A Global, Systematic Review of Intervention Studies to Address the Intersection of Gender-Based Violence and HIV: State of the Science and Future Directions

Background and Purpose: Overlapping gender-based violence (GBV) and HIV has received significant attention in recent years. Ongoing concentrated epidemics of HIV worldwide combined with the individual level complications of being exposed to GBV and HIV (GBV-HIV), and research on the syndemic effect of GBV-HIV on morbidity and mortality have served as the impetus for new multi-level interventions. However, to date, there have been no comprehensive review papers on the efficacy of GBV-HIV interventions, globally. This paper summarizes the state of the science with respect to GBV-HIV interventions and provides recommendations for future research and practice.

Methods: Following PRISMA guidelines, we conducted a systematic review of GBV-HIV interventions. To be included, studies had to report outcomes related to both GBV and HIV. Specifically, we included: 1) integrated interventions developed and tested to address dual risk or exposure to GBV and HIV; 2) interventions where GBV was the primary outcome and HIV-related outcomes were secondary, or vice-versa; and 3) studies utilizing varied research designs (e.g. pilot studies, RCTs) and levels of intervention (e.g. individual, dyadic, structural). Although the authors use the term GBV, an inclusive review approach was taken, understanding that violence occurs within same sex relationships, against LGBTQI populations, and that men may also be victims.

Results: 3257 peer-reviewed papers were identified in the search; 98 met the inclusion criteria, and yielded a total of 57 studies. The vast majority of the studies were RCTs conducted in African countries, North America, and India, and targeted women, with fewer than 20 studies focusing on men, couples/dyads, families, or the larger community. Among the studies targeting women, eligibility often focused on marital status, engagement in female sex work, or substance use. Virtually no studies focused on LGBTQI populations, or men as victims/survivors. Only five studies focused on adolescent populations. Studies were primarily individual level interventions, with less than half classified as multi-level or structural level interventions. Common core components included: empowerment, goal setting, safety planning, psychoeducation, skills building, HIV testing and counseling, harm reduction, and referrals to services. Examining outcomes, the majority of studies indicated varying degrees of successful HIV related outcomes (i.e. increased testing and counseling, reductions in risky sexual and substance use behaviors). GBV related outcomes, on the other hand, were widely inconsistent, with the exception of acceptance of GBV, where studies almost universally reported positive reductions.

Conclusions and Implications: Although there have been demonstrable successes in the development and testing of GBV-HIV interventions, several challenges and methodological gaps persist including limited follow-up periods and attention on adolescents, LGBTQI populations, and people living with HIV. Adolescents present a unique population for prevention and early intervention; LGBTQI populations and people living with HIV face unique challenges in service access and multiple forms of stigma that may increase their risk and potential for adverse outcomes related to GBV-HIV. Moreover, findings suggest an urgent need to shift away from primarily focusing interventions on women if we are to see successes in GBV-related outcomes, although there is growing attention on men/boys and communities at large.