7122Impact of intimate partner violence on women's risk of HIV acquisition and engagement in HIV care cascade in sub-Saharan Africa: a meta-analysis of population-based surveys

S. Kuchukhidze * (1), D. Panagiotoglou (1), M.-C. Boily (2), S. Diabaté (3), J. Eaton (2), F. Mbofana (4), L. Sardinha (5), L. Schrubbe (6), H. Stöckl (7), R. Wanyenze (8), M. Maheu-Giroux (1) (1) McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Canada, (2) Imperial College London, Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, London, United Kingdom, (3) Université Laval, Département de Médecine Sociale et Préventive, Quebec City, Canada, (4) Conselho Nacional de Combate ao HIV/Sida, Maputo, Mozambique, (5) University of Bristol, Bristol Poverty Institute, School for Policy Studies, Bristol, United Kingdom, (6) London School of Hygiene & Tropical Medicine, Department of Population Health, Faculty of Epidemiology and Population Health, London, United Kingdom, (7) Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometry, and Epidemiology, Munich, Germany, (8) Makerere University, Department of Disease Control and Environmental Health, School of Public Health, Kampala, Uganda

BACKGROUND: Achieving the 95-95-95 targets for HIV diagnosis, treatment, and viral load suppression (VLS) to end the AIDS epidemic hinges on eliminating manifestations of structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa (SSA) has among the world's highest prevalence of IPV and HIV but an examination of the impact of IPV on HIV incidence, and women's engagement in HIV care cascade is yet to be conducted.
METHODS: We pooled individual-level data from all available nationally representative surveys with information on physical and/or sexual IPV in SSA (2000-2020;Figure). We used generalized estimating equations with robust standard errors to estimate adjusted prevalence ratios (aPR) of lifetime and past year experience of IPV on HIV incidence (measured cross-sectionally by recent infection testing algorithm), past-year HIV testing (self-reported), antiretroviral therapy (ART) uptake, and VLS among ever-partnered women. Models were adjusted for age, age at first sex, residence type, women's marital status, women's education, and survey as a proxy of time and country.
RESULTS: Fifty-nine surveys were available from 30 countries, encompassing over 273,000 (N_i) respondents. Most surveys were from East Africa (48%); median survey year was 2013. Overall, 32% of women reported lifetime physical and/or sexual IPV (N_i=255,564) and 22% experienced IPV in the past year (N_i=273,603). Women exposed to past year IPV were 2.75 times (95%CI:1.26-6.00;N_i=19,852) more likely to have a recent HIV infection, adjusting for potential confounders. Past year IPV was not associated with HIV testing (aPR=1.00, 95%CI:0.98-1.01;N_i=273,603), but women living with HIV experiencing IPV in the last year were 10% less likely to be on ART (aPR=0.90; 95%CI:0.82-0.99;N_i=5,205) and to achieve viral suppression (aPR=0.90; 95%CI:0.81-0.99;N_i=5,205).
CONCLUSIONS: IPV was associated with increased HIV incidence and, among women living with HIV, lower ART uptake and VLS. Preventing IPV is inherently imperative, and a crucial milestone in reducing population-level HIV incidence and burden.