Summary: Study reveals women who experience domestic abuse are three times more likely to contract HIV infection.
Source: McGill University
Women that experience recent intimate partner violence (IPV) are three times more likely to contract HIV, according to a new study led by McGill University researchers. In regions like Sub-Saharan Africa, women face an intersecting epidemic of intimate partner violence and HIV.
“Worldwide, more than one in four women experience intimate partner violence in their lifetime,” says McGill University Professor Mathieu Maheu-Giroux, a Canada Research Chair in Population Health Modeling.
“Sub-Saharan Africa is among one of the regions in the world with the highest prevalence of both IPV and HIV. We wanted to examine the effects of intimate partner violence on recent HIV infections and women’s access to HIV care in this region,” he says.
Their study, published in The Lancet HIV, shows considerable overlap between violence against women and the HIV epidemics in some of the highest burdened countries. Among women living with HIV, those experiencing intimate partner violence were nine percent less likely to achieve viral load suppression—the ultimate step in HIV treatment.
New calls to eliminate all forms of sexual and gender-based violence
“The 2021 UN General Assembly, attended and supported by the Government of Canada, adopted the Political Declaration on HIV and AIDS with bold new global targets for 2025. This encompasses a commitment to eliminate all forms of sexual and gender-based violence, including IPV, as a key enabler of the HIV epidemic. Improving our understanding of the relationships between IPV and HIV is essential to meet this commitment,” says Professor Maheu-Giroux.
The researchers found that physical or sexual intimate partner violence in the past year was associated with recent HIV acquisition and less frequent viral load suppression. According to the researchers, IPV could also pose barriers for women in accessing HIV care and remaining in care while living with the virus.
“Given the high burden of IPV worldwide, including in Canada, the need to stem the mutually reinforcing threats of IPV and HIV on women’s health and well-being is urgent,” says Salome Kuchukhidze, a Ph.D. candidate studying epidemiology and the lead author of the research.
About this domestic violence and HIV research news
The effects of intimate partner violence on women’s risk of HIV acquisition and engagement in the HIV treatment and care cascade: a pooled analysis of nationally representative surveys in sub-Saharan Africa
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. We aimed to examine the effects of IPV on recent HIV infection and women’s engagement in the HIV care cascade in sub-Saharan Africa.
We did a retrospective pooled analysis of data from nationally representative, cross-sectional surveys with information on physical or sexual IPV (or both) and HIV testing, from Jan 1, 2000, to Dec 31, 2020. Relevant surveys were identified from data catalogues and previous large-scale reviews, and included the Demographic and Health Survey, the AIDS Indicator Survey, the Population-based HIV Impact Assessment, and the South Africa National HIV Prevalence, Incidence, Behavior and Communication Survey. Individual-level data on all female respondents who were ever-partnered (currently or formerly married or cohabiting) and aged 15 years or older were included. We used Poisson regression to estimate crude and adjusted prevalence ratios (PRs) for the association between past-year experience of physical or sexual IPV (or both), as the primary exposure, and recent HIV infection (measured with recency assays), as the primary outcome. We also assessed associations of past-year IPV with self-reported HIV testing (also in the past year), and antiretroviral therapy (ART) uptake and viral load suppression at the time of surveying. Models were adjusted for participant age, age at sexual debut (HIV recency analysis), urban or rural residency, partnership status, education, and survey-level fixed effects.
57 surveys with data on self-reported HIV testing and past-year physical or sexual IPV were available from 30 countries, encompassing 280 259 ever-partnered women aged 15–64 years. 59 456 (21·2%) women had experienced physical or sexual IPV in the past year. Six surveys had information on recent HIV infection and seven had data on ART uptake and viral load suppression. The crude PR for recent HIV infection among women who had experienced past-year physical or sexual IPV, versus those who had not, was 3·51 (95% CI 1·64–7·51; n=19 179). The adjusted PR was 3·22 (1·51–6·85). Past-year physical or sexual IPV had minimal effect on self-reported HIV testing in the past year in crude analysis (PR 0·97 [0·96–0·98]; n=274 506) and adjusted analysis (adjusted PR 0·99 [0·98–1·01]). Results were inconclusive for the association of ART uptake with past-year IPV among women living with HIV (crude PR 0·90 [0·85–0·96], adjusted PR 0·96 [0·90–1·02]; n=5629). Women living with HIV who had experienced physical or sexual IPV in the past year were less likely to achieve viral load suppression than those who had not experienced past-year IPV (crude PR 0·85 [0·79–0·91], adjusted PR 0·91 [0·84–0·98], n=5627).
Past-year physical or sexual IPV was associated with recent HIV acquisition and less frequent viral load suppression. Preventing IPV is inherently imperative but eliminating IPV could contribute to ending the HIV epidemic.
Canadian Institutes of Health Research, the Canada Research Chairs Program, and Fonds de recherche du Québec-Santé.