Findings from this first nationally‐representative examination of men's perpetration of IPV and their sexual health indicate that more than one in three married men in Bangladesh reported physically or sexually abusing their wives in the past year. This result is consistent with previous studies based on women's reports conducted in both urban and rural Bangladesh demonstrating similarly high rates of IPV.1,22,23,24,25
These findings also demonstrate that men reporting perpetration of IPV in the past year are more likely to engage in extramarital sexual behaviour and are at significantly increased risk for recent STI symptoms/diagnosis. These findings are consistent with those from a large study of married men from a rural northern Indian state that demonstrated associations of lifetime IPV perpetration with both premarital and extramarital sex, as well as STI symptoms.15
Notably, current findings of associations between sexual risk and IPV perpetration are also consistent with multiple prior studies conducted in a diversity of international settings outside South Asia (eg, the USA and South Africa).16,17
Thus, the implications of the current findings may extend beyond the South Asian context and inform a growing global body of evidence linking perpetration of gender‐based violence with men's sexual risk behaviour. Primary among such implications is the need for inclusion of IPV and other forms of gender‐based violence within sexual health promotion and STI/HIV prevention efforts conducted among both men and women.
New to this body of work, IPV perpetration in the past year was associated with both past‐year extramarital sex (for IPV reported as both physical and sexual) and past‐year STI (for physical IPV with or without sexual IPV), indicating potential concurrency of men's violence against wives and their extramarital sexual behaviour and related infection. This concurrency indicates a compounding of the danger faced by abused wives in that, beyond the injury and non‐sexual health risks directly related to victimisation through physical and sexual violence, their sexual and reproductive health may be compromised on the basis of their husbands' sexual risk behaviours and STIs. The sexual risk behaviours of men who perpetrate violence against their partners have been posited to underpin the associations consistently demonstrated between women's violence victimisation and their increased risk for STI, including HIV/AIDS.31,32
Present analyses support this hypothesis by providing evidence that perpetrators of recent IPV are more likely to engage in recent risky sexual behaviours and recently contract STIs compared with men not perpetrating IPV. These findings, coupled with the documented limited sexual negotiation power (ie, the capacity to refuse sexual activity, or to insist on condom use or other protection) among women who are physically abused by their male partners,9,10,11
present a clear pathway for abused women's sexual risk.
South Asian cultural norms have been described as limiting communication concerning sexual health among married couples.10
Men reporting past‐year physical IPV in this study were more likely to not disclose this infection to their spouse than other men who had contracted an STI, although this finding did not reach statistical significance. This finding indicates a possible further compounding of the risk abusive men pose to their wives' sexual health, in that such men are more likely to contract an STI and to, perhaps, not disclose the infection, thus inhibiting their wives' ability to make informed choices regarding sexual protection. Previous research has documented fear of partner violence as a primary reason for women choosing not to disclose their HIV serostatus to sexual partners,33,34,35,36
but the present findings represent the first assessment of the role of IPV perpetration in men's disclosure of STI/HIV status to their partners. Given the growing epidemic of HIV infection among monogamous South Asian women who have intercourse with infected multiple‐partnering husbands,21
research into the issues of violence and coercion in such relationships and how this relates to men's disclosure of STIs and other aspects of women's ability to protect themselves should be considered a high priority. Future research should examine this relationship in greater depth with a broader array of disclosure outcomes including women's reports of such communication.
These findings should be considered in the light of several design limitations. Cross‐sectional analyses do not allow us to determine the relative chronology of extramarital sexual behaviours and STI symptoms/diagnosis in relation to IPV perpetration within the past‐year timeframe assessed. Longitudinal and qualitative research is needed to clarify the causal and temporal relationships between IPV and sexual risk and sexual health. All instances of premarital sexual behaviour may not represent partnering with women other than wives—that is, men may report having had premarital sex with women they later married. Thus, such behaviour, in itself, would not confer sexual risk. Although the syndromic approach to STI diagnosis such as the assessment currently used is recommended for settings that lack diagnostic facilities,37
the under‐reporting of STI may have occurred on the basis of not receiving formal STI diagnosis or lack of familiarity with the STI symptoms assessed. Such under‐reporting and resulting misclassification of STI status may have biased results in the direction of the null, thus underestimating associations of STI and IPV. Conversely, symptoms listed as indicative of STI may not definitely indicate such infection (eg, painful urination based on prostate enlargement). Notably, other critically important sexual risk behaviours (eg, frequency of condom use with wives and extramarital partners) were not available for consideration as outcomes or confounders in the present analyses. Analyses concerning inconsistent condom use during last STI and disclosure of STI to spouse faced limited statistical power given the reduced sample size used for these analyses. Finally, although this sample is nationally representative of married Bangladeshi men residing in private dwellings, it is unclear to what extent these findings may generalise to men living in other types of housing or those of other nationalities and cultures.
- More than 1 in 3 (36.8%) married Bangladeshi men reported physically and/or sexually abusing their wives in the past year.
- Bangladeshi men who perpetrate intimate partner violence represent a greater threat to the sexual health of their wives compared with non‐abusive men, based on increased rates of extramarital sexual behaviour and acquisition of STI.
- Given the growing epidemic of heterosexual HIV infection among monogamous South Asian women, research and intervention regarding men's violence in marriage and implications of such behaviour for women's sexual health should be prioritised.
The findings clearly demonstrate a high level of IPV perpetration among married Bangladeshi men, with more than 1 in 3 reporting having physically and/or sexually abused their wives in the past year, and increased rates of both extramarital sex and STI symptoms/diagnoses during this same period among men perpetrating such abuse. Given the stigma and severe social and economic costs associated with divorce and separation in Bangladesh;23
low levels of help‐seeking for IPV among Bangladeshi women who are abused,24
cultural norms dictating low levels of communication between spouses concerning sexuality and diminished sexual negotiating power among women10
who are abused; and the present findings of greater risk for STI presented by abusive married men should serve to emphasise the great need for intervention to both prevent and intervene in men's violence against their wives and better assist women physically and sexually victimised by their husbands. Such prevention and intervention may be critical not only for preventing the direct and injurious consequences of IPV, but also for protecting women from STIs, including HIV.