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Abstract #153383

Kristin Dunkle, MPH PhD, Rollins School of Public Health and Center for AIDS Research, Emory Univeristy, 1518 Clifton Rd NE, Atlanta, GA 30322, +1 404 712-4702, kdunkle@sph.emory.edu and Rachel K. Jewkes, MBBS, MSc, MD, Gender and Health Research Group, Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa.

Background: Gender-based violence and gender inequality play an important role in driving the HIV pandemic, however empirical research linking violence and inequality to HIV serostatus remains limited. Most available evidence comes from sub-Saharan Africa, which is also home to most of the world's HIV positive women. Synthesizing this evidence is crucial for developing effective prevention policy and programs.

Methods: We reviewed studies from sub-Saharan Africa which link data on gender-based violence and gender inequality to HIV serostatus.

Results: Multiple pathways link gender-based violence and inequality to HIV infection among women: direct infection during sexual assault, reduction in women's power to determine the timing and circumstances of sex, and increased sexual risk as a consequence of violence. Gender power inequalities in the absence of overt violence are also associated with increased HIV infection among women. Men who perpetrate violence engage in higher levels of HIV risk behavior than non-perpetrators, and may be at higher risk for both acquiring and transmitting HIV. Interventions jointly targeting HIV risk taking and violence perpetration among men show preliminary evidence of efficacy.

Conclusions: Emerging evidence supports multiple pathways between gender-based violence, gender inequality, and HIV risk for both women and men in sub-Saharan Africa. The constraints placed on women's sexuality strongly suggest that men must be kept central in strategies for HIV prevention. We advocate a shift in focus to “gender transformative” policies and programs which move beyond acknowledging the status quo of violence and inequality in women's lives and actively seek to transform gender roles.

Learning Objectives:

1.Evaluate the research from sub-Saharan Africa pertaining to gender-based violence and HIV risk. 2.Articulate the mechanisms that determine a heightened risk for HIV among women living in sub-Saharan Africa as a function of gender-based violence.
• Recognize that interventions to prevent HIV infection and reduce gender-based violence must seek to transform societal gender-roles.

Keywords: Women and HIV/AIDS, Domestic Violence

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.