New evidence on link between partner violence and HIV shows need for urgent action

A major analysis of more than 280,000 women in sub-Saharan Africa has found that women who experienced intimate partner violence (IPV) in the last year were three times more likely to have recently got HIV than women who had not. Women with HIV who experienced IPV were also less likely to be virally suppressed. 

What is the research about?

Whether experiencing intimate partner violence increases women’s risk of getting HIV, and whether IPV affects women’s engagement with the HIV treatment cascade. Researchers analysed 57 national surveys from 30 sub-Saharan African countries collected between 2000 and 2020. The data represented around 280,260 women who were or had been in relationships with men (ages 15–64).

Why is this research important?

In 2021, women and girls accounted for 63% of all new HIV infections in sub-Saharan Africa. Young women (ages 15–24) are particularly at risk, as they are twice as likely to have HIV as young men.

One of the reasons for this is IPV. Having a male partner who is physically or sexually violent can stop a woman from having the agency, knowledge or financial means to protect her health. She may not be able to decide when and how to have sex, use condoms or PrEP or test for HIV. In addition, women with HIV are at an increased risk of partner violence, and this can stop them getting and staying on antiretroviral treatment (ART).

A lot of research has been done on HIV and IPV. But most studies have focused on single countries, specific groups of women, or on HIV infections only. This study uses more robust, multi-country data collected over the past 20 years to assess HIV and IPV across the whole HIV care cascade.

What did they find out?

Around one in five women (21%) had experienced physical or sexual IPV in the past year. This ranged between 29% of women in Central Africa to 15% of women in Southern Africa.

Women who had experienced IPV in the past year tended to be younger than women who had not. They were also more likely to have been educated to primary level only.

Women who had experienced IPV in the past year were 3.22 times more likely to have recently got HIV compared to women had not experienced IPV in the past year.

Around a quarter of women (26-27%) had tested for HIV in the previous 12 months. Half (52%) had tested for HIV at some point in their life. Experiencing IPV did not affect whether women tested for HIV.

Findings on whether experiencing IPV stopped women with HIV from taking ART were inconclusive. But women with HIV who experienced IPV in the past year were 9% less likely to be virally suppressed than women who had not.

What does this mean for HIV services?

There is a need for renewed and urgent attention to stop IPV in and of itself and to reduce women’s HIV risk.

If you are working on HIV prevention, advocating for policies and programmes that acknowledge the link between HIV and IPV is important. For example, healthcare providers and community health workers need to be trained to support women to safely disclose if they are experiencing IPV.

HIV prevention and care services also need to be designed in ways that will work for women who have violent partners. For example, women-only adherence support groups or safe, community-based ART or PrEP pick-up points could help women take care of their sexual and reproductive health in a safe way. To design support like this it is important to work with a diverse range of women who have experienced IPV. They can advise on what kind of support women who experience IPV need and how to provide it.