Violence and sexually transmitted infections in pregnancy

In this systematic review, we conducted basic activities of identification, compilation, and registration of the trials. The instruments of data collection were studies that investigated, explicitly, relationships between violence, gestation, and STI, from July 2012 to July 2017, using PubMed, Cochrane Library, SciELO, and LILACS.

RESULTS:

In all, 26 articles were chosen to form the basis of the analysis of this study. The relationship between violence and STI was observed in 22 of the 26 studies, and in eight of them, the violence was practiced during the gestation period. In two studies, there was no evidence of this relationship. In one study, the lack of care for STI was attributed to the unpreparedness of health professionals. Mental disorders were cited as resulting from STI in three articles and in another as a result of violence. One study found more frequent violence against adolescents, while two others cited gestation as a protective factor.

CONCLUSIONS:

IPV combines characteristics that have a different expression when the woman is in the gestational period. The literature points to a relationship between IPV against women and the presence of STI. The monitoring of pregnancy, whether in the prenatal or postpartum period, offers unique opportunities for the health professional to identify situations of violence and thus provide assistance.

KEYWORDS:
Violence Against Women; Sexually Transmitted Infections; Pregnancy; Abortion; Stillbirth; Sex Offenses

Autor/ Year	Design	Sample	Objective	Results
Oza et al., 2015	cohort	25 ♀	Explore experiences during childhood and adolescence that influenced the sexual and reproductive health among women who entered in the sex industry.	Identified four main themes: early sexual abuse, early use of illicit drugs, ongoing violence and limited access to health care. The participants who reported these experiences face the risk of unintended pregnancy, miscarriage or stillbirth, and untreated STIs.ace
Recto & Champion, 2016	transversal	461 ♀	To study psychological disturbance and associated factors among adolescents.	Adolescents in risk behaviors, interpersonal violence, use of illicit substances and pregnant women are at risk of psychological distress.
Gómez-Camargo et al., 2014	transversal	934 ♀	To investigate the state of sexual and reproductive health among university students in Colombia.	12.3% had a history of pregnancy; physical violence (21.6%), sexual violence (4.6%, predominant silence of victims of sexual abuse (61.8%), history of STI (1.9%) and history of symptoms suggestive of STI (42%).
Northridge et al., 2017	transversal	149 ♀	To determine the prevalence of reproductive coercion and IPV, and risks to health.	Reproductive coercion is experienced by 1 in 5 girls of school age in a poor community and is associated with chlamydia and IPV infection.
Baumgartner et al., 2015	Clinical trial	138 ♀	Measure IPV and examine the associations between risk factors, sociodemographic factors, and HIV risk factors.	Married women reported IPV. Many believed that beatings were normal. One-third of the single women reported abuse by relatives. Teenagers have experienced high rates of domestic violence, and young people were more likely to report aggression.
Secor-Turner et al., 2013	cohort	241 ♀	Understand the interaction of multiple contexts of sexual risk behaviors of adolescents.	The latent construction of individual risk encompasses the use of illicit substances, the perpetration of violence, having suffered violence and witnessing situations of violence; the family breakdown included family disconnection, low-income family communication and perception of lack of safety at home.
Perry et al., 2015	transversal	19465 pregnant women	To estimate the prevalence of rape-related pregnancy as an indication for abortion and to describe the demographic and clinical correlations of these women.	Chlamydia and gonorrhea infection were no more prevalent among women who completed rape-related pregnancies than among those who ended up with other indications.
Zihindula & Maharaj, 2015	cohort	19 ♀	Explore the perceptions and experiences of the risk of sexual violence in the Democratic Republic of Congo.	Rape used to have extreme brutality against women, with long-term consequences, including unwanted pregnancies and/or HIV/AIDS. Many have lived with uncertainty about their future and that of their children.
Ceccon & Meneghel, 2015	transversal	161 ♀ HIV +	To determine the prevalence and forms of violence.	Psychological violence (72.7%), physical (54.6%) and sexual violence (25.4%).
Turan et al.,2016	cohort	614 pregnant women	Explore the forced migration of pregnant women in an area of high HIV prevalence as a strategy to escape from a violent partner.	Violent situations in pregnancy, such as voluntary leaving home to escape violence or being kicked out for exercising autonomy. In the quantitative analysis, pregnant women who migrated were more educated, less likely to live with their partners and with fewer children.
Shamu et al., 2013	transversal	2042 puerperal women	To describe the occurrence, dynamics, and predictors of IPV during pregnancy, including HIV links, in urban Zimbabwe.	63.1% of the interviewees reported physical, emotional and/or sexual IPV during pregnancy: 46.2% reported physical and/or sexual violence, 38.9% sexual violence, 15.9% physical violence and 10% reported severe violence during pregnancy. Physical violence was less common during pregnancy than in the last 12 months before pregnancy.
Hatcher et al., 2013	transversal	29 pregnant women	Explore the context and triggers of IPV in general and for pregnant women in rural Kenya.	Physical consequences and IPV induce pregnant women to avoid prenatal care and HIV testing because they fear violent reprisals from partners. The ♀ suffered physical, sexual and economic IPV, such as being kicked out of home or losing material support. They hide the HIV test from their partners because the test is seen as a sign of infidelity. The community considers IPV a common and untreatable issue, which seemed to normalize its use.
Teixeira et al., 2017	transversal	681 ♀	To analyze the factors associated with the occurrence of pregnancy after the diagnosis of HIV infection.	Violence related to the diagnosis of HIV/AIDS. Pregnancy after a diagnosis of HIV infection = 35.2%. Pregnancy after an HIV diagnosis is associated with a lower level of schooling.
Aguilar-Zapata et al., 2017	case-control	152 pregnant women	To study sociodemographic differences between recent pregnant women HIV positive and HIV negative.	Strong evidence of an association between HIV infection, STI history and history of violence. Only 6% of controls were tested for HIV during prenatal follow-up.
McDougal et al., 2013	cohort	582 ♀	To examine the prevalence of gestational losses among female professionals who inject drugs and measure their associations with physical and sexual violence.	30% of participants had at least one miscarriage/stillbirth, 51% suffered sexual violence, and 49% had suffered physical violence. The history of miscarriage/stillbirth was associated with sexual violence, but not with physical violence.
Narasimhan et al.,2016	transversal	945 ♀ HIV- positive	Determine the sexual and reproductive health priorities of women with HIV and apply their values and preferences to the construction of new guidelines.	89.0% feared or suffered gender violence; 56.7% had an unplanned pregnancy; 72.3% received advice on contraception; 58.8% had mental problems after they discovered their HIV status.
Ashaba et al., 2017	cohort	20 ♀	Explore the psychosocial challenges experienced by women living with HIV during pregnancy and postpartum.	Discrimination of health professionals and personal shame associated with pregnancy with HIV has led to the difficulty of care of HIV, especially when associated with structural barriers such as the lack of transport to the clinic. IPV and lack of support from partners and family members.
Maman et al.,2016	transversal	1092 ♀	Examine whether HIV increases the risk of IPV in the postpartum and the interaction in its disclosure.	HIV was not associated with physical IPV in the postpartum period. Statistically significant positive interaction between HIV and its disclosure.
Shamu et al., 2014	transversal	1951 puerperal women	Study the IPV after disclosure of HIV test results by pregnant women.	Factors associated with IPV were gender inequality, past of IPV, risky sexual behaviors and living with relatives. The IPV after the disclosure of HIV in pregnancy although lower is still high and strongly related to IPV before pregnancy.
Malaju & Alene, 2013	transversal	400 pregnant women	To study the reaction of the partners regarding the positive result for HIV in pregnant women.	78.50% expected a negative reaction from their partners over the positive HIV test. A positive reaction was associated to pregnant women with their own income, residing in urban areas, with a higher educational level, without a stigmatizing attitude with people living with HIV and having access to health care facilities.
Hampanda, 2016	transversal	320 ♀ HIV+ in the postpartum	To determine if there is a relationship between IPV and non-adherence to VT prevention.	Intimate partner violence is associated with non-adherence to VT prevention during and after pregnancy.
Peltzer et al., 2013	cohort	239 couples with pregnant women (n = 478 individuals)	Describe the high-risk sexual behavior among 239 couples during pregnancy, examine the relationship of sexual risk behavior to HIV serostatus and intimate partner violence.	31.8% of the pregnant women and 20.9% of the ♂ were HIV positive, with ± 2/3 knowing their serological status. 46.9% of the ♀ did not know the HIV status of their partner. 47.7% ♀ reported at least one unprotected sexual relation in the previous week. 17.6% of the ♂ and 10.0% of the ♀ indicated sexual intercourses with another person in the previous month. IPVs were associated with unprotected intercourse in the previous week.
Peltzer & Mlambo, 2013	transversal	1502 pregnant	To assess the sexual behavior of HIV risk and its associated factors among pregnant women in Mpumalanga, South Africa.	63% never used a condom with their primary sexual partner in the last 3 months, 60% did not know the partner's HIV status. Behaviors found: being HIV positive, experiencing partner violence and psychological distress due to the diagnosis of an STI other than HIV, unplanned pregnancy, belief that the medications cure HIV.
Chersich et al., 2014	cohort	400 ♀	Investigate alleged links between alcohol consumption, unprotected sex and HIV infection in sub-Saharan Africa.	Excessive alcohol led to more unprotected sex and a higher number of partners. Sex, when the woman was intoxicated, was frequent and associated with less frequent condom use. The occurrence of accidents with condoms has increased steadily with each increase in the AUDIT category. Associated violence and HIV incidence are higher in ♀ with alcohol use disorders.
Darak et al., 2014	cohort	460 ♀	Investigate women who, within the low-risk population, are potentially at higher risk of HIV infection.	19.4% of women perceived themselves to be at risk of HIV, and most of them reported some vulnerability in their relationship as couples, such as IPV, alcoholic partner and lack of communication with partners.
Rotheram-Borus et al., 2015	transversal	1238 pregnant women	To compare the standard care condition with the condition of home intervention in the use of alcohol, IPV and depression.	Alcohol, conjugal violence, and depression are significantly related over time. A home visit intervention improved the emotional health of low-income mothers, even when depression was not the initial target.
STI: Sexually Transmitted Infection; ♀: women; ♂: men; IPV: Intimate Partner Violence; AUDIT: Alcohol Use Disorders Identification Test.

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