Violência por parceiro íntimo e infecções sexualmente transmissíveis em parturientes da região metropolitana do Rio de Janeiro

Abstract

Several authors point to intimate partner violence (IPV) in pregnancy as being associated with a higher risk of STI, as well as the increase of this violence in pregnancy, even if the high underreporting rate of this compulsory notification by the health sector is taken into account. The objective of this research was to study the relationship between intimate partner violence and the occurrence of three sexually transmitted infections (HIV, HTLV and syphilis) in gestation, in parturients hospitalized in two hospitals in the metropolitan region of the city of Rio de Janeiro, the University Hospital Pedro Ernesto, reference for high-risk pregnant women and the State Hospital of the Mother, for low-risk pregnant women. A cross-sectional study was carried out through structured interviews and blood samples collected for the diagnosis of HIV, syphilis and HTLV of parturients hospitalized in the mentioned hospitals. Interviews conducted with the pregnant women followed a structured script that contained personal, socio-family, behavioural, sexual and reproductive health data, and a validated WHO questionnaire to investigate the occurrence of IPV of three types: psychological, physical and sexual. The variables collected were used in the comparative analysis to identify the prevalence ratios. The associations between HIV infections, syphilis, HTLV and possible risk factors were statistically tested. The magnitude of the associations was evaluated through the calculation of association measures (odds ratio) and respective 95% CI. Multiple regression models were used to control the effect of sociodemographic variables on STIs. At the end of the study, for a better robustness in the evaluation of factor causality, a multivariate analysis of the data was performed. A total of 1204 parturients were interviewed, with a mean age of 24.8 ± 6.5 years. The prevalence of STI was 6.9% and that of violence, whether psychological, physical or sexual, reached 42.4%. It was verified a higher prevalence of these STIs in the group that attended less prenatal consultations. Among the most frequent victims of violence were women of non-white race, over 19 years old, without completing high school, income below 3 minimum wages, with sexual initiation below 15 years old. Although the violence was lower in pregnancy, even with the apparent substitution of physical violence for the verbal one, its practice, banalization and lack of perception are still great, especially in relation to psychological violence, less valued or even less observed by the community. When we analysed the relationship between violence, before and during pregnancy, and the STIs surveyed, we did not find statistical significance (p = 0.07), although there is a trend in this direction. In the analysis of violent situations only during gestation, this association became more distant (p = 0.99). However, considering the violence, only prior to pregnancy, and the presence of any of the STIs studied, this relationship was statistically significant (p = 0.02). Conclusion: the high prevalence of STIs and violence in pregnancy was confirmed, as well as the association between IPV and STI. The non-statistical confirmation of the association between IPV in pregnancy and STI suggests the possibility that the condition of being pregnant is a protective factor for IPV.