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No abstract available. Keywords: HIV; women living with HIV; sexual and reproductive health; human rights; pregnancy; gender-based violence; anti-retroviral therapy; serodiscordant; serodifferent (Published: 8 March 2017) Citation: Orza L et al. Journal of the International AIDS Society 2017, 20(Suppl 1) :21469 http://www.jiasociety.org/index.php/jias/article/view/21469 | http://dx.doi.org/10.7448/IAS.20.2.21469

End-user involvement in HIV guidelines development is often little, late or absent. Other disciplines have long advocated ‘handing over the stick’ (i.e. power and control), as both ethical and strategic. Women HIV activists have called this respectful engagement with, and learning from, communities ‘MIWA’ (meaningful involvement of women living with HIV and AIDS).

Gender-based violence (GBV) is a significant human rights violation and a key driver of the HIV epidemic in southern and eastern Africa. We frame GBV from a broad human rights approach that includes intimate partner violence and structural violence. We use this broader definition to review how National Strategic Plans for HIV and AIDS (NSPs) in southern and eastern Africa address GBV. NSPs for HIV and AIDS provide the national-level framework that shapes government, business, donor, and non-governmental responses to HIV within a country. Our review of these plans for HIV and AIDS suggests that attention to GBV is poorly integrated; few recognize GBV and program around GBV. The programming, policies, and interventions that do exist privilege responses that support survivors of violence, rather than seeking to prevent it. Furthermore, the subject who is targeted is narrowly constructed as a heterosexual woman in a monogamous relationship. There is little consideration of GBV targeting women who have non-conforming sexual or gender identities, or of the need to tackle structural violence in the response to HIV and AIDS. We suggest that NSPs are not sufficiently addressing the human rights challenge of tackling GBV in the response to HIV and AIDS in southern and eastern Africa. It is critical that they do so.

Introduction : Women living with HIV are vulnerable to gender-based violence (GBV) before and after diagnosis, in multiple settings. This study’s aim was to explore how GBV is experienced by women living with HIV, how this affects women’s sexual and reproductive health (SRH) and human rights (HR), and the implications for policymakers. Methods : A community-based, participatory, user-led, mixed-methods study was conducted, with women living with HIV from key affected populations. Simple descriptive frequencies were used for quantitative data. Thematic coding of open qualitative responses was performed and validated with key respondents. Results : In total, 945 women living with HIV from 94 countries participated in the study. Eighty-nine percent of 480 respondents to an optional section on GBV reported having experienced or feared violence, either before, since and/or because of their HIV diagnosis. GBV reporting was higher after HIV diagnosis (intimate partner, family/neighbours, community and health settings). Women described a complex and iterative relationship between GBV and HIV occurring throughout their lives, including breaches of confidentiality and lack of SRH choice in healthcare settings, forced/coerced treatments, HR abuses, moralistic and judgemental attitudes (including towards women from key populations), and fear of losing child custody. Respondents recommended healthcare practitioners and policymakers address stigma and discrimination, training, awareness-raising, and HR abuses in healthcare settings. Conclusions : Respondents reported increased GBV with partners and in families, communities and healthcare settings after their HIV diagnosis and across the life-cycle. Measures of GBV must be sought and monitored, particularly within healthcare settings that should be safe. Respondents offered policymakers a comprehensive range of recommendations to achieve their SRH and HR goals. Global guidance documents and policies are more likely to succeed for the end-users if lived experiences are used. Keywords: HIV; women; human rights; gender-based violence; values and preferences; survey; intimate partner violence; evidence base. (Published: 1 December 2015) Citation: Orza L et al. Journal of the International AIDS Society 2015, 18(Suppl 5) :20285 http://www.jiasociety.org/index.php/jias/article/view/20285 | http://dx.doi.org/10.7448/IAS.18.6.20285