Targeting the SAVA (Substance Abuse, Violence, and AIDS) Syndemic among Women and Girls: A Global Review of Epidemiology and Integrated Interventions

Objectives: Multiple pathways link gender-based violence (GBV) to HIV and other sexually transmitted infections among women and girls who use or inject drugs. The aim of this article is to synthesize global literature that examines associations among the synergistic epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic. It also aims to identify a continuum of multilevel integrated interventions that target key SAVA syndemic mechanisms.

Methods: We conducted a selective search strategy, prioritizing use of meta-analytic epidemiological and intervention studies that address different aspects of the SAVA syndemic among women and girls who use drugs worldwide from 2000 to 2015 using PubMed, MEDLINE, and Google Scholar.

Results: Robust evidence from different countries suggests that GBV significantly increases the risk of HIV and other sexually transmitted infections among women and girls who use drugs. Multiple structural, biological, and behavioral mechanisms link GBV and HIV among women and girls. Emerging research has identified a continuum of brief and extended multilevel GBV prevention and treatment interventions that may be integrated into a continuum of HIV prevention, testing, and treatment interventions to target key SAVA syndemic mechanisms among women and girls who use drugs.

Conclusions: There remain significant methodological and geographical gaps in epidemiological and intervention research on the SAVA syndemic, particularly in low- and middle-income countries. This global review underscores the need to advance a continuum of multilevel integrated interventions that target salient mechanisms of the SAVA syndemic, especially for adolescent girls, young women, and transgender women who use drugs.

Below: Continuum of integrated GBV and HIV interventions to address SAVA syndemic among women and girls who use drugs

Full article at:   http://goo.gl/DgFZL1

By:   Gilbert, Louisa PhD^*; Raj, Anita PhD^†; Hien, Denise PhD^‡; Stockman, Jamila PhD^†; Terlikbayeva, Assel MD, MS^§; Wyatt, Gail PhD^‖

^*Social Intervention Group, Columbia University School of Social Work, New York, NY;

^†Division of Global Public Health, Department of Medicine, University of California, San Diego, CA;

^‡The Gordon Derner Institute of Advanced Psychological Studies, Adelphi University, New York, NY;

^§Global Health Center of Central Asia, School of Social Work, Columbia University Almaty, Kazakhstan; and

^‖Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA.

Correspondence to: Louisa Gilbert, PhD, 1255 Amsterdam Avenue, New York, NY 10027 (e-mail: lg123@columbia.edu). 

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Knowledge, Attitudes & Practices of Adolescents in Upper Egypt on Gender-Based Violence, with a Focus on Early Girls' Marriage

A large proportion of the female population all over the world, particularly in developing countries, experience some form of gender-based violence (GBV) during their life. Early marriage, a form of GBV, is particularly highly prevalent in rural Upper Egypt.

The aim of the current study was to assess the knowledge, attitudes and practices (KAP) of adolescents in Upper Egypt on domestic GBV, with a focus on early girls' marriage.

The study was a cross-sectional descriptive household survey targeting 400 randomly selected adolescent boys and girls aged 11-16 years from five villages of Minya Governorate in Upper Egypt.

The proportion of interviewed adolescents who could identify certain practices as forms of GBV was relatively low: the identified practices were mainly deprivation of work (9.0%), deprivation of inheritance (3.3%), arbitrary neglect and desertion (2.8%), and preventing from visiting relatives (0.5%). Abusive sexual behavior was not identified by any of the study participants as a form of domestic GBV. A total of 112 boys (56.0%) reported that they have been perpetrators in domestic GBV events at least once and 118 girls (59.0%) reported that they have been actual victims of domestic GBV. An overall 65.6% of study participants could correctly identify the legal age of marriage as 18 years, yet only 22.0% identified earlier ages of marriage as a form of domestic GBV. The vast majority of girls and boys reported that they would not agree to get married before the age of 18 years (91.0 and 87.0%, respectively).

Adolescents in Upper Egypt demonstrated a less than satisfactory knowledge about the forms of GBV. Although early girls' marriage was not universally recognized by adolescents as a form of domestic GBV, they demonstrated satisfactory knowledge about the legal age of marriage, as well as a tendency to abandon the practice. Establishing a community-based awareness program for adolescents of both sexes about GBV with a focus on early girls' marriage is highly recommended.

Purchase full article at:  http://goo.gl/EwKl2x

By: Mahmoud Ael D1.

• 1Community Medicine Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt. 

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