A woman and her smiling baby.
Credit: Jon Hrusa/EPA
Gender Equality and Gender-Based Violence
Gender inequality and gender-based violence are critical barriers to reaching 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. Experiences of gender-based violence, particularly intimate partner violence, is associated with lower use of HIV antiretroviral treatment, half the odds of self-reported antiretroviral treatment adherence, and significantly worsened viral suppression among women. Gender inequality, gender-based violence, and unrelenting stigma and discrimination are holding the global community back from achieving sustained control of the HIV epidemic.
Preventing and responding to gender-based violence and advancing gender equality are essential to meeting PEPFAR’s 95-95-95 goals. Gender inequality and gender-based violence impact HIV prevention and each phase of the HIV clinical cascade, underscoring the importance of addressing HIV, gender inequality, and gender-based violence concurrently.
Advancing gender equality and preventing and responding to gender-based violence are essential to meeting UNAIDS’s 95-95-95 goals and 10-10-10 targets. This means identifying and responding to the unique needs of women, men, girls, boys, and lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals – of all ages and abilities – so they are equally able to:
- Access and use HIV prevention, care, and treatment services;
- Protect themselves and practice healthy behaviors;
- Exercise their rights; and,
- Live lives free from violence, stigma, and discrimination.
USAID’s approach emphasizes the integration of interventions to prevent and respond to gender-based violence and promote gender equality in all HIV prevention and treatment services. USAID uses evidence-based interventions to prevent both HIV and gender-based violence, and the provision of clinical and nonclinicalpost-violence care integrated in HIV services, such as HIV pre-exposure prophylaxis (PrEP), index testing, and care and treatment services.
This is reflected not only in the way HIV services are designed and delivered, but also in how they are measured and monitored. For example, in HIV prevention strategies, interventions to address the specific, harmful gender norms that reinforce behaviors that put individuals at risk for HIV are a part of individual-, group-, or community-based HIV prevention programs.
For biomedical prevention interventions such as PrEP, clients experiencing intimate partner violence are identified and provided appropriate support and referrals to GBV response services, improving their ability to successfully continue on PrEP.
GBV case identification during HIV testing, initiation on ART, and routine HIV appointments are essential to identify people living with HIV who are survivors of violence and provide them with timely and compassionate care, as well as support their linkage and adherence to and continuation of treatment. Those who disclose a fear of or current experience of violence should be offered post-violence care services per World Health Organization (WHO) guidelines, or provided escorted or active referrals to gender-based violence response services if none are available at the site where testing and treatment is provided. Such interventions will not only help provide survivors of gender-based violence with the care and support they need, but it will also help to improve their overall HIV outcomes with the goal of achieving viral suppression.
Addressing Violence and Inequality Across the HIV Cascade
Addressing Violence and Inequality Across the HIV Cascade
Addressing gender-based violence and gender inequality is key to achieving HIV epidemic control. USAID has integrated violence prevention, case identification, and response into each component of the HIV prevention and clinical cascade in order to improve HIV prevention and treatment outcomes and reach 95-95-95 goals.
USAID provided integrated gender-based violence clinical services in 23 countries. In 2022, over 400,000 survivors were provided with post-violence clinical care services through USAID’s programming support, which is a demonstrated increase in program growth from the previous year (in 2021, 316,344 survivors were reached).
In 2022, 429,698 individuals received post-violence clinical care services based on the minimum package. This was an achievement of 116 percent of USAID’s FY22 targets for the provision of post-violence clinical care. Since 2016, each year USAID has continued to reach more individuals with post-violence clinical care services. The majority of these services in 2022 were provided to females for physical and/or emotional violence. (Source: GBV Review Tableau Workbook, updated February 23, 2023)
In 2022, 429,698 individuals received post-violence clinical care services based on the minimum package. Per the World Health Organization Guidelines and current PEPFAR guidance, the full minimum package includes:
- rapid HIV testing with referral to care and treatment as appropriate, post-exposure prophylaxis (PEP),
- sexually transmitted infections (STI) screening/testing and treatment,
- emergency contraception (EC),
- counseling (other than counseling for testing, PEP, STI and EC), and,
- the treatment of serious or life-threatening medical issues (e.g., lacerations, broken bones).
This was an achievement of 116 percent of USAID’s FY22 targets for the provision of post-violence clinical care. Since 2016, each year USAID has continued to reach more individuals with post-violence clinical care services. The majority of these services in 2022 were provided to females for physical and/or emotional violence.
USAID continued to advance key technical priorities, emphasizing program quality and innovation. USAID’s implementing partners have employed strategies to increase the accessibility of integrated HIV and post-violence care services, including mobile services, hotlines, transportation assistance, virtual counseling, and first-line support. In addition, USAID continued to expand its network of local partners providing critical services to prevent and respond to gender-based violence and promote gender equality.
- USAID: Fighting Gender-Based Violence During COVID-19: A Success Story in Zimbabwe.
- USAID: Infographic: Gender-Based Violence as a Barrier to HIV Epidemic Control.
- PEPFAR: Gender and Sexual Diversity Training: A Facilitator's Guide for Public Health and HIV Programs.
- WHO: Responding to child maltreatment: a clinical handbook for health professionals.
- WHO: Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook