Main Authors: Koenig, Michael A, Lutalo, Tom, Zhao, Feng, Nalugoda, Fred, Kiwanuka, Noah, Wabwire-Mangen, Fred, Kigozi, Godfrey, Sewankambo, Nelson, Wagman, Jennifer, Serwadda, David, Wawer, Maria, Gray, Ron
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Alcohol Drinking - epidemiology; Alcohol Drinking - psychology; Biological and medical sciences; Coercion; Cohabitation; Domestic violence; Educational Status; Female; Females; Gender; Gender aspects; Health Knowledge, Attitudes, Practice; Health Surveys; HIV; HIV Infections - epidemiology; HIV Infections - psychology; Humans; Intimate partner violence; Male; Medical sciences; Middle Aged; Miscellaneous; Prevalence; Prevention; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rape; Risk Factors; Risk-Taking; Rural areas; Rural Health - statistics & numerical data; Rural Population; Sex; Sex crimes; Sex Offenses - prevention & control; Sex Offenses - statistics & numerical data; Sexual assault; Sexual Coercion; Sexual coercion Intimate partner violence Gender Uganda; Sexual intercourse; Sexual Partners - psychology; Sexual violence; Sexually Transmitted Diseases - psychology; Sociodemographic Factors; Spouse Abuse - statistics & numerical data; Uganda; Uganda - epidemiology; Victims of violence; Violence; Women's health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(03)00244-2

Despite growing recognition of the problem, relatively little is known about the issue of coercive sex in developing countries. This study presents findings from a community-based survey of 4279 reproductive-aged women in current partnerships in the Rakai District of Uganda carried out in 1998–99. One in four women in our study report having experienced coercive sex with their current male partner, with most women reporting its occasional occurrence. In a regression analysis of risk factors for coercive sex, conventional socio-demographic characteristics emerged as largely unpredictive of the risk of coercive sex. Behavioral risk factors—most notably, younger age of women at first intercourse and alcohol consumption before sex by the male partner—were strongly and positively related to the risk of coercive sex. Coercive sex was also strongly related to perceptions of the male partner's HIV risk, with women who perceived their partner to be at highest risk experiencing almost three times the risk of coercive sex relative to low risk partnerships. Supplemental analysis of 1-year longitudinal data provides additional support for the hypothesis that coercive sex may frequently be a consequence of women's perceptions of increased HIV risk for their male partner. The findings of this study are discussed in terms of the need for sexual violence prevention programs more generally in settings such as Uganda, and in terms of the possible importance of incorporating issues of sexual and physical violence within current HIV prevention programs.