Saturday, December 12, 2015

“Violence. Enough Already”: Findings from a Global Participatory Survey among Women Living with HIV

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.

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.

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.

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 experiencedaBefore 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 spouse208 (43)80 (17)70 (15)282 (59)181 (38)17 (4)480 (100)
From a family member/neighbours75 (16)80 (17)112 (24)215 (45)244 (51)16 (3)475 (100)
In the community76 (16)109 (23)146 (32)250 (53)196 (42)25 (5)471 (100)
In health settings28 (6)133 (28)164 (35)253 (53)209 (44)13 (3)475 (100)
From police/military/prison or detention services44 (9)34 (7)26 (6)78 (17)360 (77)31 (7)469 (100)
Fear of violence118 (25)136 (29)184 (39)322 (68)140 (30)11 (2)473 (100)
aCategories in columns 2 to 4 are not mutually exclusive. Only columns 5 to 7 add up to 100% across each row.

Table 3

What women living with HIV think are the most important ways to address or prevent gender-based violence
StrategyCritical 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 HIV363 (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 services332 (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/counselling330 (71)114 (24)9 (2)13 (3)466 (100)
 Increase access to harm reduction-based treatment for women who use drugs238 (51)178 (38)26 (6)23 (5)465 (100)
 Address alcohol abuse206 (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 HIV376 (80)79 (17)9 (2)8 (2)472 (100)
 Strengthen legal protections around all forms of violence against women/gender-based violence358 (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/transmission235 (51)112 (24)63 (14)48 (10)458 (100)
 Remove laws which criminalize same sex practices181 (40)131 (29)97 (21)48 (11)457 (100)
 Remove laws which criminalize sex work166 (35)153 (33)89 (19)61 (13)469 (100)
 Remove laws which criminalize drug use157 (34)148 (32)106 (23)54 (12)465 (100)
Through financial security
 Increase social protection for women and children333 (71)116 (25)12 (3)8 (2)469 (100)
 Increase access to employment for women, including transgender women269 (58)153 (33)26 (6)17 (4)465 (100)

Full article at:

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. ( ten.tsurtrednamalas@ecila)

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