Relationship power, partner risk characteristics, and recent intimate partner violence among adolescent girls and young women in a high HIV incidence setting in Kenya

Abstract

Adolescent girls and young women (AGYW) in sub-Saharan Africa face intersecting risks of HIV and intimate partner violence (IPV). Although pre-exposure prophylaxis (PrEP) expands HIV prevention options, its use is often constrained by imbalanced relationship power and male partner behaviors. We used baseline data from the Tu'Washindi na PrEP cluster randomized trial to describe PrEP use, relationship dynamics and identify attributes associated with recent IPV among Kenyan AGYW. From 2022 to 2025, we enrolled 1,557 AGYW, aged 15-24 years, in sexual relationships at elevated HIV risk. Interviewer-administered questionnaires captured socio-demographics, partner characteristics, relationship dynamics, and IPV. Mixed-effects Poisson regression models examined associations between relationship measures and IPV, adjusting for covariates and clustering at the trial level. Participants mean age was 21 years; 70% experienced food insecurity. PrEP use was low: 7% were current users and 80% had never used it. 17% reported recent IPV (past 3-months). In adjusted models, IPV risk was higher for married AGYW (aRR = 2.42, 95% CI: 1.82, 3.22), and risk increased with relationship length (aRR = 1.10, 95% CI: 1.03, 1.07, respectively). Significant partner-related risks included not knowing his HIV status and weekly alcohol use among partners. Among relationship dynamics, higher relationship power was protective. Healthy communication and PrEP self-efficacy were not significantly associated with IPV. Partner and relationship factors, such as imbalanced power shape IPV amid low PrEP use. Findings underscore the need for interventions that strengthen AGYW's autonomy and relationship power, alongside male engagement, to reduce IPV and improve HIV prevention outcomes.