Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic

Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic Kalysha Closson, Bongiwe Zulu, Julie Jesson, Janan J. Dietrich, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2403223/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Nov, 2023 Read the published version in BMC Public Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Young women and Lesbian, Gay, Bisexual, Trans, Non-binary/no gender, or Questioning (LGBTQ+) youth in South Africa face some of the highest global levels of intimate partner violence (IPV). Given limited evidence in the wake of the COVID-19 pandemic, which has fuelled IPV globally, we aimed to describe and compare experiences and perpetration of IPV of youth aged 16-24 by sexual orientation and gender identity (SOGI). Methods: December 2021-May 2022, youth aged 16-24 years from eThekwini district, South Africa completed an online survey to understand multilevel impacts of the pandemic on youth. Participants were asked about experiences and perpetration of physical IPV since the COVID-19 pandemic. Descriptive statistics and adjusted logistic regressions compared the likelihood of experiencing and/or perpetrating physical IPV between heterosexual men; heterosexual women; gay, bisexual, or questioning men [GBQM; lesbian, gay, bisexual, or questioning women [LGBQW]; or gender/sexual non-conforming youth [non-conforming]. Results: Of 1,584 youth (mean age=21.7 [SD=2.3]; 71.7% Black) with non-missing SOGI and physical IPV data, 239 (15.1%) were LGBTQ+ (40.6% LGBQW and 36.0% non-conforming). The proportion of youth both experiencing and perpetrating physical IPV differed by SOGI (13.3% of heterosexual men, 14.1% of heterosexual women, 23.2% of GBQM, 20.8% of LGBQW, and 25.6% of non-conforming youth experienced and 10.9% of heterosexual men; 7.7% of heterosexual women; 10.7% of GBQM; 16.5% of LGBQW; and 16.3% of non-conforming youth perpetrated). In adjusted models, compared to heterosexual women, non-conforming youth had increased odds of experiencing (adjusted odds ratio [aOR]=2.73; 95%CI, 1.57-5.06) physical IPV and non-conforming youth (aOR=3.02; 95%CI, 1.42-6.41), LGBQW (aOR=2.09; 95%CI, 1.06-4.09), and heterosexual men (aOR=1.55; 95%CI, 1.01-2.37) all had greater odds of perpetrating physical IPV during the pandemic. Conclusion: In the first two years of the COVID-19 pandemic, over one in six youth in our study experienced and one in ten perpetrated physical IPV, with gender and sexual non-conforming youth experiencing and perpetrating IPV at significantly greater rates than cisgender/heterosexual peers. Our findings highlight the need for gender transformative efforts that move beyond the gender binary to support healthy relationships and IPV prevention for LGBTQ+ youth in South Africa and globally. Figures Figure 1 Figure 2 Introduction Over one in four women who have ever been in a relationship will experience some form of intimate partner violence (IPV) in their lifetime. Experiences of IPV begin at an early age, with past year IPV being higher among women aged 15–24 years than any other age group [ 1 ]. While global estimates of IPV perpetration by men are limited, perpetration in select populations including military populations (26%) [ 2 ] and youth in disadvantaged communities in Johannesburg, South Africa (40%) [ 3 ]are similarly high or higher than global estimates of IPV experiences. Given that IPV perpetration by men directed at women in heterosexual relationships may be the most common pattern of IPV, with potentially the greatest health consequences, the vast majority of studies have focused on experiences and perpetration of IPV in heterosexual relationships. However, IPV perpetration by women as well as perpetration and experiences within non-heterosexual relationships have also been reported [ 4 ]. A recent review reported that IPV experiences and perpetration within non-heterosexual relationships happen at rates comparable to heterosexual relationships [ 5 ]. However, studies involving non-heterosexual participants have primarily explored IPV experiences within the relationships of gay and bisexual men leaving gaps in the literature and understanding about IPV among LGBTQ + communities. Across the globe, there is growing evidence that the COVID-19 pandemic and the subsequent public health response to “stay home” through legally enforced and self-imposed social distancing, fueled environments in which IPV could thrive [ 6 ]. These environments included the increase of situational stressors related to the COVID-19 pandemic, such as economic stress, social isolation, and pandemic-related stress [ 7 , 8 ]. While evidence suggests that LGBTQ + communities, who are frequently subjected to social stigma and minority stress[ 9 ], may have faced additional challenges with mental health and experiences of discrimination and violence amidst the global lockdown [ 10 , 11 ], limited research has explored other inequities faced by this important population during the pandemic. As the onset of IPV often begins in adolescence and early adulthood, and in turn increases the risk of violence victimization and perpetration into adulthood, it is critical that research efforts focus on mitigating experiences and perpetration of IPV in this population. Thus, while recent research is highlighting the added risk and experiences of IPV during the pandemic, the experiences of youth, the majority of whom are or were non-cohabitating during the pandemic are less understood [ 12 , 13 ]. In South Africa, rates of IPV were at critical levels pre-pandemic, with 21% of women experiencing physical IPV in their lives [ 14 ]. For over two decades, gender-based violence, including IPV and femicide, has been highly publicized in the South African media [ 15 ] with large scale governmental campaigns being launched across the country to end violence against women, including the 16 days of activism and the Presidential Summit on Gender-Based Violence and Femicide [ 16 ]. Much prior work has documented high rates of both experiencing IPV and perpetrating IPV across multiple settings and populations in South Africa [ 17 – 20 ]. Within sub-Saharan African settings of high sustained IPV, including South Africa, much research has explored the drivers and factors associated with IPV experiences and perpetration. Education, employment, and having children are drivers of IPV experiences [ 18 , 21 ], while alcohol use[ 22 ]; experiences of violence during childhood, or witnessing violence in childhood being significant drivers of IPV perpetration [ 21 ]. For this reason at the onset of the COVID-19 pandemic, and when the South African President called a national lockdown in March 2020, there was serious concern that mounting rates of IPV faced by women across the globe during the pandemic would result in an increase in IPV and IPV-related crime South Africa [ 23 ]. Early reporting from the South African Police Service (SAPS) suggested that reports of IPV in South Africa actually decreased by up to 68% from prior pandemic reporting periods [ 24 , 25 ] yet domestic abuse hotlines utilization was reported to have increased by 65–100% during the initial lockdown [ 26 ]. These data highlight the challenges in capturing IPV data, which has historically been underreported [ 27 ]. IPV reporting has been made especially challenging and unreliable during periods of lockdown in which victims of IPV were confined at home with their perpetrator, having little to no support services, and no ability to report violence to the police [ 28 , 29 ]. While this early data has begun to shine a light on the experiences and perpetration of IPV within South Africa during the pandemic, certain populations have been left out of the conversation including LGBTQ + youth. While South Africa has progressive laws preventing LGBTQ + discrimination and violence and was the first African nation to make homosexuality and gay marriage legal (since 1998 and 2004, respectively), there exist vast disparities between the law and the everyday lived experiences of LGBTQ + individuals in South Africa [ 30 , 31 ]. Moreover, the historical invisibility of IPV within LGBTQ + communities [ 32 , 33 ] likely contributes to a lack of knowledge and awareness of IPV risks and support options [ 5 ], which may be particularly salient for LGBTQ + youth, many of whom are entering their first intimate relationship. Thus, while research around the globe has highlighted the exacerbating effects of the pandemic on existing health inequities, including increased systemic and structural violence towards LGBTQ + communities, it is imperative to characterize and compare experiences of perpetration of IPV during the pandemic across sexual orientation and gender identity (SOGI). The aim of this study is to describe and compare the experiences and perpetration of physical intimate partner violence by SOGI among youth aged 16–24 living in eThekwini district, KwaZulu Natal, South Africa during the COVID-19 pandemic. Methods Study setting AYAZAZI RIGHTS (Rapid Investigation of Gendered Health outcomes in the Time of Sars-Cov-2) took place over six months between December 2021 and May 2022, recruiting youth aged 16–24 from across eThekwini district South Africa. AYAZAZI stems from prior South African adolescent and youth health research[ 34 – 37 ], where AYA stands for adolescents and young adults, and “Zazi” meaning knowing themselves in isiZulu. The city of Durban, situated within eThekwini district, has been criticized their conservative views on LGBTQ + acceptance [ 38 ] and the lack of political response to the high sustained incidents of LGBTQ + hate crimes occurring within and around the city in recent years [ 39 ]. Study Design AYAZAZI RIGHTS was a cross-sectional, on-line health survey which aimed to explore youth experiences of the COVID-19 public health response and impacts on sexual, reproductive, and mental health outcomes. Youth aged 16–24 years, living in the eThekwini district, Durban, South Africa, who could read in English and/or isiZulu and had access to a mobile phone, tablet, or computer that could access the internet were eligible for participation. This study includes all participants who had complete data on gender, sexual orientation, experiences of IPV and all measured confounding factors. To improve accessibility, the survey was delivered to participants via the data-free Moya messenger app which allowed participants to complete the survey without using data from their mobile devices. Recruitment A multi-pronged recruitment strategy was used to enrol participants. Recruitment strategies included contacting and inviting eligible former participants from studies led by WitsMRU who have agreed to be recontacted for other research projects; through the Wits MRU; community-based and youth-led organisations; and Community Advisory Boards (CABs), especially the Adolescent CAB (ACAB) which includes girls from High schools and Tertiary institutions from in and around the Durban area, as well as Senior CAB members of the MRU. Study information was also distributed via flyers in areas highly frequented by youth such as commercial retail settings, transit areas on their way into work or school, and CAB offices. The survey was also advertised online and via e-mails to various local institutions including on the WitsMRU website and social media platforms of multiple community organizations. Participants had also the opportunity to share the link and the QR code of the survey to their eligible peers and family members. To promote the study widely, participants who completed the full mobile survey were eligible to enter a cash prize draw of R100 (CAD $ 8.50). The chances of winning ranged from one in every five to one in every twenty over the enrolment period to support within a limited timeframe. Ethical considerations Ethical approval was provided by the Research Ethics British Columbia (REBC) network and the Office of Research Ethics (ORE) at Simon Fraser University in Canada (REB number: H21-02027), and by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC-Medical) in South Africa (REB number: M210863). Participants were provided with an electronic consent letter, detailing the purpose of the survey, benefits and risk for participation, and key contacts for further question prior to accessing to the questionnaire. A list of resources including online and in-person local support services such as for mental health and sexual and reproductive health care was provided at the end of the questionnaire. Data collection The questionnaire was auto-administered and structured with close-ended questions and one final open-ended question (“To conclude, has the COVID-19 pandemic affected you in any other way you want to tell us about?), with four main sections: demographics; COVID-19 experiences (including COVID-19 vaccine uptake and perceptions, changes in income, work disruptions, access to food and social grants); sexual and reproductive health, care and behaviours; and mental health, care and substance use. Questions include standard, validated scales, previously asked questions for this population in former studies led by WitsMRU, and COVID-19 specific questions adapted from previous surveys such as EMERGE [ 40 ]. The questionnaire was developed in English and translated in isiZulu, with back translation into English to ensure accuracy, and was piloted with community members, research assistants and various experts prior to being launched. Overall, the median time of survey completion was 15 minutes (Interquartile Range [IQR] = 8–26). Participants who completed the whole survey in less than 4.5 minutes were subsequently excluded from the analyses as our team concluded that any amount of time under 4.5 minutes would be insufficient to fully read, understand, and complete the full survey. Other quality assessments were made to identify potential outliers and duplicates, such as screening for very similar final comments, exact same responses in the demographics’ section of the survey, as well as same phone number. Those steps did not lead us to further exclude participants. Data quality was also ensured when developing the survey by adding adequate skip patterns according to participants’ responses (e.g., questions on pregnancy outcomes were only asked for respondents indicating female as their sex assigned at birth). The mobile health survey and associated database were created using REDCap (Research Electronic Data Capture) [ 41 ]. Outcome Variables Physical IPV experiences were captured by asking respondents “Since the start of the COVID-19 pandemic (March 2020) (or since the start of your relationships if after the pandemic began) Has your partner slapped you, hit you, kicked you, thrown things at you, or done anything else to physically hurt you?” (yes vs. no). While physical IPV perpetration was captured by asking respondents “Since the start of the COVID-19 pandemic (March 2020) (or since the start of your relationships if after the pandemic began) Have you slapped, hit, kicked, thrown things at, or done anything else to physically hurt your partner?” (yes vs. no). These measures were similar to other youth-based South African IPV studies[ 42 , 43 ]. Other IPV-related variables of interest For each of the IPV questions, participants were also asked did this occur more often or less often since the COVID-19 pandemic (more often; same; less often). Exposure of interest The exposure of interest in this study was SOGI by asking participants what is your gender identity (1) boy/man; 2) girl/woman; 3) non-binary; 4) I do not identify with any specific gender; 5) Prefer to self-identify; 6) Prefer not to say) and what is your sexual orientation? (1.) Heterosexual/Straight; 2) Lesbian or Gay; 3) Bisexual; 4) I do not identify with any specific sexual orientation; 5) Undecided/Questioning; 6) prefer not to say; or 7) Other, please specify: _____). We combined the above categories to explore SOGI differences in the risk of IPV by compare cisgender and transgender inclusive heterosexual women; heterosexual men; lesbian, gay, bisexual or questioning women (LGBQW), gay, bisexual, or questioning men (GBQM), and any youth identifying as non-binary or that selected that they did not identify with any gender or sexual orientation were categorized as non-conforming. Potential Confounders We adjusted for potential confounding by age (continuous), race (Black; coloured; Indian or Asian or white [ref]), school/employment status (currently in school or employed vs. not in school or employed), relationship status (not in a current relationship [ref]; in a relationship, living together; in a relationship not living together), any children (yes vs. no), and alcohol use frequency during the pandemic (once or twice per week or more; less than monthly or once per month; never). Statistical Analyses Characteristics of the study population were described overall and by SOGI using frequency (%) for categorical variables and means (SD) for numeric variables. Crude associations between SOGI and other socio-demographic characteristics with experiences and perpetration of physical IPV during the pandemic were evaluated using Pearson’s Chi-squared and Fisher’s exact test for categorical variables, and Wilcoxon ranked sum test for continuous variables. Bivariable and multivariable logistic regressions estimated the association between SOGI and (a) experiencing, and (b) perpetrating physical IPV, which was expressed though crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) to provide a measure of precision for the ORs. Heterosexual women were selected as the reference group as they were the group with the largest sample and because they have been the demographic group of interest in IPV research. The multivariable logistic regression models were adjusted for age, race, sex, current school/employment status, relationship status, any children, and alcohol use frequency during the pandemic. We considered ORs with 95% CIs that did not include 1.00 to be statistically significant at the α = 0.05 level. However, in considering public health significance, the magnitude of association was of primary interest in our interpretations, rather than statistical significance. Results Overall, 2694 youth were reached and accessed the online survey. Among them, 303 (11%) did not consent to participate, 142 (6%) participants did not complete the entire survey. Among the 2,249 participants that completed the entire survey, we excluded 154 (7%) who completed it in less than 4.5minutes, leading to a final sample of 2,095. For this analysis, we restricted our sample to participants who had available data on gender, sexual orientation, and IPV leading to a final analytic sample of 1,584, with 1,486 and 1,482 participants with non-missing potential confounding variable data included in the adjusted IPV experiences and perpetration analyses, respectively (see flowchart in Fig. 1 for study selection). [Insert Fig. 1 here] Sample Characteristics Of 1,584 youth (47.9% heterosexual women and 15.0% lesbian, gay, bisexual, questioning, or gender and/or sexual non-conforming youth, mean age = 21.7 [SD = 2.34]) who had valid gender and physical IPV data, 3.5% were GBQM 6.1% were LGBQW, and 5.4% were non-conforming. The majority of respondents were Black (71.7%), in school or currently employed (69.5%), and in a current relationship not living with their partner (77.1%). Compared to the overall sample, a larger proportion of non-conforming youth were Black (88.2%) and in a current relationship, not living with their partner (92.9%), and a small proportion of heterosexual men reported being currently in school or employed (64.9%)(Table 1 a). Table 1 a- Sample characteristics by sexual orientation and gender identity of youth aged 15–24 living in eThekwini District of South Africa during the COVID-19 pandemic (n = 1584) Overall n (%) Heterosexual women n (%) 758 (47.9) Heterosexual man n (%) 587 (37.1) Gay, bisexual, or questioning men n (%) 56 (3.5) Lesbian, gay, bisexual or questioning woman n (%) 97 (6.1) Gender and Sexual Non-conforming youth n (%) 86 (5.4) Characteristics Age mean, SD 21.73 (2.34) 21.74 (2.45) 21.78 (2.31) 21.09 (2.34) 21.30 (2.06) 22.17 (1.63) Race/Ethnicity Black 1080 (71.7) 502 (68.9) 396 (72.4) 41 (78.8) 67 (70.5) 75 (88.2) Coloured 181 (12.0) 86 (11.8) 62 (11.3) <10 (10–15%) 20 (21.1) <10 (5–10%) white, Indian, or Asian 246 (16.3) 141 (19.3) 89 (16.3) <10 (5–10%) 8 (8.4) <5 (1–5%) Unknown 76 Employed and/or in school : Yes 1090 (69.5) 489 (64.9) 423 (73.3) 43 (76.8) 73 (75.3) 63 (73.3) Unknown 14 Relationship Status No relationship 209 (13.3) 96 (12.7) 68 (11.7) 19 (33.9) 22 (22.9) <5 (1–5%) In relationship, living together 151 (9.6) 88 (11.6) 40 (6.9) <10 (5–10%) 14 (14.6) <5 (1–5%) In relationship not living together 1214 (77.1) 572 (75.7) 474 (81.4) 30 (53.6) 60 (62.5) 79 (92.9) Unknown 9 Any Children : Yes 679 (43.1) 382 (50.5) 240 (41.2) 15 (26.8) 37 (38.1) <10 (5–10%) Unknown 6 Alcohol use during the pandemic once or twice per week or more 417 (26.5) 111 (14.7) 209 (35.8) 22 (39.3) 28 (29.2) 48 (55.8) less than monthly or once a month 522 (33.1) 289 (38.3) 171 (29.3) 10 (17.9) 26 (27.1) 26 (30.2) never 636 (40.4) 355 (47.0) 203 (34.8) 24 (42.9) 42 (43.8) 12 (14.0) Unknown 8 Experience of Physical IPV change since before the pandemic (n = 228)^ Same 116 (50.9) 57 (57.0) 37 (49.3) 8 (66.7) <10 (30–35%) <10 (35–40%) Less 99 (43.4) 39 (39.0) 34 (45.3) <5 (15–20%) 11 (57.9) 13 (59.1) More 13 (5.7) <5 (1–5%) <5 (5–10%) <5 (15–20%) <5 (10–15%) <5 (5–10%) ^Only among 228 participants who experienced physical IPV and who reported change in IPV experience since before the COVID-19 pandemic Proportions for small cell sizes < 5 or < 10 were provided as a range to protect anonymity IPV intimate partner violence; SD Standard Deviation Overall, 15.2% of respondents experienced physical IPV, 10.0% perpetrated physical IPV, and 6.5% reported both perpetrating and experiencing physical IPV at some point between the start of the COVID-19 pandemic and their interview date, with 26.2% of non-conforming youth, 25% of GBQM, 20.7% of LGBQW, 14.2% of heterosexual men, and 14.1% of heterosexual women reporting experiencing physical IPV during the pandemic and 17.2% of LGBQW, 16.7% of non-conforming youth, 11.5% of GBQM, 11.4% of heterosexual men, and 7.6% of heterosexual women reporting perpetrating physical IPV during the pandemic (Fig. 2 ). [Insert Fig. 2 here] Of note, all GBQM and non-conforming youth who perpetrated physical IPV during the COVID-19 pandemic also experienced physical IPV during the COVID-19 pandemic. Among the 240 respondents reported experiencing physical IPV during the COVID-19 pandemic, 228 reported on whether the frequency changed during the pandemic, with 13 (5.7%) reported experiencing more physical IPV, 43.4% reporting less, and 50.9% reporting experiencing the same level of physical IPV during the COVID-19 pandemic. Sparse data limited our ability to explore differences in the change of IPV frequency during the pandemic by SOGI (Table 1 b). Table 1 b- Bivariate differences of between youth aged 15–24 living in eThekwini District of South Africa who did and did not experience physical intimate partner violence (n = 1583) and who did and did not perpetrate physical intimate partner (n = 1578) violence during the COVID-19 pandemic Experienced Physical IPV P-value Perpetrated Physical IPV P-value No Yes No Yes Exposure of Interest: Sexual Orientation and Gender Identity 0.005 0.009 Heterosexual women 651 (48.5) 107 (44.6) 697 (49.1) 58 (36.7) Heterosexual men 509 (37.9) 78 (32.5) 521 (36.7) 64 (40.5) Gay, bisexual, or questioning men 43 (3.2) 13 (5.4) 50 (3.5) 6 (3.8) Lesbian, gay, bisexual, or questioning women 76 (5.7) 20 (8.3) 80 (5.6) 16 (10.1) Gender and sexual non-conforming youth 64 (4.8) 22 (9.2) 72 (5.1) 14 (8.9) Potential Confounders Age mean, SD 21.59 (2.42) 22.47 (1.64) < 0.001 21.66 (2.40) 22.32 (1.64) 0.001 Race/Ethnicity < 0.001 < 0.001 Black 918 (72.1) 162 (69.5) 973 (72.1) 103 (67.3) Coloured 131 (10.3) 50 (21.5) 141 (10.5) 40 (26.1) white, Indian, or Asian 225 (17.7) 21 (9.0) 235 (17.4) 10 (6.5) Unknown 69 7 71 5 Employed and/or in school : Yes 937 (70.5) 153 (64.0) 0.056 988 (70.2) 100 (64.1) 0.141 Unknown 13 < 5 12 < 5 Relationship Status < 0.001 < 0.001 No relationship 165 (12.4) 44 (18.4) 172 (12.2) 34 (21.7) In relationship, living together 99 (7.4) 52 (21.8) 116 (8.2) 35 (22.3) In relationship not living together 1071 (80.2) 143 (59.8) 1124 (79.6) 88 (56.1) Unknown 8 < 5 8 < 5 Any Children : Yes 544 (40.7) 135 (56.5) < 0.001 587 (41.5) 91 (58.0) < 0.001 Unknown 5 < 5 5 < 5 Alcohol use during the pandemic < 0.001 < 0.001 once or twice per week or more 319 (23.9) 98 (40.8) 341 (24.1) 75 (47.5) less than monthly or once a month 473 (35.4) 49 (20.4) 501 (35.5) 21 (13.3) never 543 (40.7) 93 (38.8) 571 (40.4) 62 (39.2) Unknown 8 0 7 0 Proportions for small cell sizes < 5 or < 10 were provided as a range to protect anonymity Table 2 presents unadjusted ORs and adjusted ORs (aORs) for the estimated associations between SOGI and experiences of physical IPV and for perpetration of physical IPV, respectively, during the pandemic. In unadjusted analyses, compared to heterosexual women, GBQM (adjusted odds ratio [aOR] = 2.03; 95%CI, 1.05–3.93) and non-conforming youth (aOR = 2.16; 1.27–3.66) had greater odds of experiencing physical IPV during the pandemic. After adjusting for potential confounders, non-conforming youth remained at greater odds of physical IPV (vs. heterosexual women, aOR = 2.73; 95%CI, 1.47–5.06). In both unadjusted and adjusted analyses, compared to heterosexual women, heterosexual men (aOR = 1.55; 95%CI, 1.01–2.37), LGBQW (aOR = 2.09; 95%CI, 1.06–4.09), and non-conforming youth (aOR = 3.02; 95%CI, 1.42–6.41) all had greater odds of perpetrating physical IPV during the pandemic. Table 2 unadjusted and adjusted association between sexual orientation and gender identity and 1. Experiencing physical IPV (n = 1,486) and 2. Perpetrating physical IPV (n = 1,482) Experiencing Physical IPV Perpetrating Physical IPV Unadjusted Odds Ratio (95%CI) Adjusted Odds Ratio (95%CI) Unadjusted Odds Ratio (95%CI) Adjusted Odds Ratio (95%CI) Sexual Orientation and Gender Identity Heterosexual women Ref Ref Ref Ref Heterosexual men 1.00 (0.73–1.38) 1.01 (0.71–1.44) 1.56 (1.06–2.29) 1.55 (1.01–2.37) Gay, bisexual, or questioning men 2.03 (1.05–3.93) 1.90 (0.92–3.93) 1.58 (0.64–3.86) 1.21 (0.47–3.15) Lesbian, gay, bisexual or questioning women 1.58 (0.92–2.73) 1.44 (0.79–2.62) 2.55 (1.39–4.66) 2.09 (1.06–4.09) Gender non-conforming youth 2.16 (1.27–3.66) 2.73 (1.47–5.06) 2.42 (1.28–4.57) 3.02 (1.42–6.41) Models adjusted for age, race/ethnicity, having any children, school/employment status, relationship status, and alcohol frequency during the pandemic Discussion This study presents differences in experiences and perpetration of physical IPV faced by youth residing in eThekwini district of South Africa during the COVID-19 pandemic across gender and sexual orientation. Despite a large proportion of youth experiencing violence during the pandemic reporting that this was less than pre-pandemic times, our results indicated that over one in 6 youth aged 16 to 24 experienced and one in 10 perpetrated physical IPV during the pandemic. We found that gender and sexual non-conforming youth experienced 2.7 times the odds of physical IPV than heterosexual women. Consistent with the literature heterosexual men had 1.5 times the odds of perpetrating IPV than heterosexual women [ 21 , 44 ]. Novel findings from our study include two-times and three-times the odds, of LGBQW and non-conforming youth, respectively, perpetrating IPV than heterosexual women. Across SOGI there was considerable overlap between physical IPV perpetration and experiences. Findings from our study corroborate global research demonstrating the high levels of experiences and perpetration of IPV within LGBTQ + relationships [ 45 – 47 ]. Given the focus and efforts put towards preventing heterosexual women from experiences of IPV, and supporting those who do experience IPV, in South Africa[ 14 , 48 – 51 ], our results demonstrating similar or lower levels of physical IPV experiences among heterosexual women were unexpected. Contrary to other studies conducted in South Africa highlighting the disproportionate levels of IPV experiences among woman compared to men [ 21 ], our study found that heterosexual young women and men experienced similar rates of physical IPV in their relationships. Our results do align with prior research among Kenyan adults [ 52 ] and youth in Tanzania [ 44 ] showing higher but similar levels of recent and lifetime IPV experiences and perpetration among women and men. High levels of both experiencing and perpetrating violence among men and women in heterosexual relationships has been previously reported among adults in Kenya, with a 2022 study showing that 23% of women and 18% of men experienced physical violence in their relationship in the 12 months prior to being interviewed [ 52 ]. The same study showed that IPV perpetration was higher among those also reporting experiencing IPV among both women and men [ 52 ]. Our data further adds to these findings that did not explore experiences and perpetration of IPV in non-heterosexual relationships, demonstrating that queer and gender non-conforming youth face and perpetrate IPV at higher levels than their heterosexual peers, apart from gay, bisexual, and questioning men who perpetrated the lowest levels of IPV in their relationships. Our data aligns with global research highlighting elevated levels of IPV experiences within LGBTQ + relationships. For example, in the US CDC’s National Intimate Partner and Sexual Violence Survey (NIPSVS), 44% of lesbians and 61% of bisexual women experience rape, physical violence, or stalking by an intimate partner, compared to 35% of straight women [ 53 ]. Bisexual women had significantly higher lifetime prevalence of rape, physical violence, and/or stalking by an intimate partner when compared to both lesbian and heterosexual women, while on the other hand lesbian women and gay men reported levels of IPV and sexual violence equal to or higher than those of heterosexuals [ 54 ]. A systematic review of 52 global studies of IPV within gay, bisexual, and other men who have sex with men found a pooled prevalence of physical IPV experiences at 17% and perpetration 12% perpetration [ 55 ]. These global levels align with reporting among GBQM in our study of whom 25% experienced and 11% perpetrated physical IPV over the course of the pandemic. These data reveal a growing concern and documentation of experiences in the LGBTQ + community, and a need to focus IPV prevention and supports for LGBTQ + youth. Levels of experiences and perpetration of physical IPV among youth aged 16–24 years in our study was higher than lifetime experiences of physical IPV reported by women of all ages in KwaZulu Natal (15.0% vs. 13.7%) and prior reports of physical IPV perpetration among young women aged 15–24 years across South Africa (10.0% vs. 4.6%)[ 14 ]. However, these data are difficult to compare as we explored experiences and perpetration across all genders and sexual orientations and our sample was limited to youth living in eThekwini District. In our study, 65% of youth reporting perpetrating physical IPV had also experienced physical IPV, with 100% of non-conforming youth and lesbian and bisexual young women who perpetrated physical IPV also having had experienced physical IPV. Higher perpetration among individuals who are survivors of violence is well documented in the literature globally and sub-Saharan Africa, which may be particularly prevalent in LGBTQ + relationships[ 56 , 57 ]. For example, previous research among gay, bisexual, and other men who have sex with men in South Africa and Namibia found that 7.3% of men had experienced IPV from their partners and 10.2% reported experiencing bi-directional violence in the 12 months prior to being surveyed. Multiple interacting factors are likely driving the elevated rates of IPV among LBGTQ + youth observed in our study. These may include individual-levels factors including internalized stigmas or homophobia, as well as minority stress, which might result in higher levels of violent behaviour towards in-group members, including one’s partner [ 58 – 60 ]. While South Africa has one of the most progressive laws and policies promoting LGBTQ + rights and protections [ 30 ], LGBTQ + discrimination across the country is still widespread and this includes discrimination and violence from intimate partner [ 61 ]. There is a dearth of research exploring the impact of the COVID-19 pandemic on the sexual and reproductive health outcomes inclusive of IPV of LGBTQ + youth [ 62 ], especially within low-and-middle income countries. While rates of IPV during the pandemic were high, reports of increased frequency during this period were extremely low, which is promising. Reduced rates may have been due to limited contact between partners during lockdown periods. Reduced experiences may have also been impacted by South Africa’s alcohol ban, which did result in reductions in violence and trauma unit admissions for alcohol-related injuries [ 63 , 64 ]. Despite these reductions in experiences of physical IPV reported during the pandemic, our results signal a critical need for efforts to move beyond focusing on supporting and preventing IPV within heterosexual relationships to address high levels of experiences and perpetration faced by LGBTQ + youth in South Africa and globally. Efforts should include exploring how gender transformative efforts, such as SASA! and Stepping Stones Creating Futures, which have shown promise in reducing IPV experiences [ 65 , 66 ] and perpetration [ 67 ] within heterosexual relationships in South Africa can be adapted to address IPV in LGBTQ + relationships. Gender transformative efforts aim to move beyond individual-level efforts to address societal and community-level power and gender inequities to transform gender norms that perpetuate violence, especially IPV [ 68 ]. While these efforts have shown promise among women and men, by working to address inequitable gender norms and relations, there is limited understanding into how the success of these programs could expand to include individuals of all genders in non-heterosexual relationships. Current interventions aimed at preventing IPV are framed within heteronormative notions that women are passive victims of violence and men are perpetrators. Narrow conceptualizations of gender as binary, exclude individuals who do not conform to these narrow categories. Thus, leaving few to no options for support within these communities. This is concerning as our study found that non-conforming youth were both more likely to experience as well as perpetrate physical IPV. Efforts are needed to address experiences of IPV that are not solely focused on unidirectional IPV perpetrated by men towards women in heterosexual relationships. This should include efforts to better understand and seek to prevent and support bilateral IPV that might be occurring at higher rates among gender and sexual non-conforming and young queer women’s relationships. Strengths and limitations of this study While much research has centered on youth, gender, and violence in the context of HIV in South Africa, most studies have been underpowered or lack data on experiences of LGBTQ + youth. We were able to explore experiences and perpetration of IPV across sexual orientation and gender identity. However, our results also present several limitations of note. To limit missing data and questionnaire fatigue from the mobile health survey, we restricted the survey to take an average of 15 minutes to complete. This limited our ability to ask detailed questions about youth’s relationships and the context of the relationship and violence experienced and perpetrated. As such, findings demonstrating that physical IPV was reported as happening less than prior to the pandemic should be taken with caution. Moreover, the study was cross-sectional, and the low reporting of changes to experiences of IPV before and after the pandemic limits our ability to make inferences about the extent to which individuals experiences were due to the COVID-19 pandemic, if these experiences were new, and relationship dynamics pre/post-COVID (e.g., length of relationship, gender and age of partner, if violence was being experienced/perpetrated by multiple or a single partner). We also did not ask about when during the pandemic the violence happened, which at the time of the survey was ~ 2 years since the public health emergency was declared, thus limiting comparability with other studies measuring IPV in the last 12 months or lifetime experiences. Missing data on IPV was likely influenced by respondents’ relationship experiences that were not captured through skip patterns in the survey due to the limited scape of the survey. Given the sensitive nature of these data the results may have been influenced by social desirability bias. However, our study design with data being collected completely anonymously via a mobile survey may have reduced this bias. Conclusion Across gender identity and sexual orientation our results highlight that gender non-conforming youth report both experiencing and perpetrating IPV at significantly higher levels than their heterosexual peers, with over one-quarter of non-conforming youth having experienced physical IPV during the pandemic. During the first two years of the COVID-19 pandemic, young heterosexual women reported IPV levels similar to young men and lower IPV levels than queer men, queer women, and non-conforming youth. Our findings signal a critical need for research to better understand experiences and consequences of IPV within the relationships of LGBTQ + youth. Efforts need to move beyond the gender binary to address and create programming that works to prevent and support young people of diverse genders and sexual orientations in forming and experiencing healthy relationship dynamics free of violence in South Africa and globally. Declarations Ethics approval and consent to participate Participants were provided with an electronic consent letter, detailing the purpose of the survey, benefits and risk for participation, and key contacts for further question prior to accessing to the questionnaire. A list of resources including online and in-person local support services such as for mental health and sexual and reproductive health care was provided at the end of the questionnaire. Ethical approval was provided by the Research Ethics British Columbia (REBC) network and the Office of Research Ethics (ORE) at Simon Fraser University in Canada (REB number: H21-02027), and by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC-Medical) in South Africa (REB number: M210863). All study methods were performed in accordance with relevant guidelines and regulations. Consent for publication Not applicable Availability of data and materials The de-identified data cannot be publicly shared as we do not have community or REB approval to do so. For researchers or trainees wishing to access the data, please contact Dr. Angela Kaida to request access. Competing Interests The authors declare that they have no competing interests Funding AYAZAZI RIGHTS is funded by the Centre for International Child Health (CICH) Catalyst Grant, with support from the British Columbia Children’s Hospital Foundation, Canada. KC is supported by a CIHR Banting Postdoctoral Fellowship. The work reported herein for JJD was made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Postdoctoral Programme from funding received from the South African National Treasury as well as the CIPHER GROWING THE LEADERS OF TOMORROW grant from the International AIDS Society. The authors received no funding to produce this manuscript as it is part of the first author’s dissertation research. Author’s contributions K.C., B.Z., J.J., T.P., J.J.D., M.B., and A.K. were involved in the conception and design of the study. A.K., J.J.D., MB, K.C., and J.J secured funding for this study. B.Z. led recruitment and the development of the questionnaire tool. K.C. analyzed the data with support from C.A.B. K.C. drafted the original manuscript and was responsible for the final submission. 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Cite Share Download PDF Status: Published Journal Publication published 21 Nov, 2023 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Major revision 02 Oct, 2023 Reviews received at journal 22 Sep, 2023 Reviewers agreed at journal 11 Sep, 2023 Reviews received at journal 19 Aug, 2023 Reviewers agreed at journal 08 Aug, 2023 Reviewers agreed at journal 07 Aug, 2023 Reviewers agreed at journal 10 Jul, 2023 Reviewers agreed at journal 10 Jul, 2023 Reviewers invited by journal 13 Jun, 2023 Editor assigned by journal 06 Jun, 2023 Editor invited by journal 30 Dec, 2022 Submission checks completed at journal 30 Dec, 2022 First submitted to journal 21 Dec, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2403223","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":163898982,"identity":"edc24a05-52c3-4bfa-8612-01875980bad4","order_by":0,"name":"Kalysha Closson","email":"","orcid":"","institution":"Simon Fraser University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kalysha","middleName":"","lastName":"Closson","suffix":""},{"id":163898983,"identity":"66f5ca2d-8439-4827-be7b-e378fac84d46","order_by":1,"name":"Bongiwe Zulu","email":"","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bongiwe","middleName":"","lastName":"Zulu","suffix":""},{"id":163898984,"identity":"d491a354-c072-4af7-8b59-041b33220f28","order_by":2,"name":"Julie Jesson","email":"","orcid":"","institution":"Simon Fraser University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Julie","middleName":"","lastName":"Jesson","suffix":""},{"id":163898986,"identity":"dd8f50f3-0b42-41a3-abd5-ad05b15a5fd6","order_by":3,"name":"Janan J. Dietrich","email":"","orcid":"","institution":"Perinatal HIV Research Unit","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Janan","middleName":"J.","lastName":"Dietrich","suffix":""},{"id":163898988,"identity":"2f1cb791-0d44-44ab-824c-50c2f7e703a9","order_by":4,"name":"Tatiana Pakhomova","email":"","orcid":"","institution":"Simon Fraser University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tatiana","middleName":"","lastName":"Pakhomova","suffix":""},{"id":163898990,"identity":"4ab56fd5-27ac-49e7-861b-e3dc82a40fbc","order_by":5,"name":"C. Andrew Basham","email":"","orcid":"","institution":"Brigham and Women's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"C.","middleName":"Andrew","lastName":"Basham","suffix":""},{"id":163898992,"identity":"21b14adf-8224-461e-b769-432472fe2ade","order_by":6,"name":"Mags Beksinska","email":"","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mags","middleName":"","lastName":"Beksinska","suffix":""},{"id":163898994,"identity":"6cc625bb-ea0e-4042-bd0c-9fe71a878729","order_by":7,"name":"Angela Kaida","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYLCCBwwMBgzMQPyBQY5ILQlQLYwzGIxJ0QLEzDzEaOGf3X7xQUINgzF/O/PGzzZ/DBIb2A8/wKtF4s6ZYoOEYwxmEofZiqVz24BaeNIM8FtzIydNIoGNwYbhMI+BdG7Dn8QGCQb8WuRv5KT/SPjHYCN/mMf4twXIYRLsH/BqMbiRfowhsY3BzOAwj5k0AxtICw9+Wwxv5DBLJPYxGBseZiuz7G0zMG7jySnAq0XuRvrDDx++MRjOO394840ffwxk+9mPb8CrhYEB7Iz/CD4bAfVAwP6AsJpRMApGwSgY2QAAUIJD9qImx3YAAAAASUVORK5CYII=","orcid":"","institution":"Simon Fraser University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Angela","middleName":"","lastName":"Kaida","suffix":""}],"badges":[],"createdAt":"2022-12-22 01:59:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2403223/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2403223/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-023-17199-x","type":"published","date":"2023-11-21T15:01:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":31118388,"identity":"07f83a57-02b0-4eef-880c-35b7fd4a5941","added_by":"auto","created_at":"2023-01-04 19:00:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":117969,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of analytic sample of youth aged 16-24 living in eThekwini District, South Africa included in this study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2403223/v1/2556f1172792fc5c21077abe.png"},{"id":31119362,"identity":"b7bfdcf6-974d-4f5c-8141-83706657efa1","added_by":"auto","created_at":"2023-01-04 19:08:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54349,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of youth living in eThekwini District of South Africa who experienced (left) or perpetrated (right) physical intimate partner violence over the course of the COVID -19 pandemic (March 2020 to interview date [January to May 2022] or since their relationship started if after March 2020\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2403223/v1/2a6d069f2b5edaaf59b91612.png"},{"id":47146374,"identity":"805852f7-b889-41f2-9e42-bca52e9331ae","added_by":"auto","created_at":"2023-11-27 15:07:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2314619,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2403223/v1/6b77e7f2-4f30-4475-9f09-68b140d398cc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver one in four women who have ever been in a relationship will experience some form of intimate partner violence (IPV) in their lifetime. Experiences of IPV begin at an early age, with past year IPV being higher among women aged 15\u0026ndash;24 years than any other age group [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While global estimates of IPV perpetration by men are limited, perpetration in select populations including military populations (26%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and youth in disadvantaged communities in Johannesburg, South Africa (40%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]are similarly high or higher than global estimates of IPV experiences. Given that IPV perpetration by men directed at women in heterosexual relationships may be the most common pattern of IPV, with potentially the greatest health consequences, the vast majority of studies have focused on experiences and perpetration of IPV in heterosexual relationships. However, IPV perpetration by women as well as perpetration and experiences within non-heterosexual relationships have also been reported [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A recent review reported that IPV experiences and perpetration within non-heterosexual relationships happen at rates comparable to heterosexual relationships [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, studies involving non-heterosexual participants have primarily explored IPV experiences within the relationships of gay and bisexual men leaving gaps in the literature and understanding about IPV among LGBTQ\u0026thinsp;+\u0026thinsp;communities.\u003c/p\u003e \u003cp\u003eAcross the globe, there is growing evidence that the COVID-19 pandemic and the subsequent public health response to \u0026ldquo;stay home\u0026rdquo; through legally enforced and self-imposed social distancing, fueled environments in which IPV could thrive [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These environments included the increase of situational stressors related to the COVID-19 pandemic, such as economic stress, social isolation, and pandemic-related stress [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While evidence suggests that LGBTQ\u0026thinsp;+\u0026thinsp;communities, who are frequently subjected to social stigma and minority stress[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], may have faced additional challenges with mental health and experiences of discrimination and violence amidst the global lockdown [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], limited research has explored other inequities faced by this important population during the pandemic. As the onset of IPV often begins in adolescence and early adulthood, and in turn increases the risk of violence victimization and perpetration into adulthood, it is critical that research efforts focus on mitigating experiences and perpetration of IPV in this population. Thus, while recent research is highlighting the added risk and experiences of IPV during the pandemic, the experiences of youth, the majority of whom are or were non-cohabitating during the pandemic are less understood [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn South Africa, rates of IPV were at critical levels pre-pandemic, with 21% of women experiencing physical IPV in their lives [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. For over two decades, gender-based violence, including IPV and femicide, has been highly publicized in the South African media [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] with large scale governmental campaigns being launched across the country to end violence against women, including the 16 days of activism and the Presidential Summit on Gender-Based Violence and Femicide [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Much prior work has documented high rates of both experiencing IPV and perpetrating IPV across multiple settings and populations in South Africa [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Within sub-Saharan African settings of high sustained IPV, including South Africa, much research has explored the drivers and factors associated with IPV experiences and perpetration. Education, employment, and having children are drivers of IPV experiences [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], while alcohol use[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; experiences of violence during childhood, or witnessing violence in childhood being significant drivers of IPV perpetration [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For this reason at the onset of the COVID-19 pandemic, and when the South African President called a national lockdown in March 2020, there was serious concern that mounting rates of IPV faced by women across the globe during the pandemic would result in an increase in IPV and IPV-related crime South Africa [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Early reporting from the South African Police Service (SAPS) suggested that reports of IPV in South Africa actually decreased by up to 68% from prior pandemic reporting periods [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] yet domestic abuse hotlines utilization was reported to have increased by 65\u0026ndash;100% during the initial lockdown [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These data highlight the challenges in capturing IPV data, which has historically been underreported [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. IPV reporting has been made especially challenging and unreliable during periods of lockdown in which victims of IPV were confined at home with their perpetrator, having little to no support services, and no ability to report violence to the police [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile this early data has begun to shine a light on the experiences and perpetration of IPV within South Africa during the pandemic, certain populations have been left out of the conversation including LGBTQ\u0026thinsp;+\u0026thinsp;youth. While South Africa has progressive laws preventing LGBTQ\u0026thinsp;+\u0026thinsp;discrimination and violence and was the first African nation to make homosexuality and gay marriage legal (since 1998 and 2004, respectively), there exist vast disparities between the law and the everyday lived experiences of LGBTQ\u0026thinsp;+\u0026thinsp;individuals in South Africa [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Moreover, the historical invisibility of IPV within LGBTQ\u0026thinsp;+\u0026thinsp;communities [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] likely contributes to a lack of knowledge and awareness of IPV risks and support options [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which may be particularly salient for LGBTQ\u0026thinsp;+\u0026thinsp;youth, many of whom are entering their first intimate relationship. Thus, while research around the globe has highlighted the exacerbating effects of the pandemic on existing health inequities, including increased systemic and structural violence towards LGBTQ\u0026thinsp;+\u0026thinsp;communities, it is imperative to characterize and compare experiences of perpetration of IPV during the pandemic across sexual orientation and gender identity (SOGI).\u003c/p\u003e \u003cp\u003eThe aim of this study is to describe and compare the experiences and perpetration of physical intimate partner violence by SOGI among youth aged 16\u0026ndash;24 living in eThekwini district, KwaZulu Natal, South Africa during the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eStudy setting\u003c/h2\u003e\n \u003cp\u003eAYAZAZI RIGHTS (Rapid Investigation of Gendered Health outcomes in the Time of Sars-Cov-2) took place over six months between December 2021 and May 2022, recruiting youth aged 16\u0026ndash;24 from across eThekwini district South Africa. AYAZAZI stems from prior South African adolescent and youth health research[\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e], where AYA stands for adolescents and young adults, and \u0026ldquo;Zazi\u0026rdquo; meaning knowing themselves in isiZulu. The city of Durban, situated within eThekwini district, has been criticized their conservative views on LGBTQ\u0026thinsp;+\u0026thinsp;acceptance [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e] and the lack of political response to the high sustained incidents of LGBTQ\u0026thinsp;+\u0026thinsp;hate crimes occurring within and around the city in recent years [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec4\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cp\u003eAYAZAZI RIGHTS was a cross-sectional, on-line health survey which aimed to explore youth experiences of the COVID-19 public health response and impacts on sexual, reproductive, and mental health outcomes. Youth aged 16\u0026ndash;24 years, living in the eThekwini district, Durban, South Africa, who could read in English and/or isiZulu and had access to a mobile phone, tablet, or computer that could access the internet were eligible for participation. This study includes all participants who had complete data on gender, sexual orientation, experiences of IPV and all measured confounding factors. To improve accessibility, the survey was delivered to participants via the data-free Moya messenger app which allowed participants to complete the survey without using data from their mobile devices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec5\"\u003e\n \u003ch2\u003eRecruitment\u003c/h2\u003e\n \u003cp\u003eA multi-pronged recruitment strategy was used to enrol participants. Recruitment strategies included contacting and inviting eligible former participants from studies led by WitsMRU who have agreed to be recontacted for other research projects; through the Wits MRU; community-based and youth-led organisations; and Community Advisory Boards (CABs), especially the Adolescent CAB (ACAB) which includes girls from High schools and Tertiary institutions from in and around the Durban area, as well as Senior CAB members of the MRU. Study information was also distributed via flyers in areas highly frequented by youth such as commercial retail settings, transit areas on their way into work or school, and CAB offices. The survey was also advertised online and via e-mails to various local institutions including on the WitsMRU website and social media platforms of multiple community organizations. Participants had also the opportunity to share the link and the QR code of the survey to their eligible peers and family members.\u003c/p\u003e\n \u003cp\u003eTo promote the study widely, participants who completed the full mobile survey were eligible to enter a cash prize draw of R100 (CAD\u003cspan\u003e$\u003c/span\u003e 8.50). The chances of winning ranged from one in every five to one in every twenty over the enrolment period to support within a limited timeframe.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec6\"\u003e\n \u003ch2\u003eEthical considerations\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003ewas provided by the Research Ethics British Columbia (REBC) network and the Office of Research Ethics (ORE) at Simon Fraser University in Canada (REB number: H21-02027), and by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC-Medical) in South Africa (REB number: M210863). Participants were provided with an electronic consent letter, detailing the purpose of the survey, benefits and risk for participation, and key contacts for further question prior to accessing to the questionnaire. A list of resources including online and in-person local support services such as for mental health and sexual and reproductive health care was provided at the end of the questionnaire.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003eData collection\u003c/h2\u003e\n \u003cp\u003eThe questionnaire was auto-administered and structured with close-ended questions and one final open-ended question (\u0026ldquo;To conclude, has the COVID-19 pandemic affected you in any other way you want to tell us about?), with four main sections: demographics; COVID-19 experiences (including COVID-19 vaccine uptake and perceptions, changes in income, work disruptions, access to food and social grants); sexual and reproductive health, care and behaviours; and mental health, care and substance use. Questions include standard, validated scales, previously asked questions for this population in former studies led by WitsMRU, and COVID-19 specific questions adapted from previous surveys such as EMERGE [\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eThe questionnaire was developed in English and translated in isiZulu, with back translation into English to ensure accuracy, and was piloted with community members, research assistants and various experts prior to being launched. Overall, the median time of survey completion was 15 minutes (Interquartile Range [IQR]\u0026thinsp;=\u0026thinsp;8\u0026ndash;26). Participants who completed the whole survey in less than 4.5 minutes were subsequently excluded from the analyses as our team concluded that any amount of time under 4.5 minutes would be insufficient to fully read, understand, and complete the full survey. Other quality assessments were made to identify potential outliers and duplicates, such as screening for very similar final comments, exact same responses in the demographics\u0026rsquo; section of the survey, as well as same phone number. Those steps did not lead us to further exclude participants. Data quality was also ensured when developing the survey by adding adequate skip patterns according to participants\u0026rsquo; responses (e.g., questions on pregnancy outcomes were only asked for respondents indicating female as their sex assigned at birth). The mobile health survey and associated database were created using REDCap (Research Electronic Data Capture) [\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eOutcome Variables\u003c/h2\u003e\n \u003cp\u003ePhysical IPV experiences were captured by asking respondents \u0026ldquo;Since the start of the COVID-19 pandemic (March 2020) (or since the start of your relationships if after the pandemic began) Has your partner slapped you, hit you, kicked you, thrown things at you, or done anything else to physically hurt you?\u0026rdquo; (yes vs. no). While physical IPV perpetration was captured by asking respondents \u0026ldquo;Since the start of the COVID-19 pandemic (March 2020) (or since the start of your relationships if after the pandemic began) Have you slapped, hit, kicked, thrown things at, or done anything else to physically hurt your partner?\u0026rdquo; (yes vs. no). These measures were similar to other youth-based South African IPV studies[\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\n \u003cdiv class=\"Section3\" id=\"Sec9\"\u003e\n \u003ch2\u003eOther IPV-related variables of interest\u003c/h2\u003e\n \u003cp\u003eFor each of the IPV questions, participants were also asked did this occur more often or less often since the COVID-19 pandemic (more often; same; less often).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003eExposure of interest\u003c/h2\u003e\n \u003cp\u003eThe exposure of interest in this study was SOGI by asking participants what is your gender identity (1) boy/man; 2) girl/woman; 3) non-binary; 4) I do not identify with any specific gender; 5) Prefer to self-identify; 6) Prefer not to say) and what is your sexual orientation? (1.) Heterosexual/Straight; 2) Lesbian or Gay; 3) Bisexual; 4) I do not identify with any specific sexual orientation; 5) Undecided/Questioning; 6) prefer not to say; or 7) Other, please specify: _____). We combined the above categories to explore SOGI differences in the risk of IPV by compare cisgender and transgender inclusive heterosexual women; heterosexual men; lesbian, gay, bisexual or questioning women (LGBQW), gay, bisexual, or questioning men (GBQM), and any youth identifying as non-binary or that selected that they did not identify with any gender or sexual orientation were categorized as non-conforming.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003ePotential Confounders\u003c/h2\u003e\n \u003cp\u003eWe adjusted for potential confounding by age (continuous), race (Black; coloured; Indian or Asian or white [ref]), school/employment status (currently in school or employed vs. not in school or employed), relationship status (not in a current relationship [ref]; in a relationship, living together; in a relationship not living together), any children (yes vs. no), and alcohol use frequency during the pandemic (once or twice per week or more; less than monthly or once per month; never).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec12\"\u003e\n \u003ch2\u003eStatistical Analyses\u003c/h2\u003e\n \u003cp\u003eCharacteristics of the study population were described overall and by SOGI using frequency (%) for categorical variables and means (SD) for numeric variables. Crude associations between SOGI and other socio-demographic characteristics with experiences and perpetration of physical IPV during the pandemic were evaluated using Pearson\u0026rsquo;s Chi-squared and Fisher\u0026rsquo;s exact test for categorical variables, and Wilcoxon ranked sum test for continuous variables. Bivariable and multivariable logistic regressions estimated the association between SOGI and (a) experiencing, and (b) perpetrating physical IPV, which was expressed though crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) to provide a measure of precision for the ORs. Heterosexual women were selected as the reference group as they were the group with the largest sample and because they have been the demographic group of interest in IPV research. The multivariable logistic regression models were adjusted for age, race, sex, current school/employment status, relationship status, any children, and alcohol use frequency during the pandemic. We considered ORs with 95% CIs that did not include 1.00 to be statistically significant at the \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05 level. However, in considering public health significance, the magnitude of association was of primary interest in our interpretations, rather than statistical significance.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, 2694 youth were reached and accessed the online survey. Among them, 303 (11%) did not consent to participate, 142 (6%) participants did not complete the entire survey. Among the 2,249 participants that completed the entire survey, we excluded 154 (7%) who completed it in less than 4.5minutes, leading to a final sample of 2,095. For this analysis, we restricted our sample to participants who had available data on gender, sexual orientation, and IPV leading to a final analytic sample of 1,584, with 1,486 and 1,482 participants with non-missing potential confounding variable data included in the adjusted IPV experiences and perpetration analyses, respectively (see flowchart in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for study selection).\u003c/p\u003e\n\u003cp\u003e[Insert Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec14\"\u003e\n \u003ch2\u003eSample Characteristics\u003c/h2\u003e\n \u003cp\u003eOf 1,584 youth (47.9% heterosexual women and 15.0% lesbian, gay, bisexual, questioning, or gender and/or sexual non-conforming youth, mean age\u0026thinsp;=\u0026thinsp;21.7 [SD\u0026thinsp;=\u0026thinsp;2.34]) who had valid gender and physical IPV data, 3.5% were GBQM 6.1% were LGBQW, and 5.4% were non-conforming. The majority of respondents were Black (71.7%), in school or currently employed (69.5%), and in a current relationship not living with their partner (77.1%). Compared to the overall sample, a larger proportion of non-conforming youth were Black (88.2%) and in a current relationship, not living with their partner (92.9%), and a small proportion of heterosexual men reported being currently in school or employed (64.9%)(Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea).\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ea- Sample characteristics by sexual orientation and gender identity of youth aged 15\u0026ndash;24 living in eThekwini District of South Africa during the COVID-19 pandemic (n\u0026thinsp;=\u0026thinsp;1584)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHeterosexual women\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003cp\u003e758 (47.9)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHeterosexual man\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003cp\u003e587 (37.1)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGay, bisexual, or questioning men\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003cp\u003e56 (3.5)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLesbian, gay, bisexual or questioning woman\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003cp\u003e97 (6.1)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender and Sexual Non-conforming youth\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003cp\u003e86 (5.4)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge mean, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.73 (2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.74 (2.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.78 (2.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.09 (2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.30 (2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.17 (1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/Ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1080 (71.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e502 (68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e396 (72.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eColoured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e181 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (10\u0026ndash;15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (5\u0026ndash;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewhite, Indian, or Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e246 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (5\u0026ndash;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (1\u0026ndash;5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed and/or in school\u003c/strong\u003e: Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1090 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e489 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e423 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (76.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (75.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (1\u0026ndash;5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn relationship, living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e151 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (5\u0026ndash;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (1\u0026ndash;5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn relationship not living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1214 (77.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e572 (75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e474 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny Children\u003c/strong\u003e: Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e679 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e382 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e240 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (5\u0026ndash;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use during the pandemic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eonce or twice per week or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e417 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eless than monthly or once a month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e522 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e289 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e636 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e355 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e203 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperience of Physical IPV change since before the pandemic (n\u0026thinsp;=\u0026thinsp;228)^\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSame\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (30\u0026ndash;35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10 (35\u0026ndash;40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (15\u0026ndash;20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (1\u0026ndash;5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (5\u0026ndash;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (15\u0026ndash;20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (10\u0026ndash;15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;5 (5\u0026ndash;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e^Only among 228 participants who experienced physical IPV and who reported change in IPV experience since before the COVID-19 pandemic\u003c/p\u003e\n \u003cp\u003eProportions for small cell sizes\u0026thinsp;\u0026lt;\u0026thinsp;5 or \u0026lt;\u0026thinsp;10 were provided as a range to protect anonymity\u003c/p\u003e\n \u003cp\u003eIPV intimate partner violence; SD Standard Deviation\u003c/p\u003e\n \u003cp\u003eOverall, 15.2% of respondents experienced physical IPV, 10.0% perpetrated physical IPV, and 6.5% reported both perpetrating and experiencing physical IPV at some point between the start of the COVID-19 pandemic and their interview date, with 26.2% of non-conforming youth, 25% of GBQM, 20.7% of LGBQW, 14.2% of heterosexual men, and 14.1% of heterosexual women reporting experiencing physical IPV during the pandemic and 17.2% of LGBQW, 16.7% of non-conforming youth, 11.5% of GBQM, 11.4% of heterosexual men, and 7.6% of heterosexual women reporting perpetrating physical IPV during the pandemic (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e[Insert Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/p\u003e\n \u003cp\u003eOf note, all GBQM and non-conforming youth who perpetrated physical IPV during the COVID-19 pandemic also experienced physical IPV during the COVID-19 pandemic. Among the 240 respondents reported experiencing physical IPV during the COVID-19 pandemic, 228 reported on whether the frequency changed during the pandemic, with 13 (5.7%) reported experiencing more physical IPV, 43.4% reporting less, and 50.9% reporting experiencing the same level of physical IPV during the COVID-19 pandemic. Sparse data limited our ability to explore differences in the change of IPV frequency during the pandemic by SOGI (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eb).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eb- Bivariate differences of between youth aged 15\u0026ndash;24 living in eThekwini District of South Africa who did and did not experience physical intimate partner violence (n\u0026thinsp;=\u0026thinsp;1583) and who did and did not perpetrate physical intimate partner (n\u0026thinsp;=\u0026thinsp;1578) violence during the COVID-19 pandemic\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eExperienced Physical IPV\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePerpetrated Physical IPV\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure of Interest: Sexual Orientation and Gender Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterosexual women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e651 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e697 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterosexual men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e509 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e521 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGay, bisexual, or questioning men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLesbian, gay, bisexual, or questioning women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender and sexual non-conforming youth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003ePotential Confounders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge mean, SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.59 (2.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.47 (1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.66 (2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.32 (1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/Ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e918 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e973 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eColoured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewhite, Indian, or Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed and/or in school\u003c/strong\u003e: Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e937 (70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e988 (70.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn relationship, living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn relationship not living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1071 (80.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143 (59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1124 (79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny Children\u003c/strong\u003e: Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e544 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e587 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use during the pandemic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eonce or twice per week or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e319 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e341 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eless than monthly or once a month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e473 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e501 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e543 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e571 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eProportions for small cell sizes\u0026thinsp;\u0026lt;\u0026thinsp;5 or \u0026lt;\u0026thinsp;10 were provided as a range to protect anonymity\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents unadjusted ORs and adjusted ORs (aORs) for the estimated associations between SOGI and experiences of physical IPV and for perpetration of physical IPV, respectively, during the pandemic. In unadjusted analyses, compared to heterosexual women, GBQM (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;2.03; 95%CI, 1.05\u0026ndash;3.93) and non-conforming youth (aOR\u0026thinsp;=\u0026thinsp;2.16; 1.27\u0026ndash;3.66) had greater odds of experiencing physical IPV during the pandemic. After adjusting for potential confounders, non-conforming youth remained at greater odds of physical IPV (vs. heterosexual women, aOR\u0026thinsp;=\u0026thinsp;2.73; 95%CI, 1.47\u0026ndash;5.06). In both unadjusted and adjusted analyses, compared to heterosexual women, heterosexual men (aOR\u0026thinsp;=\u0026thinsp;1.55; 95%CI, 1.01\u0026ndash;2.37), LGBQW (aOR\u0026thinsp;=\u0026thinsp;2.09; 95%CI, 1.06\u0026ndash;4.09), and non-conforming youth (aOR\u0026thinsp;=\u0026thinsp;3.02; 95%CI, 1.42\u0026ndash;6.41) all had greater odds of perpetrating physical IPV during the pandemic.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eunadjusted and adjusted association between sexual orientation and gender identity and 1. Experiencing physical IPV (n\u0026thinsp;=\u0026thinsp;1,486) and 2. Perpetrating physical IPV (n\u0026thinsp;=\u0026thinsp;1,482)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eExperiencing Physical IPV\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePerpetrating Physical IPV\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnadjusted Odds Ratio (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdjusted Odds Ratio (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnadjusted Odds Ratio (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdjusted Odds Ratio (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Orientation and Gender Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterosexual women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterosexual men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.73\u0026ndash;1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.71\u0026ndash;1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.56 (1.06\u0026ndash;2.29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.55 (1.01\u0026ndash;2.37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGay, bisexual, or questioning men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.03 (1.05\u0026ndash;3.93)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.90 (0.92\u0026ndash;3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58 (0.64\u0026ndash;3.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21 (0.47\u0026ndash;3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLesbian, gay, bisexual or questioning women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58 (0.92\u0026ndash;2.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.79\u0026ndash;2.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.55 (1.39\u0026ndash;4.66)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.09 (1.06\u0026ndash;4.09)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender non-conforming youth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.16 (1.27\u0026ndash;3.66)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.73 (1.47\u0026ndash;5.06)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.42 (1.28\u0026ndash;4.57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.02 (1.42\u0026ndash;6.41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eModels adjusted for age, race/ethnicity, having any children, school/employment status, relationship status, and alcohol frequency during the pandemic\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents differences in experiences and perpetration of physical IPV faced by youth residing in eThekwini district of South Africa during the COVID-19 pandemic across gender and sexual orientation. Despite a large proportion of youth experiencing violence during the pandemic reporting that this was less than pre-pandemic times, our results indicated that over one in 6 youth aged 16 to 24 experienced and one in 10 perpetrated physical IPV during the pandemic. We found that gender and sexual non-conforming youth experienced 2.7 times the odds of physical IPV than heterosexual women. Consistent with the literature heterosexual men had 1.5 times the odds of perpetrating IPV than heterosexual women [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Novel findings from our study include two-times and three-times the odds, of LGBQW and non-conforming youth, respectively, perpetrating IPV than heterosexual women. Across SOGI there was considerable overlap between physical IPV perpetration and experiences. Findings from our study corroborate global research demonstrating the high levels of experiences and perpetration of IPV within LGBTQ\u0026thinsp;+\u0026thinsp;relationships [\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the focus and efforts put towards preventing heterosexual women from experiences of IPV, and supporting those who do experience IPV, in South Africa[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], our results demonstrating similar or lower levels of physical IPV experiences among heterosexual women were unexpected. Contrary to other studies conducted in South Africa highlighting the disproportionate levels of IPV experiences among woman compared to men [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], our study found that heterosexual young women and men experienced similar rates of physical IPV in their relationships. Our results do align with prior research among Kenyan adults [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] and youth in Tanzania [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] showing higher but similar levels of recent and lifetime IPV experiences and perpetration among women and men. High levels of both experiencing and perpetrating violence among men and women in heterosexual relationships has been previously reported among adults in Kenya, with a 2022 study showing that 23% of women and 18% of men experienced physical violence in their relationship in the 12 months prior to being interviewed [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The same study showed that IPV perpetration was higher among those also reporting experiencing IPV among both women and men [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Our data further adds to these findings that did not explore experiences and perpetration of IPV in non-heterosexual relationships, demonstrating that queer and gender non-conforming youth face and perpetrate IPV at higher levels than their heterosexual peers, apart from gay, bisexual, and questioning men who perpetrated the lowest levels of IPV in their relationships.\u003c/p\u003e \u003cp\u003eOur data aligns with global research highlighting elevated levels of IPV experiences within LGBTQ\u0026thinsp;+\u0026thinsp;relationships. For example, in the US CDC\u0026rsquo;s National Intimate Partner and Sexual Violence Survey (NIPSVS), 44% of lesbians and 61% of bisexual women experience rape, physical violence, or stalking by an intimate partner, compared to 35% of straight women [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Bisexual women had significantly higher lifetime prevalence of rape, physical violence, and/or stalking by an intimate partner when compared to both lesbian and heterosexual women, while on the other hand lesbian women and gay men reported levels of IPV and sexual violence equal to or higher than those of heterosexuals [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. A systematic review of 52 global studies of IPV within gay, bisexual, and other men who have sex with men found a pooled prevalence of physical IPV experiences at 17% and perpetration 12% perpetration [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. These global levels align with reporting among GBQM in our study of whom 25% experienced and 11% perpetrated physical IPV over the course of the pandemic. These data reveal a growing concern and documentation of experiences in the LGBTQ\u0026thinsp;+\u0026thinsp;community, and a need to focus IPV prevention and supports for LGBTQ\u0026thinsp;+\u0026thinsp;youth.\u003c/p\u003e \u003cp\u003eLevels of experiences and perpetration of physical IPV among youth aged 16\u0026ndash;24 years in our study was higher than lifetime experiences of physical IPV reported by women of all ages in KwaZulu Natal (15.0% vs. 13.7%) and prior reports of physical IPV perpetration among young women aged 15\u0026ndash;24 years across South Africa (10.0% vs. 4.6%)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, these data are difficult to compare as we explored experiences and perpetration across all genders and sexual orientations and our sample was limited to youth living in eThekwini District. In our study, 65% of youth reporting perpetrating physical IPV had also experienced physical IPV, with 100% of non-conforming youth and lesbian and bisexual young women who perpetrated physical IPV also having had experienced physical IPV. Higher perpetration among individuals who are survivors of violence is well documented in the literature globally and sub-Saharan Africa, which may be particularly prevalent in LGBTQ\u0026thinsp;+\u0026thinsp;relationships[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. For example, previous research among gay, bisexual, and other men who have sex with men in South Africa and Namibia found that 7.3% of men had experienced IPV from their partners and 10.2% reported experiencing bi-directional violence in the 12 months prior to being surveyed.\u003c/p\u003e \u003cp\u003eMultiple interacting factors are likely driving the elevated rates of IPV among LBGTQ\u0026thinsp;+\u0026thinsp;youth observed in our study. These may include individual-levels factors including internalized stigmas or homophobia, as well as minority stress, which might result in higher levels of violent behaviour towards in-group members, including one\u0026rsquo;s partner [\u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. While South Africa has one of the most progressive laws and policies promoting LGBTQ\u0026thinsp;+\u0026thinsp;rights and protections [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], LGBTQ\u0026thinsp;+\u0026thinsp;discrimination across the country is still widespread and this includes discrimination and violence from intimate partner [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is a dearth of research exploring the impact of the COVID-19 pandemic on the sexual and reproductive health outcomes inclusive of IPV of LGBTQ\u0026thinsp;+\u0026thinsp;youth [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], especially within low-and-middle income countries. While rates of IPV during the pandemic were high, reports of increased frequency during this period were extremely low, which is promising. Reduced rates may have been due to limited contact between partners during lockdown periods. Reduced experiences may have also been impacted by South Africa\u0026rsquo;s alcohol ban, which did result in reductions in violence and trauma unit admissions for alcohol-related injuries [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Despite these reductions in experiences of physical IPV reported during the pandemic, our results signal a critical need for efforts to move beyond focusing on supporting and preventing IPV within heterosexual relationships to address high levels of experiences and perpetration faced by LGBTQ\u0026thinsp;+\u0026thinsp;youth in South Africa and globally. Efforts should include exploring how gender transformative efforts, such as SASA! and Stepping Stones Creating Futures, which have shown promise in reducing IPV experiences [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e] and perpetration [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e] within heterosexual relationships in South Africa can be adapted to address IPV in LGBTQ\u0026thinsp;+\u0026thinsp;relationships. Gender transformative efforts aim to move beyond individual-level efforts to address societal and community-level power and gender inequities to transform gender norms that perpetuate violence, especially IPV [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. While these efforts have shown promise among women and men, by working to address inequitable gender norms and relations, there is limited understanding into how the success of these programs could expand to include individuals of all genders in non-heterosexual relationships. Current interventions aimed at preventing IPV are framed within heteronormative notions that women are passive victims of violence and men are perpetrators. Narrow conceptualizations of gender as binary, exclude individuals who do not conform to these narrow categories. Thus, leaving few to no options for support within these communities. This is concerning as our study found that non-conforming youth were both more likely to experience as well as perpetrate physical IPV. Efforts are needed to address experiences of IPV that are not solely focused on unidirectional IPV perpetrated by men towards women in heterosexual relationships. This should include efforts to better understand and seek to prevent and support bilateral IPV that might be occurring at higher rates among gender and sexual non-conforming and young queer women\u0026rsquo;s relationships.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of this study\u003c/h2\u003e \u003cp\u003eWhile much research has centered on youth, gender, and violence in the context of HIV in South Africa, most studies have been underpowered or lack data on experiences of LGBTQ\u0026thinsp;+\u0026thinsp;youth. We were able to explore experiences and perpetration of IPV across sexual orientation and gender identity. However, our results also present several limitations of note. To limit missing data and questionnaire fatigue from the mobile health survey, we restricted the survey to take an average of 15 minutes to complete. This limited our ability to ask detailed questions about youth\u0026rsquo;s relationships and the context of the relationship and violence experienced and perpetrated. As such, findings demonstrating that physical IPV was reported as happening less than prior to the pandemic should be taken with caution. Moreover, the study was cross-sectional, and the low reporting of changes to experiences of IPV before and after the pandemic limits our ability to make inferences about the extent to which individuals experiences were due to the COVID-19 pandemic, if these experiences were new, and relationship dynamics pre/post-COVID (e.g., length of relationship, gender and age of partner, if violence was being experienced/perpetrated by multiple or a single partner). We also did not ask about when during the pandemic the violence happened, which at the time of the survey was ~\u0026thinsp;2 years since the public health emergency was declared, thus limiting comparability with other studies measuring IPV in the last 12 months or lifetime experiences. Missing data on IPV was likely influenced by respondents\u0026rsquo; relationship experiences that were not captured through skip patterns in the survey due to the limited scape of the survey. Given the sensitive nature of these data the results may have been influenced by social desirability bias. However, our study design with data being collected completely anonymously via a mobile survey may have reduced this bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAcross gender identity and sexual orientation our results highlight that gender non-conforming youth report both experiencing and perpetrating IPV at significantly higher levels than their heterosexual peers, with over one-quarter of non-conforming youth having experienced physical IPV during the pandemic. During the first two years of the COVID-19 pandemic, young heterosexual women reported IPV levels similar to young men and lower IPV levels than queer men, queer women, and non-conforming youth. Our findings signal a critical need for research to better understand experiences and consequences of IPV within the relationships of LGBTQ\u0026thinsp;+\u0026thinsp;youth. Efforts need to move beyond the gender binary to address and create programming that works to prevent and support young people of diverse genders and sexual orientations in forming and experiencing healthy relationship dynamics free of violence in South Africa and globally.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were provided with an electronic consent letter, detailing the purpose of the survey, benefits and risk for participation, and key contacts for further question prior to accessing to the questionnaire. A list of resources including online and in-person local support services such as for mental health and sexual and reproductive health care was provided at the end of the questionnaire. Ethical approval was provided by the Research Ethics British Columbia (REBC) network and the Office of Research Ethics (ORE) at Simon Fraser University in Canada (REB number: H21-02027), and by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC-Medical) in South Africa (REB number: M210863). All study methods were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe de-identified data cannot be publicly shared as we do not have community or REB approval to do so. For researchers or trainees wishing to access the data, please contact Dr. Angela Kaida to request access. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAYAZAZI RIGHTS is funded by the Centre for International Child Health (CICH) Catalyst Grant, with support from the British Columbia Children\u0026rsquo;s Hospital Foundation, Canada. KC is supported by a CIHR Banting Postdoctoral Fellowship. The work reported herein for JJD was made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Postdoctoral Programme from funding received from the South African National Treasury as well as the CIPHER GROWING THE LEADERS OF TOMORROW grant from the International AIDS Society.\u0026nbsp;The authors received no funding to produce this manuscript as it is part of the first author\u0026rsquo;s dissertation research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eK.C., B.Z., J.J., T.P., J.J.D., M.B., and A.K. were involved in the conception and design of the study. A.K., J.J.D., MB, K.C., and J.J secured funding for this study. B.Z. led recruitment and the development of the questionnaire tool. K.C. analyzed the data with support from C.A.B. K.C. drafted the original manuscript and was responsible for the final submission. All authors were involved in the review of draft manuscripts and read and approved the final version prior to submission.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAcknowledgement \u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the young people who participated in this research and shared their stories with us. Also, thank you to the members of the Perinatal HIV Research Unit (PHRU) and WitsMRU Adolescent Community Advisory Committees (ACAB) for providing feedback on the study. Thank you to the staff at WitsHealth in Durban for supporting the data collection and logistics of this study. The view expressed in this manuscript are the authors\u0026rsquo; own.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSardinha L, Maheu-Giroux M, St\u0026ouml;ckl H, Meyer SR, Garc\u0026iacute;a-Moreno C: \u003cstrong\u003eGlobal, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018\u003c/strong\u003e. \u003cem\u003eThe Lancet \u003c/em\u003e2022, \u003cstrong\u003e399\u003c/strong\u003e(10327):803-813.\u003c/li\u003e\n\u003cli\u003eKwan J, Sparrow K, Facer-Irwin E, Thandi G, Fear NT, MacManus D: \u003cstrong\u003ePrevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eAggression and Violent Behavior \u003c/em\u003e2020, \u003cstrong\u003e53\u003c/strong\u003e:101419.\u003c/li\u003e\n\u003cli\u003ePeitzmeier SM, K\u0026aring;gesten A, Acharya R, Cheng Y, Delany-Moretlwe S, 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Given limited evidence in the wake of the COVID-19 pandemic, which has fuelled IPV globally, we aimed to describe and compare experiences and perpetration of IPV of youth aged 16-24 by sexual orientation and gender identity (SOGI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e December 2021-May 2022, youth aged 16-24 years from eThekwini district, South Africa completed an online survey to understand multilevel impacts of the pandemic on youth. Participants were asked about experiences and perpetration of physical IPV since the COVID-19 pandemic. Descriptive statistics and adjusted logistic regressions compared the likelihood of experiencing and/or perpetrating physical IPV between heterosexual men; heterosexual women; gay, bisexual, or questioning men [GBQM; lesbian, gay, bisexual, or questioning women [LGBQW]; or gender/sexual non-conforming youth [non-conforming].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of 1,584 youth (mean age=21.7 [SD=2.3]; 71.7% Black) with non-missing SOGI and physical IPV data, 239 (15.1%) were LGBTQ+ (40.6% LGBQW and 36.0% non-conforming). The proportion of youth both experiencing and perpetrating physical IPV differed by SOGI (13.3% of heterosexual men, 14.1% of heterosexual women, 23.2% of GBQM, 20.8% of LGBQW, and 25.6% of non-conforming youth experienced and 10.9% of heterosexual men; 7.7% of heterosexual women; 10.7% of GBQM; 16.5% of LGBQW; and 16.3% of non-conforming youth perpetrated). In adjusted models, compared to heterosexual women, non-conforming youth had increased odds of experiencing (adjusted odds ratio [aOR]=2.73; 95%CI, 1.57-5.06) physical IPV and non-conforming youth (aOR=3.02; 95%CI, 1.42-6.41), LGBQW (aOR=2.09; 95%CI, 1.06-4.09), and heterosexual men (aOR=1.55; 95%CI, 1.01-2.37) all had greater odds of perpetrating physical IPV during the pandemic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e In the first two years of the COVID-19 pandemic, over one in six youth in our study experienced and one in ten perpetrated physical IPV, with gender and sexual non-conforming youth experiencing and perpetrating IPV at significantly greater rates than cisgender/heterosexual peers. Our findings highlight the need for gender transformative efforts that move beyond the gender binary to support healthy relationships and IPV prevention for LGBTQ+ youth in South Africa and globally.\u003c/p\u003e","manuscriptTitle":"Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-04 18:59:57","doi":"10.21203/rs.3.rs-2403223/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-10-03T03:28:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-09-22T18:03:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"fed4e799-8ada-497b-b0e4-11164c1b9219","date":"2023-09-12T01:54:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-08-19T15:15:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16acb2bd-5039-4723-9753-6febfffbb311","date":"2023-08-08T09:49:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"07aca2c8-3905-4cfa-b5eb-778f4788085a","date":"2023-08-07T14:42:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"ccbe3130-d1ed-42a3-b068-9af5b771904e","date":"2023-07-10T10:01:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6269a471-2ae0-4ec5-9c02-7b33ecc2c497","date":"2023-07-10T08:48:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-06-13T12:59:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-06-06T14:35:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-12-30T15:02:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-12-30T14:55:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2022-12-22T01:44:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4a63d17-9003-4540-8663-75c39a5496b4","owner":[],"postedDate":"January 4th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-11-27T15:04:48+00:00","versionOfRecord":{"articleIdentity":"rs-2403223","link":"https://doi.org/10.1186/s12889-023-17199-x","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2023-11-21 15:01:35","publishedOnDateReadable":"November 21st, 2023"},"versionCreatedAt":"2023-01-04 18:59:57","video":"","vorDoi":"10.1186/s12889-023-17199-x","vorDoiUrl":"https://doi.org/10.1186/s12889-023-17199-x","workflowStages":[]},"version":"v1","identity":"rs-2403223","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2403223","identity":"rs-2403223","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}