Experiencing Intimate Partner Violence and Risk of Hypertension Among Women Living with HIV In Zambia

Background and Purpose: Intimate partner violence (IPV) is a public health and human rights crisis and is associated with wide range of poor health outcomes for vulnerable women in sub-Saharan Africa, including Zambia. Women living with HIV may be particularly vulnerable to the compounded effects of IPV, including increased risk of chronic conditions such as hypertension due to prolonged stress, trauma, and barriers to care they may encounter. Hypertension is an emerging non-communicable disease burden, yet limited research has examined its linkage with IPV among women living with HIV using nationally representative data in Zambia. Therefore, this study examined the association between IPV and hypertension among women living with HIV in Zambia.

Methods: This cross-sectional study used data from the 2024 Zambia Demographic and Health Survey (ZDHS), a nationally representative survey of women aged 15–49 years. The analytic sample comprised women living with HIV who completed both the domestic violence module and the blood pressure assessment (N ≈1,037). The primary outcome included hypertension status, defined by measured self-reported blood pressure (yes/no). The primary independent variable included experiencing any IPV (physical, emotional, and/or sexual violence) during the past 12 months, dichotomized as yes/no. Covariates included women’s characteristics (age group, education level, marital status, work status, religion, household wealth index, resident type, health insurance, frequency of internet use, and province) and partner characteristics (age group, work status, education level, and alcohol use). Weighted descriptive statistics were used to obtain frequencies and percentages, and adjusted logistic regressions were conducted to determine significant association between IPV and hypertension while adjusting for potential confounders using SPSS vs. 31.0 (p<.05).

Results: Out of 1,037 women living with HIV, 13.9% reported having hypertension, and 26.6% experienced emotional violence, 31.4% physical violence, 10.3% sexual violence, and 40.9% any IPV. After controlling for other factors in the regression model, experiencing any emotional violence (OR=1.19; p=.545), physical violence (OR=1.05; p=.901), sexual violence (OR=0.18; p=.426), and any IPV (OR=1.03; p=.942) were not significantly associated risk of reporting hypertension among women living with HIV sampled in Zambia.

Conclusions and Implications: This study found that IPV was not significantly associated with risk of hypertension among women living with HIV in Zambia. This may indicate that biological or genetic indicators may better explain the causal pathways underlying risk of developing hypertension. However, the high prevalence of IPV occurrences requires continuous supportive efforts and screening intervention in HIV care settings, and conducting more routine medical screenings using biomarkers such as blood samples and blood pressures among other genetic conditions. Finally, future research should examine underlying causal pathways for hypertension and other associated predictors such as IPV rather than relying on associations for women HIV in Zambia.