Intimate partner violence (IPV) is a widespread violation of women’s rights and a critical public health issue, especially in sub-Saharan Africa. Women living with HIV (WLHIV) are particularly vulnerable due to gender power imbalances, HIV-related stigma, and the bidirectional relationship between violence and HIV acquisition. In Lesotho, where HIV prevalence is among the highest globally, limited evidence exists on IPV against WLHIV. This study aims to estimate the prevalence and factors associated with IPV against women living with HIV in Lesotho.

Data were drawn from the 2023/24 Lesotho DHS. A weighted sample of 467 women aged 15–49 years who were living with HIV was included. IPV was defined as having experienced at least one form of emotional, physical, or sexual violence by a partner/husband. Multivariable logistic regression was conducted to identify factors associated with IPV. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Based on the findings of the study, 34.19% (95% CI: 30.01–38.63) of WLHIV experienced at least one form of IPV in the last 12-month preceding the survey. Moreover, the 12-month prevalence for physical, emotional, and sexual violence respectively was 25.48%, 19.61%, and 10.07%. In the final model analysis, having multiple sexual partners and sexually transmitted infections (STIs) other than HIV in the past 12-month, not having own asset, disclosing HIV status, living with a jealous partner/husband and a male-headed household, and region of residence were significantly associated with experiencing IPV.

More than one-third of reproductive-age WLHIV in Lesotho experience IPV in the last 12-month preceding the survey, with key associated factors. Integrated interventions that combine HIV care with IPV screening, education, economic empowerment, and behavioral change communication are essential to mitigate IPV among WLHIV in Lesotho by considering these factors.

Intimate partner violence (IPV) is a worldwide public health concern with significant and wide-ranging impacts, especially on women [1]. IPV is defined as any act of physical, sexual, or psychological abuse committed by an intimate partner [2]. IPV includes violence performed by current and former partners or spouses. IPV has a severe impact on women’s sexual, emotional, and physical health and remains one of the most common forms of gender-based violence [3]. Women in low- and middle-income countries are disproportionately affected, with one in three women worldwide experiencing physical or sexual abuse at some point in their lives [4]. Beyond being a violation of human rights, IPV is recognized as a major factor influencing women’s health, well-being, and overall quality of life [5].

The “Elimination of Violence Against Women” was the focus of a 1993 United Nations General Assembly declaration [6]. However, such violence remains widespread globally. In sub-Saharan Africa, intimate partner violence is more prevalent than non-intimate partner violence [7]. Despite most African nations ratifying international agreements and enacting domestic legislation to combat IPV [8],, it remains pervasive across the continent [9]. IPV is an even greater issue in sub-Saharan Africa, where HIV/AIDS prevalence is exceptionally high. This region accounts for about 60% of global HIV cases, with a significant proportion affecting women. Due to biological, sociocultural, and gender-related factors that heighten women’s vulnerability to both HIV and IPV, women in sub-Saharan Africa are two to three times more likely than men to contract HIV [10].

Studies from various global contexts indicate a high prevalence of IPV among WLHIV. Outside Africa, lifetime IPV prevalence ranges from 19.2% in India [11] to 52% in the United Kingdom (UK) [12], while past-year prevalence spans 4.4% in the United States of America (USA) [13] to 14.1% in the UK [12]. The World Health Organization (WHO) survey reported that over 40% of African women in relationships have experienced IPV [8]. Globally, 40% of WLHIV have experienced violence in their lifetime, and 20% reported IPV in the past year [14]. In Africa, IPV prevalence among WLHIV varies widely. Lifetime IPV rates range from 13.1% in South Africa to 65.8% in Lagos, Nigeria [15] and 69.7% in Togo [16]. Past-year IPV prevalence ranges from 5.02% in Ogun state, Nigeria [17] to an alarming 64.2% in Ethiopia [18]. A recent meta-analysis across Sub-Saharan Africa found that 33.09% of WLHIV experienced IPV in their lifetime [19].

Previous studies have identified several factors, categorized under sociodemographic characteristics, behavioral factors, partner-related factors, socioeconomic factors, HIV-related factors, and community-related factors, that are significantly associated with experiencing IPV among WLHIV. These factors include age [20], educations status [21, 22], wealth status [11], employment status [19, 21], residence [18, 23], early start of sexual life [16], number of children in the household [24], controlling behaviour of husband/partner [25], having mental health problems [12], participants [19] and partners alcohol use habit [18, 20], inter-parental witness of violence [25], having multiple sexual partner [20, 21], justify wife-beating [25], male partner multi-partnership [16, 18], and disclosure of HIV-status to partner [25].

Lesotho, a small landlocked country in Southern Africa, is facing an HIV epidemic of crisis proportions. The Lesotho national household-based survey was conducted across all ten districts in Lesotho between November 2016 and May 2017, with one in four (25.6%) of reproductive-age women living with HIV, the second-highest HIV prevalence rate globally [26]. HIV and IPV disproportionately affect women, particularly those of reproductive age. IPV has been shown to have both immediate and long-term physical and mental health consequences [27], including an increased risk of physical injury [28], post-traumatic stress disorder [29], depressive symptoms [30], headaches or migraines [31], and gastrointestinal and gynecological issues [32], unintended pregnancies due to coercion, forced sexual activity, or interference with contraception [33].

Given that the combined burden of these two epidemics (co-occurring public health crises of HIV and IPV) in Lesotho can have serious socioeconomic and health consequences and it is imperative that WLHIV develop a nuanced understanding of IPV [34]. Despite these concerning figures, research on IPV and its contributing factors among WLHIV in Lesotho remains scarce, particularly regarding national statistics on its prevalence and associated factors. This study aims to determine the 12-month prevalence of IPV and identifying risk factors among WLHIV in Lesotho, using the 3023/24 nationally representative DHS dataset.

This study employed community-based multi-level secondary data analysis using the Lesotho Demographic and Health Survey (DHS) that was conducted from 2023–2024. The datasets were downloaded in STATA format from the DHS website (http://www.dhsprogram.com). The DHS survey, which is representative of low- and middle-income countries, collects nationwide data on various health parameters, including intimate partner violence (IPV) and sexual autonomy. Typically, DHS surveys are conducted every five years; however, in some countries, this time frame may be extended due to specific circumstances. The 2023–24 Lesotho DHS is the fourth nationally representative DHS survey in the country. Data for each survey are provided by men and women selected through a two-stage sampling technique [35]. The first stage involves identifying clusters, also known as enumeration areas (EA), while the second stage consists of selecting households for the survey. A total of 399 clusters were chosen in the first stage from the Lesotho household health survey framework by using the equal probability selection method. A previous study details the DHS’s sampling strategy and data collection process [36]. Trained survey staff, following standard DHS procedures, collected the data. These procedures include conducting household-level interviews, reviewing each question, and performing practice interviews among participants.

In the 2023–2024 DHS of Lesotho, interviews were conducted using questionnaires in both English and Sesotho. The Household, Woman’s, and Man’s Questionnaires were translated from English into Sesotho to ensure cultural relevance and comprehension. This study included the dataset produced between 2023 and 2024 that contained information from the HIV test result (v861) and DHS domestic violence modules (v044). The total individual record (IR) data contained 6,413 women participants aged 15–49. Then, only women who had received HIV positive results (n = 1,285) were first selected and women selected and interviewed for the domestic violence modules that were married, or were living with partners have been included in the study. Out of 1,285 total women living with HIV, 449 were in union, while the remaining participants were never in union. Therefore, the unweighted sample size of the current study consisted of 449 women living with HIV, while the final weighted sample comprised 467 women, who met the eligibility criteria and completed surveys on IPV.

Outcome variable

The study’s outcome variable was intimate partner violence against women living with HIV in the last twelve-month preceding the DHS survey. IPV was assessed using three categories of questions: sexual, physical, and emotional violence. These questions were derived from a modified version of the Conflict Tactics Scale [37] and served as the basis for the domestic violence module. Sexual violence was assessed by asking whether the respondent had ever been physically forced into unwanted sex, coerced into other unwanted sexual acts, or pressured into performing sexual acts against her will by her husband or partner. Physical violence was measured by determining whether the respondent had ever been pushed, shaken, had objects thrown at her, slapped, punched, hit with a harmful object, kicked, dragged, strangled, burned, threatened with a weapon, or had her arm twisted or hair pulled by her husband or partner. Emotional violence was evaluated based on whether the respondent had ever been humiliated, threatened with harm, or insulted or made to feel bad by her husband or partner. The response categories for these variables were “Yes” and “No,” coded as “1” and “0,” respectively. An index was generated using all “Yes” and “No” responses, resulting in scores ranging from 0 to 3. Scores of 1 through 3 were classified as “Yes,” while a score of 0 was classified as “No.” A dummy variable was then created, where a score of “0” indicated that a woman had never experienced sexual, emotional, or physical violence, while a score of “1” indicated that she had experienced IPV.

The independent variables included both individual and community-related factors. Individual-related factors encompassed age, age at first sex and cohabitation, duration of cohabitation, educational status, sex of the household head, current working status, ownership of assets (own land or house), the respondent’s justification of wife-beating, respondents alcohol use, cigarette/tobacco use, experiencing depression in their life, witnessing maternal abuse, wealth index (categorized as poor, middle, or rich), number of sex partner in the last 12 months (“one or multiple”), disclosure of their sero-status to partner, feeling ashamed of their sero-status, having sexually transmitted infections (STI) (other than HIV), genital ulcer/sore, and vaginal discharge in the last twelve months, jealousy of the husband/partner, and partner/husband alcohol use.

Community-related factors included media exposure (newspaper/magazine, radio, or television), residence, distance to health facility (reported as “no problem or big problem”), and region. Media exposure was measured by combining exposure to TV, radio, and newspapers. Respondents who had been exposed to any of these media were recorded as “yes,” while those who had not were recorded as “no.” Respondents were further categorized as “yes” if they had been exposed to at least one of the three media sources and “no if they had not been exposed to any.

Data analysis

The data were appended, stored, cleaned, recoded, and analyzed using STATA (version 14.0). Frequency tables and graphs were generated as part of the descriptive analysis. To ensure reliable conclusions, the sample was weighted using the sampling weight (v005). A two-level mixed-effect multinomial logistic regression model was employed due to the hierarchical nature of the dataset. Four models were fitted: a null model with no explanatory variables, a model with individual-level explanatory variables, a model with community-level explanatory variables, and a model with both individual- and community-level explanatory variables.

The models were compared using the log-likelihood ratio (LR) test to account for the hierarchical structure and differing numbers of parameters. The best-fitting model, identified by the lowest LR, was selected as the final model. To confirm the appropriateness of using mixed-effects analysis instead of standard multinomial logistic regression, the intra-class correlation coefficient (ICC) was calculated. In the final model, the proportional change in variance was also computed to quantify the variability explained by the random effects. To determine the best-fitting multivariable logistic regression model, we used Deviance, the Bayesian Information Criterion (BIC) and the Akaike Information Criterion (AIC) as a model selection criterion AIC and BIC balances model fit and complexity by penalizing the number of parameters, with lower AIC and BIC values indicating better model fit. Additionally, the difference in intimate partner violence between clusters was assessed using the Median Odds Ratio (MOR) [38]. An association between independent variables and IPV was considered statistically significant if the p-value was less than 0.05. Variations in the odds ratio scale of IPV across clusters and the degree of homogeneity in the evaluation of IPV were also measured. Ultimately, factors statistically significantly associated with IPV were identified, and the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was computed.

More than two-thirds (69.06%) of the participants were aged between 35 and 49 years. Regarding age at first sexual experience, 46.79% of women reported initiating sexual activity between the ages of 15 and 17, while 44.93% began after the age of 17. In terms of cohabitation, over three-quarters (76.72%) started living with their partner after the age of 18. The most common duration of cohabitation was 10–19 years (39.93%), followed by 20–29 years (34.17%).

In terms of educational attainment, 45.04% had completed secondary education, while 44.57% had completed primary education. More than half (53.46%) of the women were currently employed, and 40.58% had children under the age of five in the household. Additionally, 68.58% of participants owned assets such as land or a house. Half (50.75%) of the participants were classified in the rich wealth index category, while 29.55% were considered poor.

About one-quarter (25.09%) of women reported having multiple sexual partners and had experienced at least one STI (excluding HIV), genital ulcers/sores, or vaginal discharge in the 12 months preceding the survey. Alcohol consumption was reported by 51.73% of participants, 15.42% were cigarette or tobacco users, and 13.9% had ever been diagnosed with depression. A total of 21.74% of women justified wife-beating, whereas 78.26% did not. Additionally, 58.05% of participants lived in male-headed households. More than one-third (36.18%) had witnessed maternal abuse in their lifetime. Furthermore, 36.65% of women reported feeling ashamed of their HIV status, and 68.09% had disclosed their HIV status to their partners.

Regarding partner-related behaviors, 59.11% of respondents reported that their husband/partner was a current alcohol user, and 51.82% stated that their partner exhibited jealousy when they talked to other men. About half (51.30%) of the participants resided in urban areas and the majority were from Maseru district (32.6. Approximately three-fourth (74.13%) of participants indicated that distance to a health facility was a major problem and 81.16% of women reported exposure to at least one form of media (Table 1).

The lifetime prevalence of IPV among WLHIV was 54.21% (95% CI: 49.66–58.70), while the 12-month prevalence stood at 34.19% (95% CI: 30.01–38.63). Regarding the types of violence, the lifetime prevalence of physical, emotional, and sexual violence was 43.99% (95% CI: 39.53–48.55), 31.68% (95% CI: 27.60–36.06), and 13.88% (95% CI: 11.02–17.33), respectively. Correspondingly, the 12-month prevalence of physical, emotional, and sexual violence was 25.48% (95% CI: 21.72–29.64), 19.61% (95% CI: 16.24–23.47), and 10.07% (95% CI: 7.65–13.17), respectively.

Among the 253 women (54.21%) who had experienced IPV in their lifetime, 124 (26.58%) reported one form of violence, 94 (20.13%) experienced two forms, and 35 (7.50%) suffered from all three forms. Similarly, of the 160 women (34.19%) who experienced IPV in the past 12 months, 83 (17.77%) reported one form, 56 (11.92%) experienced two forms, and 21 (4.50%) experienced all three. District-level analysis revealed that the highest lifetime IPV prevalence was observed in the Thaba-Tseka region (69.12%), followed by Berea (62.55%) and Maseru (58.53%). The highest 12-month IPV prevalence was also reported in Thaba-Tseka (47.46%), followed by Maseru (41.84%) and Berea (35.52%) (Fig. 1).

The district distribution of lifetime and twelve-month IPV among women living with HIV in Lesotho

Full size image

The null model was used to assess whether the data supported examining randomness at the community level. The ICC value in this model suggests that 33.8% of the variation in IPV was attributable to differences between clusters. Moreover, the odds of experiencing IPV varied by a factor of 3.35 between high- and low-risk clusters, indicating substantial heterogeneity across communities. In the final model, the proportional change in variance (PCV) showed that 22.02% of the variability in IPV could be explained by both individual- and community-level factors. Furthermore, the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) values progressively decreased, with Model III having the lowest values, signifying the best fit. Overall, these findings suggest that Model III provides the most explanatory power, demonstrating the greatest reduction in variance and improved model performance (Table 2).

In the final model analysis, several factors were significantly associated with experiencing IPV in the past 12 months. These included having multiple sexual partners, lack of asset ownership (land or house), disclosing HIV status to a partner, having an STI other than HIV in the past year, living with a jealous partner or husband, residing in a male-headed household, and region of residence.

Women who did not own assets were more than twice as likely to experience IPV compared to those who did (AOR = 2.46; 95% CI: 1.23–4.93). Similarly, those living in male-headed households had over twice the odds of experiencing IPV than those in female-headed households (AOR = 2.21; 95% CI: 1.17–4.20). Having an STI other than HIV—such as a genital ulcer or vaginal discharge—within the past year also increased the likelihood of IPV by more than twofold (AOR = 2.37; 95% CI: 1.22–4.58). The strongest predictor was having a jealous partner or husband, which increased the odds of IPV by more than five times (AOR = 5.14; 95% CI: 2.62–10.11). Women who reported multiple sexual partners in the past 12 months were nearly three times more likely to experience IPV than those with only one partner (AOR = 2.84; 95% CI: 1.39–5.83). Additionally, women who disclosed their HIV status to their partners were more than twice as likely to face IPV compared to those who did not disclose (AOR = 2.38; 95% CI: 1.13–5.01). Regional differences were also significant: women living in Maseru (AOR = 3.35; 95% CI: 1.17–9.58) and the eastern and mountainous regions (AOR = 3.59; 95% CI: 1.04–12.44) had more than three times higher odds of experiencing IPV compared to those in the northern region (Table 3).

This study utilized data from the 2023/24 DHS to examine the 12-month prevalence and contributing factors of IPV among WLHIV of reproductive age in Lesotho. The 12-month prevalence was 34.19% (95% CI: 30.01–38.63). By type, the past 12-month prevalence of physical, emotional, and sexual violence was 25.48%, 19.61%, and 10.07%, respectively. Furthermore, among the 34.19% of women who experienced IPV in the past year, 17.77% faced one type, 11.92% encountered two types, and 4.50% endured all three types of violence. District-level analysis revealed that Thaba-Tseka had the highest 12-month IPV prevalence (47.46%), followed by Maseru (41.84%) and Berea (35.52%), while the lowest prevalence was observed in Butha-Buthe (17.90%) and Mohale’s Hoek (18.54%).

In Lesotho, women living with HIV (WLHIV) are protected under various legal frameworks, including the Constitution, the Legal Capacity of Married Persons Act (2006) [39], and the Sexual Offences Act (2003) [40], which aim to promote gender equality and protect against violence and discrimination. However, the continued influence of customary law, high rates of gender-based violence, and stigma undermine these protections [41]. Strengthening the enforcement of existing laws and addressing social norms remain essential to safeguarding the rights and well-being of WLHIV.

The findings of this study reveal a high prevalence of IPV among women living with HIV (WLHIV) in the past 12 months. These results underscore the heightened vulnerability of this demographic group and provide valuable insights into the complex relationship between IPV and HIV status. Given its serious impact on women’s physical, mental, and reproductive health, IPV remains a critical public health concern requiring urgent intervention. The prevalence of past-year IPV among WLHIV in Lesotho was consistent with prior studies conducted at Benin Teaching Hospital, Nigeria, where nearly one-third (32.5%) of women reported experiencing IPV [42]. Additionally, the prevalence of IPV in Lesotho aligns with findings from Wolaita, Southern Ethiopia, where 33.91% of WLHIV experienced IPV in the past year preceding the survey [20].

Surprisingly, the 12-month IPV prevalence observed in Lesotho exceeds the lifetime prevalence reported among WLHIV in Sub-Saharan Africa [19]. A recent systematic review and meta-analysis of studies from the region found that one-third (33.09%) of WLHIV had experienced at least one form of IPV in their lifetime. Furthermore, the past-year prevalence of IPV among WLHIV in this study was approximately seven times higher than the prevalence rate reported in a study conducted in Ogun State, Nigeria (5.02%) [17], and approximately five times higher than the rate observed in Uganda (7.5%) [43]. The prevalence of IPV in the current study was also more than 10% higher compared to a prior study conducted in Osogbo, Southwest Nigeria, where 23.6% of WLHIV experienced IPV [22], and more than 20% higher than a study in South Africa, where 13.1% of WLHIV experienced at least one form of IPV in the past year before interview [23]. This discrepancy could be due to factors such as contextual differences in the study population, variations in study methodologies, increased awareness or disclosure of IPV, or regional and temporal trends. The findings suggest that local factors, such as access to health services, socioeconomic status, and possible underreporting in other settings, might contribute to the observed differences in IPV prevalence.

Notably, outside of African context, the 12-month prevalence observed in this study exceeds the lifetime prevalence of IPV among WLHIV in India, which was 19.2% [11]. Compared to studies conducted in high-income countries such as the USA and UK, the 12-month IPV prevalence in Lesotho was significantly higher—more than four times the rate reported in the USA [13] and more than twice the rate found in the UK [12]. These disparities highlight the disproportionate burden of IPV among WLHIV in low-resource settings. Additionally, the 12-month IPV prevalence in Lesotho was 14% higher than the estimate from a recent global meta-analysis and systematic review, which included primary studies from high-, middle-, and low-income countries. The review found that, over their lifetime, about one in five women (20%) experienced at least one form of IPV in the year preceding the survey [14].

In contrast, the prevalence of IPV among WLHIV in Lesotho is significantly lower than that reported in a study conducted in Ethiopia, where 64.2% of WLHIV experienced IPV in the year preceding the survey [18]. The discrepancy in IPV prevalence between Lesotho and Ethiopia can likely be attributed to several factors, including cultural attitudes, legal frameworks, and access to services. In Ethiopia, where societal stigma against WLHIV may be more pronounced and legal protections weaker, women may be more vulnerable to IPV. A study in East Africa highlighted that discriminatory attitudes towards WLHIV (32.73%) can increase their risk of violence, which may explain the higher rates observed in Ethiopia [44]. In contrast, Lesotho may have better access to healthcare, social services, and legal protections, leading to lower IPV prevalence. Additionally, economic disparities between the two countries could also contribute, as financial stressors in relationships can exacerbate IPV risks [45].

In the final model (Model-III) of analysis, several factors were significantly associated with experiencing IPV in the past year preceding the survey. These factors included having multiple sexual partners, not owning assets (such as land or a house), disclosing HIV status to partners, having any STI other than HIV in the last 12 months, living with a jealous partner or husband, having a male household head, and the region in which the individuals lived.

Women living in male-headed households were also more than two times more likely to experience IPV than those in female-headed households. This finding is consistent with previous studies conducted among the general population of reproductive-age women in Ethiopia [46] and Nigeria [47]. Sources of conflict that often lead to intimate partner violence include male dominance and women’s attitudes toward their relationships. Strong, equitable relationships are frequently lacking in male-headed households, where unequal sharing of domestic responsibilities can create tension and a sense of disconnect between partners [48]. In such settings, women often lack decision-making power, which has been linked to increased vulnerability to intimate partner violence [49].

Respondents who did not have own assets (such as land or a house) were more than two times as likely to suffer from IPV in the past twelve months compared to those who owned assets. This may be attributed to economic dependence, power imbalances, and a limited ability to leave abusive relationships. Asset ownership strengthens women’s bargaining power, financial independence, and social status, thereby reducing their vulnerability to abuse. Studies support this, indicating that women who own property are at a lower risk of experiencing IPV [50, 51]. These findings emphasize the importance of economic empowerment initiatives in mitigating violence against women. This finding is also consistent with a previous studies employed in Ethiopia [18, 20, 52], and South Africa [23].

Women who reported having any sexually transmitted infection (STI), genital ulcer or sore, or abnormal vaginal discharge (excluding HIV) in the past 12 months were more than twice as likely to experience intimate partner violence (IPV) compared to those without such symptoms. Overlapping factors such as partner suspicion of infidelity, stigma associated with STIs, and relationship conflicts related to health may contribute to the increased risk of IPV. In contexts where restrictive gender norms hinder open discussions about sexual health, the presence of STIs or related symptoms can trigger accusations, mistrust, and conflict within relationships. Research indicates that women with STIs are more likely to experience IPV, not only due to biological vulnerability but also because of the social and relational consequences that often accompany such infections [53, 54].

Having a jealous husband or partner emerged as the strongest predictor of IPV, with affected women being more than five times as likely to experience violence. Previous studies have shown that having a jealous spouse or partner and who experience controlling behaviors from their partners is a significant predictor of intimate partner violence [25]. It is also supported by a previous study employed in Fitche, Central Ethiopia [52]. Possessiveness driven by jealousy often leads to controlling behaviors, restrictions on women’s social interactions, and, ultimately, emotional, physical, and sexual abuse.

Women who have had multiple sexual partners in the last 12 months are approximately three times more likely to experience intimate partner violence (IPV) than those with only one partner due to factors such as jealousy, control, and perceived infidelity. This finding is supported by previous evidences in Wolaita, Southern Ethiopia [20], and Zimbabwe [55]. In addition to partners becoming possessive and acting violently, women with multiple sexual partners may face stigma, relationship instability, and an increased risk of sexual and reproductive health issues, all of which contribute to IPV. Research confirms that these dynamics heighten the likelihood of IPV among women with several sexual partners [55].

Additionally, the experience of past-year IPV was more than two times higher among women who disclosed their HIV status to their partner than those who did not. This finding was supported by previous studies carried out in Ethiopia [25], Osogbo, southwest Nigeria [22], Tanzania [25], and Zimbabwe [55], which shows, sero-status disclosure to partner increases the risk of IPV in WLHIV. Disclosure is a highly sensitive process that goes beyond merely sharing medical information with a partner; it also involves issues of commitment, loyalty, and trust. As a result, women often find it more difficult to disclose their HIV status in situations where men make all the decisions [56]. Likewise, qualitative research in Kenya revealed that nearly one-third of women faced physical and/or emotional abuse from their partners following the disclosure of their HIV status [57]. These findings underscore the complex dynamics between HIV disclosure and IPV, highlighting the need for supportive interventions to protect women’s well-being during the disclosure process.

The strength of this study lies in its use of nationally representative data, derived from the most recent Lesotho DHS, which ensures reliable and broadly applicable results. The dataset in a regional study of Lesotho provides sufficient statistical power to assess the actual burden of IPV among these vulnerable populations. However, the cross-sectional nature of the DHS data limits the study’s ability to draw causal conclusions. Additionally, extremely vulnerable groups, such as the homeless, refugees, those in prison, and the institutionalized, are excluded from the DHS data. Moreover, underreporting due to fear of shame or reprisal remains a possibility, as IPV is a sensitive topic. The study also relied on secondary DHS data, which excluded women beyond reproductive age and lacked established measurement instruments for certain factors.

AIC:

Akaike Information Criteria

AOR:

Adjusted Odds Ratio

BIC:

Bayesian Information Criteria

DHS:

Demographic Health Survey

CI:

Confidence Interval

IR:

Individual Recode

ICC:

Intra-Class Correlation

MOR:

Median Odds Ratio

PCV:

Proportional Change in Variance

STIs:

Sexually Transmitted Infections

WHO:

World Health Organizations

WLHIV:

Women Living with Human Immune Virus

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GT, FA, TKT, MK, and GR: conceptualize the problem, design study, perform analysis, interpretation of data, and write up the manuscript. GT, GK, GMG, SF, TT, and GN: helped with data analysis, made revisions to data interpretation, and thoroughly examined the paper. The final text was reviewed, amended, and approved by all authors.

Correspondence to Gebresilassie Tadesse.

The DHS data of Lesotho were collected in accordance with both national and international ethical guidelines. Ethical approval was obtained from ICF International and the US Centers for Disease Control and Prevention Institutional Review Board. At the time of data collection, all study participants provided informed consent, and data were collected anonymously. For participants younger than 18 years, informed consent was obtained from a parent or legal guardian, and assent was obtained from the minors themselves, in accordance with standard DHS ethical procedures. The study’s purpose and the voluntary nature of participation were clearly explained to participants by the data collectors and no personally identifiable information was used in this analysis. Ethical guidelines were rigorously followed to ensure privacy and confidentiality, with minimal risk to participants. Additional information regarding the DHS data and ethical standards is available atwww.measuredhs.com.

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The authors declare no competing interests.

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