What you need to know:
- Physical or sexual violence also increases infection risk for women with HIV-positive partners.
- The study noted that efforts to reduce violence against women and girls must be specific to reduce infection.
- The world commemorated World Aids Day yesterday amidst the ongoing 16 Days Activism against Gender-Based Violence.
Women living with HIV and experiencing physical or sexual intimate partner violence are less likely to achieve viral load suppression, a recent study has shown.
The findings, published in the PLOS Global Public Health last week, indicate that intimate partner violence (IPV) increases HIV risk for women with HIV-positive male partners in sub-Saharan Africa.
It assessed the association between physical or sexual IPV (or both) as the primary exposure and recent HIV infection as the primary outcome. Also assessed were associations of IPV, antiretroviral therapy (ART) uptake and viral load suppression.
The study—conducted by Salome Kuchukhidze of McGill University and colleagues, with data pooled from several Sub-Saharan countries, including Kenya—revealed that partner violence perpetrators were more likely to engage in behaviours associated with an increase in HIV risk, which may be part of the reason for their higher HIV rates.
The researchers indicated that efforts to reduce violence against women and girls must be specific to reduce infection. The world commemorated World Aids Day yesterday amidst the ongoing 16 Days Activism against Gender-Based Violence.
The study also cited increased alcohol use, acceptance of IPV and stereotypes of male dominance as contributors to violence against women. The men were more likely to have multiple partners, which may contribute to the increased HIV rates.
The researchers sought to examine the effects of IPV on recent HIV infection and women's engagement in the HIV care cascade in sub-Saharan Africa. Out of 10 women who reported violence from their intimate partners, three had an increased HIV risk. “Women who reported IPV were found to have a 30 per cent increased risk of HIV, showing a joint effect of IPV with HIV, which increased the risk of HIV by a further three per cent.”
In Sub-Saharan Africa, one in three women aged 15 to 49 report IPV at some point in their lifetime. Thus, the importance of tackling IPV to reduce HIV must not be underestimated. Men who perpetrate IPV were also shown to have higher rates of HIV and were less likely to be on ART and virally suppressed compared to men who are not perpetrators.
Other factors that the researchers suggest could increase the risk of HIV for those experiencing violence were the effects of intimate violence on mental health and sexual behaviours, which could increase risk factors for HIV acquisition like substance misuse, transactional sex and coerced anal sex. The researchers analysed data from 27 different countries between 2000 and 2020.
The data was all taken from nationally representative household surveys, which were all anonymised. Some 111,659 heterosexual couples were reported to be married or cohabiting, aged over 15. Of these couples, 79,325 had data on HIV available.
IPV was detected by the female partner reporting sexual or physical violence within the last year of the survey, and the culprit was assumed to be her current partner.
A separate assessment of whether IPV increased the risk of HIV included only women aged 15–24. They had the highest risk of violence and the greatest HIV incidence, making them the best group to estimate the additional HIV risk in the context of IPV.
“Overall, 21 per cent of women reported intimate violence. Unsurprisingly, women who were younger, poorly educated, less likely to have a say in household decisions and less wealthy were more likely to report intimate partner violence.”
Also, women earning more than their partner were more likely to experience violence, which may be due to the challenge this poses to gender stereotypes, leaving the male partner feeling threatened.
“These women may be more likely to refuse sex and negotiate condom use which would reduce their HIV risk but may increase their violence risk,” it states.
Further research to assess the causality of the increase in HIV amongst women subjected to IPV must be undertaken, which will inform efforts to reduce both IPV and HIV.
“Achieving the 95-95-95 targets for HIV diagnosis, treatment, and viral load suppression to end the HIV epidemic hinges on eliminating structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa has among the highest prevalence of IPV and HIV worldwide,” recommended the study.
“The impacts of violence and HIV are profound and have long-lasting effects on the well-being of millions of women and girls globally. Actions to eliminate violence and end AIDS must be accelerated," the researchers note.
Preventing IPV is fundamentally imperative but eliminating IPV could contribute to ending the HIV epidemic.