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BackgroundTransgender women (also known as transwomen) are disproportionately affected by all forms of gender-based violence (GBV). A high prevalence of physical, sexual and emotional violence not only predisposes transwomen to HIV infection but also limits uptake of HIV prevention, care and treatment services. Despite the high prevalence of HIV and GBV among the transwomen, there is limited evidence of how GBV affects uptake of HIV prevention, care and treatment services. This qualitative study therefore explored how GBV affects uptake of HIV prevention, treatment and care services among transgender women in the Greater Kampala Metropolitan Area (GKMA), Uganda. Methods This qualitative study was conducted among transgender women in the Greater Kampala Metropolitan Area. A total of 20 in-depth interviews, 6 focus group discussions and 10 key informant interviews were conducted to explore how GBV affects uptake of HIV prevention, treatment and care services among transgender women. Data were analyzed using a thematic content analysis framework. Data were transcribed verbatim, and NVivo version 12 was used for coding.ResultsAt individual level, emotional violence suffered by the transwomen led to fear of disclosing their HIV status and other health conditions to intimate partners and healthcare providers respectively; inability to negotiate condom use; and non-adherence to antiretroviral therapy (ART). Sexual violence compromised the ability of the transwomen to negotiate condom use with their intimate partners, clients and employers. Physical and emotional violence at community level led to fear among the transwomen to travel to healthcare facilities. Emotional violence suffered by the transwomen in healthcare settings led to limited use of pre-exposure prophylaxis and HIV testing services, denial of healthcare services and delays in receiving appropriate care. The fear of emotional violence also made it difficult for the transwomen to approach healthcare providers for services. Fear of physical violence such as being beaten while in healthcare settings made the transwomen shun healthcare facilities.Conclusion The effects of GBV on uptake of HIV prevention, care and treatment services were felt at the individual, community and healthcare settings. Across all levels, physical, emotional and sexual violence suffered by the transwomen led to the shunning of healthcare facilities, denial of healthcare services, delays in receiving appropriate care, and low use of post-exposure prophylaxis and HIV testing services. There is a need to develop and implement strategies/ interventions targeting a reduction in GBV, given its effects on the transmission of HIV. Interventions should include strategies to sensitize communities at accepting transgender women. Healthcare providers should create an environment at the healthcare facilities where transgender women can approach any healthcare provider of their choice so as to increase the uptake of HIV prevention, treatment and care services among transgender women.

Societal and legal impediments inhibit quality HIV prevention, care, treatment and support services and need to be removed. The political declaration adopted by UN member countries at the high-level meeting on HIV and AIDS in June 2021, included new societal enabler global targets for achievement by 2025 that will address this gap. Our paper describes how and why UNAIDS arrived at the societal enabler targets adopted. We conducted a scoping review and led a participatory process between January 2019 and June 2020 to develop an evidence-based framework for action, propose global societal enabler targets, and identify indicators for monitoring progress. A re-envisioned framework called the ‘3 S’s of the HIV response: Society, Systems and Services’ was defined. In the framework, societal enablers enhance the effectiveness of HIV programmes by removing impediments to service availability, access and uptake at the societal level, while service and system enablers improve efficiencies in and expand the reach of HIV services and systems. Investments in societal enabling approaches that remove legal barriers, shift harmful social and gender norms, reduce inequalities and improve institutional and community structures are needed to progressively realize four overarching societal enablers, the first three of which fall within the purview of the HIV sector: (i) societies with supportive legal environments and access to justice, (ii) gender equal societies, (iii) societies free from stigma and discrimination, and (iv) co-action across development sectors to reduce exclusion and poverty. Three top-line and 15 detailed targets were recommended for monitoring progress towards their achievement. The clear articulation of societal enablers in the re-envisioned framework should have a substantial impact on improving the effectiveness of core HIV programmes if implemented. Together with the new global targets, the framework will also galvanize advocacy to scale up societal enabling approaches with proven impact on HIV outcomes.

Objective(s): This study explored the effectiveness of gender-based violence (GBV) interventions on young people living with or affected by HIV in low- and middle-income countries (LMICs). Design: Systematic review and meta-analysis. Methods: We pre-registered a protocol, then searched thirteen databases and grey literature. We screened randomised and quasi-experimental studies (n = 2199) of young people (aged 10–24) living with or affected by HIV in LMICs. Outcomes were GBV and/or GBV-related attitudes. We appraised the data for risk of bias and quality of evidence. Narrative syntheses and multi-level random effects meta-analyses were conducted. Results: We included 18 studies evaluating 21 interventions. Intervention arms were categorised as: a) sexual health and social empowerment (SHSE) (n = 7); b) SHSE plus economic strengthening (n = 4); c) self-defence (n = 3); d) safer schools (n = 2); e) economic strengthening only (n = 2); f) GBV sensitisation (n = 2) and g) safer schools plus parenting (n = 1). Risk of bias was moderate/high and quality of evidence low. Narrative syntheses indicated promising effects on GBV exposure, but no or mixed effects on GBV perpetration and attitudes for self-defence and GBV sensitisation interventions. Safer schools interventions showed no effects. For SHSE interventions and SHSE plus economic strengthening, meta-analysis showed a small reduction in GBV exposure but not perpetration. Economic-only interventions had no overall effect. Conclusions: SHSE, SHSE plus and self-defence and gender sensitisation interventions may be effective for GBV exposure and GBV-related attitudes but not for GBV perpetration. However, the quality of evidence is poor. Future intervention research must include both boys and girls, adolescents living with HIV and key populations.

Sexual health and access to services are a pressing need for young people. This article introduces Link Up, a 3-year project in three African and two Asian countries, to enable and scale up access to integrated HIV services and sexual and reproductive health and rights for marginalized young people. The young people we worked with in this project included young men who have sex with men, young sex workers, young people who use drugs, young transgender people, young homeless people, and other vulnerable young people. The research and programmatic activities of Link Up, as illustrated in this Supplement, have highlighted the importance of recognizing and engaging with diversity among young people to improve access to services and outcomes protecting their health and human rights.

Sexual and reproductive health and rights have gained prominence in the HIV response. The role of sexual and reproductive health in underpinning a successful approach to HIV prevention, treatment, care, and services has increasingly been recognized. However, the "second R," referring to sexual and reproductive rights, is often neglected. This leads to policies and programs which both fail to uphold and fulfill these rights and which fail to meet the needs of those most affected by HIV by neglecting to take account of the human right-based barriers and challenges they face. In this commentary, the authors draw on the approach and practical experiences of the Link Up program, and the findings of a global consultation led for and by young people living with and most affected by HIV, to present a five-point framework to improve programming and health outomces by better protecting, respecting, and fulfilling the sexual health and reproductive rights of young people living with and most vulnerable to HIV.

To determine the sexual and reproductive health priorities of women living with human immunodeficiency virus (HIV) and to allow the values and preferences of such women to be considered in the development of new guidelines.A core team created a global reference group of 14 women living with HIV and together they developed a global community online survey. The survey, which contained mandatory and optional questions, was based on an appreciative enquiry approach in which the life-cycle experiences of women living with HIV were investigated. The same set of questions was also used in focus group discussions led by the global reference group.The study covered 945 women (832 in the survey and 113 in the focus groups) aged 15-72 years in 94 countries. Among the respondents to the optional survey questions, 89.0% (427/480) feared or had experienced gender-based violence, 56.7% (177/312) had had an unplanned pregnancy, 72.3% (227/314) had received advice on safe conception and 58.8% (489/832) had suffered poor mental health after they had discovered their HIV-positive status.The sexual and reproductive health needs and rights of women living with HIV are complex and require a stronger response from the health sector. The online survey placed the voices of women living with HIV at the start of the development of new global guidelines. Although not possible in some contexts and populations, a similar approach would merit replication in the development of guidelines for many other health considerations.Déterminer les priorités en matière de santé sexuelle et génésique des femmes vivant avec le virus de l'immunodéficience humaine (VIH) et permettre la prise en considération des valeurs et préférences de ces femmes lors de l'élaboration de nouvelles lignes directrices.Une équipe de base a formé un groupe de référence mondial, composé de 14 femmes vivant avec le VIH, avec lequel elle a préparé une enquête communautaire en ligne à l'échelle mondiale. Cette enquête, qui comportait des questions obligatoires et facultatives, s'appuyait sur une démarche appréciative qui a permis d'examiner l'expérience de vie des femmes vivant avec le VIH. La même série de questions a été utilisée lors de réunions de groupes de discussion animées par le groupe de référence mondial.L'étude a pris en compte 945 femmes (832 qui ont répondu à l'enquête et 113 dans les groupes de discussion) âgées de 15 à 72 ans dans 94 pays. Parmi les femmes ayant répondu aux questions facultatives de l'enquête, 89,0% (427/480) craignaient ou avaient déjà subi des violences sexistes, 56,7% (177/312) avaient eu une grossesse non désirée, 72,3% (227/314) avaient reçu des conseils sur la conception en toute sécurité et 58,8% (489/832) avaient connu des problèmes de santé mentale après avoir appris qu'elles étaient séropositives.Les droits et les besoins des femmes vivant avec le VIH en matière de santé sexuelle et génésique sont complexes et nécessitent une réponse plus forte du secteur de la santé. Cette enquête en ligne a permis aux femmes vivant avec le VIH de faire entendre leur voix pour l'élaboration de nouvelles lignes directrices mondiales. Bien que cela ne soit pas possible dans certains contextes et certaines populations, une démarche similaire mériterait d'être appliquée à l'élaboration de lignes directrices concernant de nombreuses autres questions de santé.Determinar las prioridades de salud sexual y reproductiva de mujeres que viven con el virus de la inmunodeficiencia humana (VIH) y permitir la consideración de los valores y preferencias de dichas mujeres en el desarrollo de nuevas directrices.Un equipo básico ha creado un grupo de referencia mundial de 14 mujeres que viven con el VIH, las cuales, juntas, han desarrollado una encuesta comunitaria en línea a nivel mundial. La encuesta, que contiene preguntas obligatorias y opcionales, se basó en un enfoque de investigación apreciativa en el cual se han estudiado las experiencias vitales de mujeres que viven con el VIH. También se utilizó el mismo conjunto de preguntas en grupos de discusión dirigidos por el grupo de referencia mundial.El estudio cubrió 945 mujeres (832 en la encuesta y 113 en los grupos) de 94 países de edades comprendidas entre los 15 y los 72 años. Entre las encuestadas que respondieron las preguntas opcionales, el 89,0% (427/480) había temido o experimentado violencia de género, el 56,7% (177/312) había sufrido un embarazo no deseado, el 72,3% (227/314) había recibido asesoría sobre la concepción segura y el 58,8% (489/832) había sufrido problemas de salud mental tras descubrir que son VIH positivas.Las necesidades de salud sexual y reproductiva y los derechos de las mujeres que viven con el VIH son complejos y requieren una mayor respuesta por parte del sector sanitario. La encuesta en línea dio voz a mujeres que viven con el VIH al principio del desarrollo de nuevas directrices mundiales. Aunque en algunos contextos y poblaciones resulta imposible, es necesario adoptar un enfoque similar en el desarrollo de directrices por muchos otros motivos sanitarios.تحديد أولويات الصحة الجنسية والإنجابية لدى النساء المتعايشات مع فيروس نقص المناعة البشري (HIV) والسماح بمراعاة القيم التي تؤمن بها هؤلاء النساء وتفضيلاتهن عند وضع المبادئ التوجيهية الجديدة.تولى فريق أساسي إعداد فريق مرجعي عالمي يتكون من 14 امرأة متعايشة مع فيروس نقص المناعة البشري (HIV) وتعاون الفريقان في إنشاء استطلاع للرأي عبر الإنترنت من خلال مجتمع عالمي. واعتمد استطلاع الرأي – الذي تضمن بعض الأسئلة الإجبارية وأخرى اختيارية – على أسلوب الاستقصاء الإيجابي الذي تم من خلاله البحث في تجارب النساء المتعايشات مع فيروس نقص المناعة البشري (HIV) في مراحل الحياة المختلفة. وتم أيضًا استخدام نفس مجموعة الأسئلة في النقاشات التي أدارها الفريق المرجعي العالمي فيما بين أعضاء مجموعة التركيز.شملت الدراسة 946 امرأة (حيث تضمنت الدراسة 832 منهن بينما شملت مجموعات التركيز 113 منهن) من 94 دولة، وتراوحت أعمارهن بين 15 و72 سنة. واشتملت مجموعة المشاركات اللاتي أجبن على الأسئلة الاختيارية في استطلاع الرأي على 89.0‏% (‏427/480) ممن عانين من الخوف أو العنف ضد المرأة، و56.7‏% (177‏/312) ممن تعرضن للحمل دون تخطيط منهن، و72.3‏% (‏227/314) ممن تلقين النصح بشأن الحمل الآمن و58.8‏‏% (489‏/832) ممن عانين من تدهور الصحة العقلية بعد اكتشافهن حالة الإصابة بفيروس نقص المناعة البشري (HIV).تتسم الاحتياجات والحقوق المتعلقة بالصحة الجنسية والإنجابية التي تستحقها النساء المتعايشات مع فيروس نقص المناعة البشري (HIV) بالتعقيد ويتطلب الأمر استجابة أكثر قوة من جانب قطاع الصحة. وقد وضع استطلاع الرأي عبر الإنترنت أصوات النساء المتعايشات مع فيروس نقص المناعة البشري (HIV) في بداية مراحل وضع المبادئ التوجيهية العالمية الجديدة. ويجدر اتباع أسلوب منهجي مماثل أثناء وضع المبادئ التوجيهية المتعلقة بالعديد من الاعتبارات الصحية الأخرى، رغم عدم إمكانية تطبيق ذلك في ظل بعض الظروف والتركيبات السكانية.旨在确定感染艾滋病毒 (HIV) 女性的性和生殖健康，并在制定新指南过程中考虑此类女性的价值和偏好。.核心团队创建一支由 14 名感染艾滋病毒女性组成的全球参照组，共同开展全球社区在线调查。本次调查采用肯定式询问法，包含一些必答和选答问题，从而调查感染艾滋病毒女性的生命周期体验。同一组问题同样用于全球参照组主导的重点小组讨论。.本次调查涉及 94 个国家中 945 名 15-72 岁的女性（参与调查的 832 名和重点小组的 113 名）。参与选答问题调查的受访者中，89.0% (427/480) 害怕或曾体验过性别暴力；56.7% (177/312) 曾经历了意外怀孕；72.3% (227/314) 获得过安全概念的建议及 58.8% (489/832) 在发现其 HIV 检测结果呈阳性后患上心理问题。.感染艾滋病毒女性的性和生殖健康需求及权利很复杂，需要卫生部门给予更有力的回应。本次在线调查在开始制定全球新指南时，评定感染艾滋病毒女性的声音。尽管这在有些环境和人口不可能实现，但是出于众多其他卫生因素考虑，制定指南时，值得采用类似方法。.Определить приоритеты женщин, живущих с ВИЧ, в сфере сексуального и репродуктивного здоровья и создать возможности для того, чтобы их ценности и предпочтения были учтены при разработке новых руководящих принципов.Основная группа сформировала глобальную референтную группу из 14 женщин, живущих с ВИЧ, вместе с которой был подготовлен интернет-опрос мирового сообщества. В основу опроса, предполагающего как обязательные, так и дополнительные вопросы, был заложен поощрительный подход с целью изучения жизненного опыта женщин, живущих с ВИЧ. Глобальная референтная группа также проводила дискуссии в фокус-группах, в которых использовался тот же набор вопросов.В исследовании приняли участие 945 женщин (832 опрошенных и 113 членов целевых групп) в возрасте от 15 до 72 лет в 94 странах. Среди лиц, ответивших на факультативные вопросы, 89,0% (427 из 480) опасаются гендерного насилия или сталкивались с ним, 56,7% (177 из 312) сталкивались с незапланированной беременностью, 72,3% (227 из 314) консультировались на тему безопасной контрацепции, у 58,8% (489 из 832) развивалось какое-либо психическое расстройство после того, как у них был диагностирован ВИЧ-положительный статус.Потребности и права женщин, живущих с ВИЧ, в сфере сексуального и репродуктивного здоровья представляют собой сложную систему и требуют более значительных мер со стороны системы здравоохранения. Благодаря интернет-опросу голоса женщин, живущих с ВИЧ, получили приоритет при разработке новых руководящих принципов. Аналогичный подход стоит применять при разработке руководящих принципов для решения многих других задач здравоохранения, хотя при определенных условиях и для отдельных групп населения это не представляется возможным.

This commentary describes young people's leadership from the perspective of a youth-led organization in the Link Up project in Burundi, Réseau National des Jeunes vivant avec le VIH. It describes processes that enable young people to guide, influence, deliver, and improve health service provision; the challenges faced by Réseau National des Jeunes vivant avec le VIH and how they are addressing these challenges.

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

This article describes the achievements, challenges, and lessons emerging from the Parliamentarians for Women's Health (PWH) project. This ground-breaking pilot project has been implemented in Southern and East Africa. It attempted to support a different expression, or redefinition, of leadership – at the level of both parliamentarians and community members. It did this through facilitating dialogue and the exchange of information, views and analysis between MPs, civil-society organisations, HIV-positive women's networks, and community members. The article examines changes in attitude among individuals, mutual learning, policy processes and action generated at this ‘power interface’, and engenders a discourse on supporting leadership at disparate levels, emphasising the values of participation, GIPA,1 and experiential learning.

Introduction: Women living with HIV experience a disproportionate burden of mental health issues. To date, global guidelines contain insufficient guidance on mental health support, particularly regarding perinatal care. The aim of this article is to describe the extent and impact of mental health issues as experienced by women living with HIV on their sexual and reproductive health and human rights (SRH&HR). Methods: A global, mixed-methods, user-led and designed survey on SRH&HR of women living with HIV was conducted using snowball sampling, containing an optional section exploring mental health issues. Statistical quantitative data analysis included descriptive statistics, correlation and multiple linear regression analysis for the mental health responses. Thematic analysis of open free-text responses was performed for qualitative data. Results: A total of 832 respondents from 94 countries participated in the online survey with 489 responses to the optional mental health section. Of the respondents, 82% reported depression symptoms and 78% rejection. One-fifth reported mental health issues before HIV diagnosis. Respondents reported experiencing a 3.5-fold higher number of mental health issues after diagnosis (8.71 vs 2.48, t[488] 23.00, p

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).

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