Introduction
Women living with HIV
are vulnerable to gender-based violence (GBV) before and after diagnosis, in
multiple settings. This study's aim was to explore how GBV is experienced by
women living with HIV, how this affects women's sexual and reproductive health
(SRH) and human rights (HR), and the implications for policymakers.
Methods
A community-based,
participatory, user-led, mixed-methods study was conducted, with women living
with HIV from key affected populations. Simple descriptive frequencies were
used for quantitative data. Thematic coding of open qualitative responses was
performed and validated with key respondents.
Results
In total, 945 women
living with HIV from 94 countries participated in the study. Eighty-nine
percent of 480 respondents to an optional section on GBV reported having
experienced or feared violence, either before, since and/or because of their
HIV diagnosis. GBV reporting was higher after HIV diagnosis (intimate partner,
family/neighbours, community and health settings). Women described a complex
and iterative relationship between GBV and HIV occurring throughout their
lives, including breaches of confidentiality and lack of SRH choice in
healthcare settings, forced/coerced treatments, HR abuses, moralistic and
judgemental attitudes (including towards women from key populations), and fear
of losing child custody. Respondents recommended healthcare practitioners and
policymakers address stigma and discrimination, training, awareness-raising,
and HR abuses in healthcare settings.
Conclusions
Respondents reported
increased GBV with partners and in families, communities and healthcare
settings after their HIV diagnosis and across the life-cycle. Measures of GBV
must be sought and monitored, particularly within healthcare settings that
should be safe. Respondents offered policymakers a comprehensive range of
recommendations to achieve their SRH and HR goals. Global guidance documents
and policies are more likely to succeed for the end-users if lived experiences
are used.
Table 2
Categories, frequencies and timings of violence reported by women with HIV
| Category of violence experienceda | Before HIV diagnosis n (%) | Since HIV diagnosis n (%) | Because of HIV diagnosis n (%) | Any experience n (%) | Never n (%) | Don't know n (%) | Total n (%) |
|---|---|---|---|---|---|---|---|
| From a sexual partner or spouse | 208 (43) | 80 (17) | 70 (15) | 282 (59) | 181 (38) | 17 (4) | 480 (100) |
| From a family member/neighbours | 75 (16) | 80 (17) | 112 (24) | 215 (45) | 244 (51) | 16 (3) | 475 (100) |
| In the community | 76 (16) | 109 (23) | 146 (32) | 250 (53) | 196 (42) | 25 (5) | 471 (100) |
| In health settings | 28 (6) | 133 (28) | 164 (35) | 253 (53) | 209 (44) | 13 (3) | 475 (100) |
| From police/military/prison or detention services | 44 (9) | 34 (7) | 26 (6) | 78 (17) | 360 (77) | 31 (7) | 469 (100) |
| Fear of violence | 118 (25) | 136 (29) | 184 (39) | 322 (68) | 140 (30) | 11 (2) | 473 (100) |
Table 3
What women living with HIV think are the most important ways to address or prevent gender-based violence
| Strategy | Critical n(%) | Importantn (%) | Less important n(%) | Don't known (%) | Total responsen (%) |
|---|---|---|---|---|---|
| Through safe health services that protect, respect and uphold women's rights | |||||
| Sensitize healthcare workers to the rights of women living with HIV | 363 (77) | 86 (18) | 11 (2) | 11 (2) | 471 (100) |
| Increase access to quality support services for women who experience gender-based violence (including sexual violence) | 356 (76) | 94 (20) | 11 (2) | 8 (2) | 469 (100) |
| Ensure effective complaints/redress mechanisms in case of rights violations within health services | 332 (71) | 114 (24) | 10 (2) | 10 (2) | 466 (100) |
| Provide a minimum post-rape care and support package, including post-exposure prophylaxis, emergency contraception, screening for other sexually transmitted infections, and psychosocial care/counselling | 330 (71) | 114 (24) | 9 (2) | 13 (3) | 466 (100) |
| Increase access to harm reduction-based treatment for women who use drugs | 238 (51) | 178 (38) | 26 (6) | 23 (5) | 465 (100) |
| Address alcohol abuse | 206 (44) | 182 (39) | 54 (12) | 22 (5) | 464 (100) |
| Through a protective legal and policy environment and decriminalization | |||||
| Strengthen laws and policies to protect the rights of people living with HIV | 376 (80) | 79 (17) | 9 (2) | 8 (2) | 472 (100) |
| Strengthen legal protections around all forms of violence against women/gender-based violence | 358 (76) | 90 (19) | 9 (2) | 14 (3) | 471 (100) |
| Recognize and address marital rape and “date rape” | 280 (60) | 143 (31) | 17 (4) | 25 (5) | 465 (100) |
| Remove laws which criminalize HIV exposure/transmission | 235 (51) | 112 (24) | 63 (14) | 48 (10) | 458 (100) |
| Remove laws which criminalize same sex practices | 181 (40) | 131 (29) | 97 (21) | 48 (11) | 457 (100) |
| Remove laws which criminalize sex work | 166 (35) | 153 (33) | 89 (19) | 61 (13) | 469 (100) |
| Remove laws which criminalize drug use | 157 (34) | 148 (32) | 106 (23) | 54 (12) | 465 (100) |
| Through financial security | |||||
| Increase social protection for women and children | 333 (71) | 116 (25) | 12 (3) | 8 (2) | 469 (100) |
| Increase access to employment for women, including transgender women | 269 (58) | 153 (33) | 26 (6) | 17 (4) | 465 (100) |
Full article at: http://goo.gl/cJHdMU
By:
1Salamander Trust, London, UK
2ATHENA Network, London, UK
3Women's Health Academic Centre, King's
College London, London, UK
4Transgender Law Center, Oakland, CA, USA
5ATHENA Network, Seattle, WA, USA
6International Community of Women Living
with HIV and AIDS (ICW) East Africa, Kampala, Uganda
§Corresponding author: Alice Welbourn, Salamander Trust, c/o
Positively UK, 345 City Road, London EC1V 1LR, UK. Tel: +44 203 289 7398. (Email: ten.tsurtrednamalas@ecila)
More at: https://twitter.com/hiv_insight
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