Violence experience of women living with HIV: a global study

Violence. Enough already: findings from a global participatory survey among women living with HIV.

Orza L, Bewley S, Chung C, Crone ET, Nagadya H, Vazquez M, Welbourn A. J Int AIDS Soc. 2015 Dec 1;18(6 Suppl 5):20285. doi: 10.7448/IAS.18.6.20285. eCollection 2015.

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.

Abstract [1]  Full-text [free] access [2]

Editor’s notes: Violence against women who are living with HIV is common globally. This paper reports on a study of 832 women living with HIV from 94 countries who participated in an online survey, recruited through a non-random snowball sampling model. The survey comprised quantitative and qualitative (free text) components. Participants included women who had ever or were currently using injection drugs (14%), who had ever or were currently selling sex (14%), and who had ever or were currently homeless (14%). Lifetime experience of violence among respondents was high (86%). Perpetrators included: intimate partner (59%), family member / neighbour (45%), community member (53%), health care workers (53%) and police, military, prison or detention services (17%). Findings suggest that violence is not a one off occurrence and cannot easily be packaged as a cause or a consequence of HIV. Instead violence occurs throughout women’s lives, takes multiple forms, and has a complex and iterative relationship with HIV.

The study population did not represent all women living with HIV, and was biased towards women with internet access who have an activist interest. Nonetheless, the study provides further evidence of the breadth and frequency of gender based violence experienced by women living with HIV. Key recommendations for policy makers include training of health care workers working in sexual and reproductive services to offer non-discriminatory services to women living with HIV and to effectively respond to disclosures of gender based violence (such as intimate partner violence) as part of the package of care.

Africa [12], Asia [13], Europe [14], Latin America [15], Northern America [16], Oceania [17]
Algeria [18], Angola [19], Argentina [20], Armenia [21], Australia [22], Austria [23], Azerbaijan [24], Belarus [25], Belgium [26], Belize [27], Bolivarian Republic of Venezuela [28], Bolivia [29], Botswana [30], Burkina Faso [31], Burundi [32], Cambodia [33], Cameroon [34], Canada [35], Chile [36], China [37], Colombia [38], Costa Rica [39], Côte d'Ivoire [40], Czech Republic [41], Democratic Republic of the Congo [42], Denmark [43], Dominican Republic [44], Ecuador [45], El Salvador [46], Estonia [47], Ethiopia [48], France [49], Gabon [50], Germany [51], Ghana [52], Greece [53], Guatemala [54], Honduras [55], Hungary [56], India [57], Indonesia [58], Ireland [59], Italy [60], Jamaica [61], Kazakhstan [62], Kenya [63], Kyrgyzstan [64], Lesotho [65], Malawi [66], Mali [67], Mexico [68], Moldova [69], Morocco [70], Mozambique [71], Myanmar [72], Namibia [73], Nepal [74], Netherlands [75], New Zealand [76], Nicaragua [77], Nigeria [78], Norway [79], Panama [80], Paraguay [81], Peru [82], Poland [83], Republic of the Congo [84], Romania [85], Russian Federation [86], Rwanda [87], Serbia [88], South Africa [89], Spain [90], Sri Lanka [91], Sudan [92], Swaziland [93], Switzerland [94], Tajikistan [95], Togo [96], Transdniestria [97], Turkey [98], Uganda [99], Ukraine [100], United Kingdom [101], United Republic of Tanzania [102], United States of America [103], Uruguay [104], Uzbekistan [105], Viet Nam [106], Zambia [107], Zimbabwe [108]
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