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Gender-based violence and HIV infection: Overlapping epidemics in Brazil

Kristin Kay Gundersen's picture
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One woman is victimized by violence every 15 seconds in Brazil, with a total of 23% of all Brazilian women experiencing violence in their lifetime. There are many notable consequences affecting victims of gender-based violence, yet many health consequences of violence have not been widely addressed in Brazil. This leads to the question: Are victims of gender-based violence at a higher risk for HIV infection in Brazil?
 
Brazil has 730,000 people living with HIV, the largest number in Latin America and the Caribbean. Brazil is also one of 15 countries that account for 75% of the number of people living with HIV worldwide. Although the HIV epidemic in Brazil is classified as stable at the national level, incidence is increasing in various geographic regions and among sub-groups of women.
 
Rates of violence against women (VAW) are particularly high in the Southeastern and Southern regions of Brazil. These regions also have the highest HIV prevalence, accounting for 56% and 20% of all the people living with HIV in Brazil, respectively. Violence and HIV in Brazil are clearly linked, with 98% of women living with HIV in Brazil reporting a lifetime history of violence and 79% reporting violence prior to an HIV diagnosis.
 
Despite these statistics, there is limited research in Brazil examining VAW in relation to HIV. Accordingly, a bi-national collaboration of researchers from the University of California, San Diego, University of Campinas, São Paulo and the University of Rio Grande do Sul, Porto Alegre developed an innovative study to investigate these intersecting epidemics.
 
The focus of the study is in the regions of Brazil with the highest rates of VAW and highest prevalence of HIV: São Paulo in the Southeastern region and Porto Alegre in the Southern region.
 
The aims of the research were to describe the contextual factors of violence victimization among women in Brazil and to examine the association with HIV infection.
 
The study merged two population-based studies with identical sampling methodologies conducted in the São Paulo and Porto Alegre, Brazil. Women ages 18-49 years were sampled from public health centers, including 2,000 women from São Paulo and 1,326 from Porto Alegre. These women were administered surveys that gathered extensive data on violence victimization and social-ecological factors on access to preventative health services.


 
Below are key preliminary findings:

Lifetime Prevalence of Violence Among Women in Brazil 
 

 Any Violence: 
 

 
Type of Violence Experienced:

Physical Violence
  • 25% of women experienced physical violence on two or more occasions
  • Timing: 45% experienced physical violence during childhood or adolescence
 Sexual Violence
  • 6.6% experienced sexual violence on two or more occasions
  • Timing: 39.8% experienced sexual violence during childhood or adolescence
    
  


Violence and HIV Infection

 
Women who experienced:
  • Any lifetime violence – 1.63 x greater odds of HIV infection
  • Lifetime physical violence – 1.47 x greater odds of HIV infection
  • Lifetime sexual violence – 2.13 greater odds of HIV infection
  • Sexual violence during first sexual experience – 2.57 x greater odds of HIV infection

The most notable finding: Women were at increasingly greater odds of being HIV-positive with greater frequency of experiencing physical violence and sexual violence during their lifetime.
 
To answer the original question, women who were victimized at some point in their lifetime had greater risk of HIV infection in Brazil. These findings are consistent with studies across the world that have investigated the association between violence victimization and HIV infection.
 
These findings support the development of integrated violence prevention programs and HIV care programs for women in Brazil. Prevention programs around the globe have been most successful in integrating gender-based violence prevention strategies into existing HIV programming. Brazil’s socialized national healthcare system, as well as the HIV healthcare program, provides vast opportunity to reduce these overlapping epidemics in women.

The World Bank Group and the Sexual Violence Research Initiative (SVRI) recently awarded a total of $1.2 million to this research team and eight other teams from around the world, in recognition of their innovations to prevent gender-based violence.
 
For more information on this study, contact Kristin Kay Gundersen at kkgundersen@ucsd.edu

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