Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa

Abstract

Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.

Greentree White Paper: Sexual Violence, Genitoanal Injury, and HIV: Priorities for Research, Policy, and Practice

“…A growing body of behavioral and social science research points to a significant and bidirectional a relationship between SV and HIV transmission risk, especially in conflict-affected situations and hyperendemic areas, as well as among populations at high risk, such as young adolescent women, sex workers, and widows. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Although some exploratory mathematical modeling has shown the potential for increased risk at a population level in some settings, 11,16 the biological and social cofactors of SV have yet to be incorporated systematically into model estimates of population level prevalence, in basic scientific and clinical research, or as a focus of HIV prevention efforts.…”

Economic Inequality and HIV in Malawi

“…This could occur because it is difficult to mobilize collective action to implement effective responses to the epidemic in places with little social cohesion. There could also be more gender violence in more unequal societies, since there 9 is more violence in general, which tends to increase female risk behavior, such as early sexual debut, as well as the number of rapes (Andersson et al, 2008).…”

“…Gender inequality is often considered an important driver of HIV (Gillespie, et al, 2007;Whiteside, 2008;Andersson et al, 2008), and may well be related to economic inequality. In specifications (4)- (6) we add gender inequality, differentiating between economic gender inequality, measured by women's participation in market work and the district gender gap in secondary schooling, and gender violence, which is measured by an indicator of whether the respondent's father ever beat the mother.…”

Gender Disparity in HIV Prevalence: A National-Level Analysis of the Association between Gender Inequality and the Feminisation of HIV/AIDS in sub-Saharan Africa

“…Such indicators are however available at the country level from other sources and it is therefore possible to include a number of contextual factors in this analysis. With respect to gender inequality, there is a plethora of evidence suggesting that a wide range of factors increase women's HIV risk and risky sexual behaviours at the individual level, including poverty, marginalization and economic dependence (Greig and Koopman 2003); sexual coercion and sexual violence (Dunkle et al 2004, Andersson et al 2008, Maman et al 2002, Jewkes et al 2003; inability to negotiate sex and less participation in decision making, particularly with regard to sex, (Bloom andGriffiths 2007, Langen 2005); lower levels of literacy and education (Snelling et al 2007, Burgoyne andDrummond 2008), and stigma and discrimination. Previous research has included several measures of gender equality in analysis of variation in the FTM ratio of HIV prevalence including inequality in education, employment and the FTM ratio of the percentage of adults who agree that it is possible to take action to avoid contracting AIDS.…”