Socio-demographic characteristics of the study population
Of the total of 43 women, aged between 20-45 years, thirty of the participants were living with HIV. Over half of the participants were married, 25 (58.1%), but 9 (20.9%) were widowed, 6 (14%) were divorced, and the remaining 3 (6.9%) were separated. Most of the participants lived in urban areas, 90.6% (39 out of 43). Almost a fifth of the participants, 9(18.6%), were not educated (S4_ file).
From the analysis, the following five themes emerged. “Women’s terrifying experiences of violence, “The effects of violence on their health,”; “Support/lack of support /controlling behaviors/,” “Women’s feelings about the available services,” and “IPV prevention strategies from the perspective of women.” The first two themes explain the women’s terrifying experience of physical, sexual, and psychological violence and the multiple health effects on the women, as reported below(S3_file).
Women's terrifying experiences of violence
Types of violence
Women's terrifying experiences of violence is a major theme of this study. The data revealed that most of the participants had experienced mixed or overlapping types of terrifying abuse from their intimate partners. The interviewees reported recurrent physical and emotional abuse, but relatively few participants reported sexual abuse. According to the participants, they were beaten with sticks, had material thrown at their faces, and some even had their hands and teeth broken.
Additionally, some indicated that their partners had extramarital relationships, but male partners restricted women in socializing and having contact with other people. As reported by the participants, their extramarital relationships led some women to the acquisition of HIV. The behavior of their intimate partners included repeated name-calling, threats to hurt, hostility, withdrawal of finances, and forced sex. Women in rural and urban areas shared the same experiences. Both younger and older women reported terrifying experiences of violence by an intimate partner; however, HIV positive status exacerbated IPV.
One of the in-depth interview participants explained:
“My husband was an alcoholic, and he was older than me. He used to stab me with a knife. One day I stayed the whole night with a knife in my body because no one can take it out of my body. He used to punch me in my face, and my teeth also changed their normal place. Here, the scars in my body that you see emerged because of the bleeding after he had beaten me. He used to drag me on the ground by my hair, and my hair disappeared in his hands two times. Also, my bone in the chest broke after he had beaten me.” (Woman living with HIV, O#2, aged 32)
A discussant from one of the focus group discussions also explained:
“In public, when I am around my family and extended family, he belittles and insults me because of my HIV status, he says, you can’t take care of your children, you are going to die because you have AIDS,” He discloses my HIV status to everybody including my friends.” (Participant S1#6, woman aged 37)
The discussant with HIV discordant result explained:
“We tested for HIV, and my results come back positive, but my husband was not. He decided to divorce; and torched me psychologically, mentioning, “You are living with HIV infection” Now I do not want to tell all the insults he heaped on me.” (Participant S2#3, woman aged 40)
There were concerns in the interviews about the severity of the violence and the threats commonly used by their partners to inculcate fear, with the partner threatening to kill or slaughter them. As in the example described above, women who were HIV positive suffered further at the hands of their partners, who stigmatized and belittled them in front of other people. Alcohol consumption and the use of other substances such as chewing “chat” and addiction to “shisha” (a way of smoking tobacco, mixed with molasses, sugar or fruit,) through a tube) by male partners, took a heavy toll on women’s experience of IPV. A discordant HIV result, the extramarital sexual contact of their partners, and women themselves having an affair with another man increased their husband's aggressive behavior, as did having children from another husband
The effects of violence on women’s health
The violence affected both women’s physical and mental health. For instance, the physical effects reported could be both short and long term, as a result of abuse at the individual and social / community level. Participants described many health problems such as miscarriage, acquisition of STI/HIV infections, uterovaginal prolapse, the sequellae of pain around the ear and back, disability, and uterine infections. As two of the women explained, abortion and child death happened as a result of their male partners’ physical abuse when the two partners were quarreling. A few of the interviewees also reported the effects of violence and the resulting disability, which then hindered women from their activities demanding physical energy. Women also reported the negative impact of violence on their daily social engagement with others. For instance, according to the discussants, as a result of the discrimination from their community, women experienced loneliness, fear, and depression, and as a result of divorce, property loss, and the inability to remarry afterward, which were severe effects of violence.
One of the FGD discussants explained her experience:
“I lost one of my eyes and became blind. I didn't get medical help. I don’t have one of my organs, but I feel good because I am still alive. He was not giving me financial support all my life.” (Participant S2#3, woman aged 40)
Another of the participants reported:
“He divorced his wife after three months of marriage. He infected her with HIV/STI. He had multiple sexual partners. He was abusing them sexually. One of his wives had a miscarriage as a result of his beatings. He kicked his wife while she was three months pregnant, and unfortunately, she had a miscarriage.” He was drinking alcohol, chewing “khat,” and smoking (Participant T#2, woman aged 28)
The FGD discussant described her experience:
“After two months of giving birth, when we were quarreling, our son fell and died. My husband threatened me if I disclose this issue to other people; “I am going to cut your neck, he said.” I left his home, and I went to my mother's house.” (Participant S1#1, woman aged 38)
According to the reports from the interviewees, violence not only hurts women’s and children’s health, but it also has an effect on their economy as well as their social and psychological wellbeing. Moreover, the violence affected women’s social status and resulted in their experiencing emotional turmoil. Its effects further resulted in men withholding finances from their female partners.
Support/lack of support/ women receive from the partner (controlling behavior of partners)
According to most of the participants, the controlling behavior of their male partners denied them any possible support. Data from the interviewees indicated that older women were less likely to experienced controlling behavior than younger women. Women also reported that their husbands closed/locked the door so that they were left in the house, but were not allowed to leave the house, which disturbed their lives. Participants also indicated that men prevented their women from going outside their home, and they even limited their contact to only communicating through the windows.
Moreover, they reported that their husbands/partners also restricted their speech. Additionally, participants received repeated phone calls from their partners who threatened the women, as they were suspicious that their wives were having sex with other men. For, example, one of the interviewees explained this:
“No person could enter my home. Even if I became ill, no friends were allowed to ask me. When my husband was going to the office, he used to lock the door, and no friend can access and suppose a person is in the home. I couldn’t make a call to contact my friends because I had no phone.”(Participant S1#7, women aged 37)
Other discussants also explained the condition as:
“He was restricting my movements. When I was out of my home, he usually makes repeated calls and threatened me as he already knows the place where I was and accuses me of also having sex with other men. My husband doesn't trust me. I will never forget how he violated me when I was in labor.” (Participant S1#9, women aged 40)
Further, another FDG discussant explained:
“He closed and locked the door when I was four months pregnant, I spoke through the window, and he severely beat me over and again, asking me why I was hanging out with my friends without his consent. I became dizzy and fell.” (Participant S1#1, women aged 38)
These actions hindering women from accessing support from their friends, relatives, and neighbors, as described above, made life difficult for women to access the available support. Moreover, women expressed their psychological trauma, as men were disturbing their life, insulting them, and preventing them from leaving their own homes.
Women’s feeling about the available services
The majority of the participants were worried about the implementation of the possible legal service, its inappropriateness, and the weak punishment (which they reported as only 2-3 days’ imprisonment), for the perpetrators. The available legal services are similar in Wolaita Zone, which the government provides to its people. As the participants pointed out, the religious leaders and elders of the communities are also involved in resolving the conflicts among couples. A few participants, however, noted the absence of a legal service to which to report their abuse. Many participants also believed that women lacked awareness about how to use the existing legal service. Some women had sought help from the justice system, but this did not appear to be a typical response. According to the participants, women who live in urban areas and who were educated were able to defend themselves and received the legal service.
An interviewee also reported that there was no women’s network, effectively working to support women experiencing gender-based violence. However, the majority of women described the availability of other women’s organizations (these comprised one leader to five members and extended to one leader for each of 30 members). One leader to five members is the subset of the one leader to 30 women division to reach women at the grassroots level. In Ethiopia, these organizations were established to accomplish certain governmental activities like infectious disease prevention, vaccination programs, and specific agricultural and educational duties. However, the majority of the women felt that the existing one leader to five members, do not play a functional role in the prevention of IPV and lack the ability to take strong actions against the perpetrators. Likewise, some women considered that there are no influential women leaders or organizations explicitly working on violence prevention in their community. Moreover, they believed that the available governmental women's affairs’ office was not functioning very well. Women felt that such an organization was not correctly doing their duties and was reluctant to punish perpetrators and that it was not satisfactory. For example, one participant explained this as:
“The justice office has only punished the perpetrator with three to four days in prison. The government’s justice is nothing. Though the police took them to jail, the perpetrator could not stay a night in jail; rather, the police were releasing the attacker from jail very soon. The punishment is loose.” (Participant T#4, woman aged 30).
One of the FGD discussants explained it as:
“There are no strong and organized women leaders (1 leader for five members), but they were supposed to be resolving some conflicts between women and men. The women44's leader is not functioning, although they are supposed to be in place to do the job.” (Women, code=S#1, aged 38).
Another discussant explained it as:
“The governmental women’s affairs office is a symbol. It cannot give us a solution. They hear our problem, and then they let us write an application letter for our case and to submit it to the court. They do not solve our problems; rather, they let us go back to the community elders for mitigation.” (Participant T#1 and T2, women aged 32 &28 respectively)
According to the participants, the religious leaders have an essential role in resolving the violence. However, a few women emphasized that it is difficult to get support from the religious leaders and that they are inaccessible to women who need to report the abuse.
There were also contrary views from other participants who disagreed with this view stating that:
“The religious leaders are also concerned with violence, and they follow the case if women report it to them. They also have a good role and sacrifice their time to resolve the issues. The religious bodies are helpful." (Participant S2#5, woman aged 40).
Most of the participants reached consensus about the available legal system, women’s affairs office, and women’s leaders’ role and perceived these as too weak to safeguard women from violence. Besides that, the participants believed that there was an absence of a women’s network actively working on violence in Wolaita Zone.
Intimate partner violence prevention strategy in the perspective of women
Participants mentioned many possible IPV preventions strategies. Most of the participants reported that after their HIV test result disclosure, their partners abuse them, and this needs a proper prevention strategy. Some of the participants believed that the right time to disclose an HIV test result to prevent a sudden violent reaction from their partners should be when they are pregnant, sick, and at night time when they are about to go to bed. The majority of the participants pointed out that the health care provider should offer HIV testing to both partners at a time when the couples are together. Most of the women believed that disclosure of an HIV test result to their partner was beneficial hat they were able to receive care and treatment; nevertheless, unwise disclosures (sudden and unplanned revelation, not assisted by health care providers) had resulted in different types of violence.
The discussants also explained that if women knew their positive HIV status before their partners, health care workers should test them again as a new case along with their male partners, and assist the disclosure.
Women believed health care providers had a role as did other women who had some awareness about violence, and that they should teach each other how to obtain legal services. Participants also felt that women should know how to generate their own income. Moreover, a few participants also reported that women should discuss their violent situation with their neighbors to get advice and support from them.
One of the discussants explained the preferred approach of HIV counselors as:
“But while she is going to disclose her status, she should be counseled by the health care providers and bring her husband to the health facility, and she should be tested again as a new client together with her husband to convince him, then the health professional should counsel her husband very well. Otherwise, in case if she discloses her issue carelessly, the husband can hurt/abuse her by assuming that it was his wife who infected him with HIV.”(Discussant S1#8, women aged 30).
The participants described the need for IPV prevention strategies since women are dependent on their husbands as:
“Women are economically dependent upon their husbands. When women accuse their husbands, they cannot pay home rent; they cannot raise their children because husbands immediately leave them alone.” (Participant S1#9, women aged 40)
Other participants also mentioned that women who were already affected by abuse should teach others how to handle the situation in an organized manner.
“It is better if the women, who were already affected by abuse, teach others in an organized manner. It is better if the government also takes a strong action upon perpetrators. It is also nice if a specific association of women is working on this issue.”(Discussant S1#8, woman aged 30)
Some women mentioned that reporting the issue to public prosecutors or the women's affairs’ office or the justice office is crucial. As a solution, women indicated that there is a need to establish a strong women’s network, with members of such a network individually working against violence. Moreover, participants highlighted that the available “one leader to five members and one leader to thirty members” of the women’s army and women’s affairs’ offices of government, has to emphasize IPV prevention activities. Most women agreed that the available laws should be stringent and provide justice to all the victims.
One of the participants explained it as:
“The one leader to five member’s organization should work strongly because the women are hiding their secret of abuse. Then the one leader to five members association should wisely ask the abuse experience of women and come up with a possible solution. Also, the woreda women’s affairs should work hard to help women.”(Participant T#1, women aged 32)
Other participants had further suggestions; for example, one interviewee said:
“In my opinion, it is better if you gather men and teach them in a group to prevent their abusive behaviors against women. Education is essential for men. It is also better if women and men get education together in violence issues.” (Participant S1#7, women aged 38)
The discussants were interested in and pointed out IPV prevention strategies that needed to be implemented or implemented more effectively, including wise disclosure of HIV, teaching others in the community, establishing a strong women’s network, teaching male partners together with females, and that the available law should be stringent and provide justice to all victims.