The world is closer than it has ever been to achieving sustained HIV epidemic control. Through commitment and collective action, the world is inching closer to meeting UNAIDS’ 95-95-95 goals, with some countries having already achieved this remarkable feat. 

Despite this incredible progress, micro-epidemics of HIV still persist among sub-populations who, due to structural and social factors, remain disproportionately vulnerable to and at risk of HIV infection, including adolescent girls and young women and key populations such as men who have sex with men, transgender persons, sex workers, people who inject drugs, and people in prisons or other enclosed settings. Two of the greatest barriers to achievement of equity in HIV and health outcomes for these populations is gender inequality and gender-based violence (GBV). Gender inequality and GBV drive unequal access to and inhibit the use of HIV prevention, testing, and treatment services, and impede individuals’ ability to practice and maintain healthy behaviors impacting their wellbeing, safety, and HIV outcomes. 

Gender Inequality and Gender-Based Violence as Barriers to Sustained HIV Epidemic Control

Globally, 35 percent of women experience intimate partner violence or non-partner sexual violence in their lifetime. Women who experience intimate partner violence are 1.5 times more likely to acquire HIV. Experience of GBV, particularly intimate partner violence, is associated with lower use of HIV antiretroviral treatment uptake and adherence, and significantly worsened viral suppression among women. Intimate partner violence is also associated with lower adherence to HIV pre-exposure prophylaxis (PrEP). 

Socio-cultural norms that sanction GBV fuel gender inequality and limit women and girls’ access to HIV and sexual and reproductive health services. Masculine gender norms that encourage behavioral risk-taking and discourage health-seeking behavior impact men and boys’ uptake of HIV testing and treatment services, resulting in the decreased likelihood of men and boys knowing their HIV status, initiating or remaining on HIV treatment, or attaining viral suppression. Additionally, members of key populations and gender and sexual minorities experience high levels of violence and gender-related stigma and discrimination that impacts their access to and uptake of HIV services. 

The human rights of women and men, girls and boys, and gender and sexual minorities of all ages and abilities are essential for people to access and use HIV prevention and treatment services; protect themselves and practice healthy behaviors; exercise their rights, and live free from violence, stigma, and discrimination.

Solutions to Addressing Gender Inequality and Gender-Based Violence in USAID’s HIV Programs

Gender inequality and GBV are hindering the global community from achieving sustained HIV epidemic control. This is among the reasons, UNAIDS launched the 10-10-10 goals, calling on the global community to address the social and legal barriers that limit access to and uptake of HIV services. These 10-10-10 goals include working to ensure that “less than 10 percent of women, girls, people living with HIV, and key populations experience gender inequality and violence.”

USAID is closely collaborating with national governments, local partners, and indigenous and civil society organizations to advance UNAIDS’ 10-10-10 goals and address gender inequality and GBV through the implementation of gender transformative community-led solutions and sustainable social welfare and health systems strengthening activities. 

Individual and Community Solutions

USAID has strategically integrated activities across HIV prevention, testing, and treatment services that address gender inequality and GBV, including violence against children, with the goal of improving HIV clinical outcomes and advancing health equity among adolescent girls and young women, key populations, and people living with HIV. An overview of these activities can be found in Figure 1. USAID supports the delivery of survivor- and person-centered differentiated integrated GBV/HIV services that are gender-affirming and grounded in a human rights approach. These activities are evidence-based, community-driven, informed by the World Health Organization (WHO) clinical and policy guidelines, and in alignment with the National Strategy on Gender Equity and Equality, the United States Strategy to Prevent and Respond to Gender-Based Violence Globally, and USAID’s Gender Equality and Women’s Empowerment Policy.

Figure 1: Addressing Gender Inequality and Gender-Based Violence across HIV Prevention and the Clinical Cascade



Health and Social Welfare Systems Solutions

USAID uses a health systems strengthening approach to enhance the sustainability of gender equity and equality and GBV prevention and response interventions within HIV services and systems. As illustrated in Figure 2, this approach rests on a foundation of gender equality and human rights for all and seeks to support the development, implementation, and monitoring of nationally-led solutions that

  • Are informed by multilateral strategies, normative guidance, and national policies that plan, fund, and deliver HIV and GBV services.
  • Support the integration of gender-responsive budgeting and financing for GBV services within national health budgets and funding mechanisms.
  • Rely on a health and social service workforce that is diverse, equitable, appropriately-compensated, technically-skilled, safe, and provided with quality mental health and psychosocial support services.
  • Rely on data and evidence to inform policy planning and service delivery.
  • Ensure continued availability of commodities within the minimum package of post-violence clinical care, including HIV post-exposure prophylaxis (PEP), emergency contraception, and prophylaxis and treatment for sexually transmitted infections, that are free of charge for survivors.
  • Ensure that HIV and GBV services are survivor-centered, gender-affirming, and trauma-informed, as well as accessible, acceptable, appropriate, for the people they serve.

Figure 2: Addressing Gender Inequality and Gender-Based Violence through Health Systems Strengthening

The goal of this approach is to strengthen countries’ health systems to sustainably respond to gender inequality and GBV in advancement of HIV epidemic control and equity in HIV outcomes for key populations, adolescent girls and young women, and people living with HIV. The sustainability of integrated HIV/GBV and gender transformative activities is enhanced through the implementation of a targeted systems strengthening approach implemented in close collaboration with national governments, local partners, and indigenous and civil society organizations to identify needs, gaps, and opportunities within countries’ health systems in relation to the national response to HIV, gender inequality, and GBV. An example of this is illustrated in Figure 3. 

Figure 3: Example of Health Systems Strengthening Activities to Respond to Gender Inequality and GBV within the National HIV Response

USAID’s Strategic Vision

USAID recognizes that sustained HIV epidemic control will never be achieved without addressing the social determinants of health that contribute to inequity in HIV and health outcomes for adolescent girls and young women, key populations, and people living with HIV. Through partnerships with governments and communities, USAID implements evidence-based, community-led interventions and sustainable systems strengthening activities to respond to gender inequality and GBV in advancement of 95-95-95 goals. As illustrated in Figure 4, this strategy is focused on growing countries’ gender and GBV programs within the national HIV response to:

  • Reach more individuals with gender transformative evidence-based HIV and gender-based violence prevention interventions and post-violence clinical care services;
  • Support quality and promote innovation within the integrated HIV/GBV response; and 
  • Sustain USAID’s investments at the national and community levels.

Figure 4: USAID’s Overarching Vision for Gender Equality and GBV within HIV Programming



For more information about USAID’s PEPFAR-funded gender equality and gender-based violence prevention, case identification, and response efforts, please see USAID’s Advancing Gender Equality and Preventing and Responding to Gender-Based Violence.