Women who experience intimate partner violence are three times more likely to become infected with HIV

Abstract: A study reveals that women who have experienced domestic abuse are three times more likely to contract HIV.

Source: McGill University

Women who have recently experienced 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 intertwined epidemic of intimate partner violence and HIV.

“Worldwide, more than one in four women experience intimate partner violence in their lifetime,” says Mathieu Maheu-Giroux, a professor at McGill University and Canada’s lead researcher on population health modeling.

“Sub-Saharan Africa is 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 Lancet HIV, shows significant overlap between violence against women and the HIV epidemic in some of the worst-hit countries. Among women living with HIV, those who experienced intimate partner violence were nine percent less likely to achieve viral load suppression—the final step in HIV treatment.

New calls for the elimination of all forms of sexual and gender-based violence

“The 2021 UN General Assembly, attended and supported by the Government of Canada, adopted a Political Declaration on HIV and AIDS with bold new global goals for 2025. These include a commitment to eliminate all forms of sexual and gender-based violence, including IPV, as a key driver of the HIV epidemic. “Improving our understanding of the relationship between IPV and HIV is essential to meeting this commitment,” says Professor Maheu-Giroux.

The researchers found that physical or sexual intimate partner violence in the past year was associated with more recent HIV acquisition and less frequent shedding of the virus. According to the researchers, IPV may also present barriers to women accessing and staying in HIV care while living with the virus.

“Given the high burden of IPV worldwide, including in Canada, there is an urgent need to stop the mutually reinforcing threats of IPV and HIV to women’s health and well-being,” says Salome Kuchukhidze, Ph.D. candidate of epidemiology studies and head of research.

About this news about domestic violence and HIV research

Author: Press office
Source: McGill University
Contact: Press Office – McGill University
Picture: The image is in the public domain

Original research: Open access.
“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” Salome Kuchukhidze et al. Lanceta HIV

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Abstract

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

Background

Achieving the 95-95-95 targets for HIV diagnosis, treatment and viral load suppression to end the HIV epidemic depends on addressing structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa has one of the highest rates of IPV and HIV in the world. 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.

Methods

We performed 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 January 1, 2000, to December 31, 2020. Relevant surveys were identified from data catalogs and previous comprehensive reviews, and included the Demographic and Health Survey, the AIDS Indicators Survey, the Population Impact Assessment of HIV and the South African National Survey on HIV Prevalence, Incidence, Behavior and Communication. Individual-level data on all respondents who have ever been in a partner relationship (currently or previously married or cohabiting) and aged 15 years or older are 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 by recency tests), as the primary outcome. We also assessed the association of past-year IPV with self-reported HIV testing (also in the past year), and taking antiretroviral therapy (ART) and viral load suppression at the time of the survey. Models were adjusted for participant age, age at onset of intercourse (recent HIV analysis), urban or rural residence, partner status, education, and survey-level fixed effects.

Findings

57 surveys with data on self-reported HIV testing and past-year physical or sexual IPV were available from 30 countries, covering 280,259 ever-partnered women aged 15–64 years. 59,456 (21·2%) women experienced physical or sexual IPV in the last year. Six surveys had data 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 physical or sexual IPV in the past year, compared with 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 a minimal effect on past-year self-reported HIV testing in the 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 an association of ART use 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 experienced physical or sexual IPV in the past year were less likely to achieve viral load suppression than those who did not experience IPV in the past year (crude PR 0.85). [0·79–0·91]adjusted PR 0·91 [0·84–0·98]n=5627).

Interpretation

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.

Financing

Canadian Institutes of Health Research, Canada Research Chairs Program and Fonds de recherche du Québec-Santé.