A woman and her smiling baby.
Credit: Jon Hrusa/EPA
Gender inequality and gender-based violence (GBV) are critical barriers to reaching HIV epidemic control. Globally, 35% 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, and experiences of GBV, particularly intimate partner violence, is associated with lower use of antiretroviral treatment, half the odds of self-reported ART adherence, and significantly worsened viral suppression among women. It is evident that 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 GBV and advancing gender equality are essential to meeting PEPFAR’s 95-95-95 goals. This graphic illustrates how gender inequality and GBV impact HIV prevention and each phase of the HIV clinical cascade, underscoring the importance of addressing HIV, gender inequality, and GBV concurrently.
Advancing gender equality and preventing and responding to gender-based violence are essential to meeting UNAIDS’s 95-95-95 goals. 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 GBV, and the provision of integrated post-violence care in HIV services such as index testing, pre-exposure prophylaxis (PrEP), and initiation of, adherence to, and retention in HIV treatment.
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, efforts to identify clients that may be currently experiencing or afraid of violence from an intimate partner are being offered in order to offer appropriate support and referrals to GBV response services, improving their ability to adhere to 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 retention in treatment. Those who disclose a fear of or current experience of violence should be offered post-GBV care services per WHO guidelines, or provided escorted or active referrals to GBV services if none are available at the site where testing and treatment is provided. Such interventions will not only help provide GBV survivors with the care and support they need, but it will also help to improve their overall HIV outcomes with the goal of viral suppression.
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 2021, over 300,000 survivors were provided with post-violence care services through USAID’s programming support, which is a demonstrated increase in program growth from the previous year (in 2020, 188,168 survivors were reached).
USAID FY21 Results: Number of people receiving post-GBV clinical care
In 2021, 316,348 individuals received post-violence clinical care services based on the minimum package. This was an achievement of 98% of USAID’s FY21 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 2021 were provided to females for physical and/or emotional violence. (Source: GBV Review Tableau Workbook, updated January 19, 2022)
USAID continued to advance key technical priorities, emphasizing program quality and innovation, particularly in response to COVID-19. USAID’s implementing partners continually adapted GBV services to respond to COVID-19, employing strategies such as mobile services, hotlines, transportation assistance, and 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 GBV 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 children and adolescents who have been sexually abused: WHO clinical and guidelines.
- WHO: Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook.