Gender-based violence and engagement in biomedical HIV prevention, care and treatment: a scoping review

Anna M Leddy,Ellen Weiss,Eileen Yam,Julie Pulerwitz

doi:10.1186/s12889-019-7192-4

Abstract

BackgroundWhile gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear. Clarifying how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP) - will not only provide insights into how to best meet individual women’s HIV care needs, but also inform public health oriented HIV epidemic control strategies.MethodsThrough a comprehensive scoping review, we synthesized and analyzed existing evidence regarding the influence of GBV on engagement in PrEP and the HIV care continuum among women living with HIV, including members of key populations (female sex workers, transgender women and women who use drugs). We explored PubMed, Scopus and Web of Science for peer-reviewed studies published in 2003–2017. Of the 279 sources identified, a subset of 51 sources met the criteria and were included in the scoping review.ResultsStudies were identified from 17 countries. The majority of studies utilized quantitative cross-sectional designs (n = 33), with the rest using longitudinal (n = 4), qualitative (n = 10) or mixed methods (n = 4) designs. Taken together, findings suggest that GBV impedes women’s uptake of HIV testing, care, and treatment, yet this can vary across different geographic and epidemic settings. Substantial gaps in the literature do still exist, including studies on the impact of GBV on engagement in PrEP, and research among key populations.ConclusionsThis scoping review contributes to our knowledge regarding the role GBV plays in women’s engagement in PrEP and the HIV care continuum. Findings reveal the need for more longitudinal research to provide insights into the causal pathways linking GBV and HIV care and treatment outcomes. Research is also needed to illuminate the impact of GBV on PrEP use and adherence as well as the impact of GBV on engagement along the HIV care continuum among key populations. It is critical that programs and research keep pace with these findings in order to reduce the global burden of GBV and HIV among women.

Highlights

While gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear
female sex workers (FSW), transgender women, and women who inject drugs are at even greater risk for HIV acquisition and HIV-related morbidity and mortality, due to their marginalized status in society, and the associated barriers they face in accessing HIV services [11]
We outline the evidence regarding the effects of experiences of violence on women’s engagement in the HIV care continuum and pre-exposure prophylaxis (PrEP)

Summary

Introduction

While gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear. Clarifying how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP) - will provide insights into how to best meet individual women’s HIV care needs, and inform public health oriented HIV epidemic control strategies. Marginalized populations including female sex workers (FSW), transgender women, and women who use drugs experience even higher rates of GBV, often perpetrated by intimate partners and non-partners such as representatives of the state [5,6,7]. FSW, transgender women, and women who inject drugs are at even greater risk for HIV acquisition and HIV-related morbidity and mortality, due to their marginalized status in society, and the associated barriers they face in accessing HIV services [11]. Members of these populations have been identified as ‘key populations’ by international HIV organizations including the Joint United Nations Programme on HIV/AIDS (UNAIDS) [12]

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Conclusion