Tackling GBV and HIV: a joint approach

Raeena Hirve, Sexual and Reproductive Health Coordinator at Brook, discusses the links between Gender Based Violence and HIV and why work to prevent either must take both into account.

[Content warning: discussion of gender based violence including rape]

Gender Based Violence (GBV) describes violence that establishes, maintains or attempts to reassert unequal power relations based on gender. While we know that GBV is a human rights violation, research has indicated that it also acts as a barrier to HIV prevention, treatment and care.  

The World Health Organisation (WHO) has evidenced four critical pathways that explain the direct and indirect links between HIV and GBV¹. As a sexual health and wellbeing organisation carrying out HIV prevention work, it’s essential that Brook’s approaches and services are informed by these links. 

The first, and probably most obvious link, is the direct risk of HIV transmission as a consequence of rape or sexual violence. The risk of HIV transmission from a single incident of rape is possible but unlikely. However, repeated occurrences (such as in intimate relationships) can and do increase the risk of contracting HIV.  

Our approach to HIV prevention is therefore two-pronged. We tackle GBV through high-quality RSE training that works to deconstruct gender norms and discrimination, while also carrying out professionals training that raises awareness of these risks, so that people who have experienced rape are supported to access HIV prevention services – be that PEP or HIV testing.  

Conversely, an HIV diagnosis and disclosure of one’s status may act a trigger for different forms of violence (e.g. forced sterilisation) against women living with HIV, due to the stigma associated with HIV. Women living with HIV often face a continuum of stigma and discrimination at an individual and institutional level ranging from being unable to seek HIV treatment (due to fear, financial restrain, and reduced mobility), forced sterilisation, verbal, physical and sexual abuse.  

Our HIV prevention work at Brook trains professionals on how best to tackle the stigma and discrimination that people living with HIV may face. 

Through simple actions such as normalising conversation and using the correct language we can address the discriminatory behaviours that result from stigma, such as violence. 

Our outreach sessions at local hubs like pharmacies and libraries also provide an opportunity for people who ordinarily might not go to a sexual health clinic to ask for advice, learn more about HIV or even just collect condoms. 

The third link describes an indirect pathway of how gender inequality acts as a common determinant of GBV. Overarching factors that drive GBV and HIV include social gender norms as well as socioeconomic inequalities such as a lack of access to education and poverty. 

At Brook, challenging inequalities is central at every level of our approach to prevent both HIV and GBV. 

Through our RSE and professionals’ trainings; digital engagement (such as our Take Charge campaign); and in-person outreach in the community; we work to stop stigma, challenge harmful gender norms, and reduce barriers to access for marginalised communities. 

Lastly, while GBV can act an indirect factor for increased HIV risk, it can also act as a barrier to HIV services and adhering to treatment.  For example, women in abusive relationships are less likely to be able to negotiate condom use and practice safer sex.  Additionally, their ability to seek HIV testing and treatment services might be limited by their partners’ controlling behaviours.   

This emphasises the importance of ensuring that people have access to the right support services (e.g. counselling) and ensuring that their voices are heard. By making sure they have a safe space, people are more likely to disclose concerns (such as HIV status) that we can then act on to ensure that they have access to regular treatment and monitoring. By ensuring that professionals working in HIV treatment services are aware of this link, we can ensure that this is reflected in the services they provide.  

It is essential that we use a human rights approach when addressing GBV and HIV. We must undertake gender transformative approaches and ensure that we continue to challenge inequality and increase accessibility for all those who need it. Work at Brook will continue to reflect these strategies so that our HIV prevention efforts account for GBV and vice versa. 

¹ Most research has been conducted in heterosexual relationships where we know women are disproportionately affected by violence. This is however not to exclude violence that occurs against boys, men, trans persons. Hence in this piece, we use women.