1. Gender inequality and violence against women and girls
Professor Charlotte Watts FMedSci

2. Globally 1 in 3 women (30%) will experience physical and/or sexual violence by an intimate partner

3. Past year levels of intimate partner violence vary widely

4. Early and first sex is often forced or coerced
Note: Zimbabwe1 data only available for year olds
Source: Violence Against Children Surveys

5. Sexual and other forms of violence are common
Note: Zimbabwe1 data only available for year olds
Source: Violence Against Children Surveys

6. Sexual and other forms of violence are common
Sexual violence against girls is often perpetrated by a boyfriend or husband
Note: Zimbabwe1 data only available for year olds
Source: Violence Against Children Surveys

7. 3 cohort studies find exposure to violence is associated with new HIV infections: Meta-analysis RR of 1.28 ( %CI)
Li et al, J. Int. AIDS 2014
In east and southern Africa, percentage of HIV among women due to IPV estimated to be between 12% and 22%
Existing evidence from cohort studies is sufficient to confirm that there is an association between experiencing partner violence and enhanced risk of acquiring HIV – at least for some individuals in some setting.
Jewkes strongest study, demonstrates a rate ration of 1.65 in adjusted analysis for wome who have experience more than 1 episode of physical or sexual partner violence
Meta analysis of cohort studies by Li, and published in Journal of the International AIDS Society
While the degree of increased risk is modest, IPV can nonetheless have a substantial impact on population levels of HIV because the practice is highly prevalent. Existing studies estimate the attributable fraction of HIV due to IPV as between 12% and 22%.
Jewkes et al, The Lancet, 2010
LI meta-analysis includes 16 countries showed the IPV was significantly associated with HIV infection [12]and the overall incidence of IPV was even higher if US data were removed, supporting a greater magnitude of IPV and sexual violence for women and girls outside the US, which via direct and indirect effects could predispose these women and girls to HIV infection.

8. Gender inequality & violence undermine 90-90-90
in equality, social norms that condone violence
High prevalence of physical and/or sexual violence (women, HIV+ women,
sex workers, transgenders, orphans)
Physical violence, emotional abuse, fear of violence
Difficulty negotiating sex or condom use
Limited or no condom use
Increased risk of HIV acquisition / transmission
Reduced uptake and adherence to PMTCT
Vertical HIV transmission
Experience/fear of violence or other negative repercussions if HIV+ status becomes known to others
Barriers to HIV testing & disclosure
Barriers to accessing care & HIV treatment
Delayed uptake / reduced adherence to treatment
Increased morbidity & mortality

9. VIOLENCE IS
PREVENTABLE

10. Small Enterprise Foundation
The Intervention with Microfinance for AIDS & Gender Equity (IMAGE Study)
Paul Pronyk, Julia Kim, Tanya Abramsky, Godfrey Phetla, James Hargreaves, Linda Morison, Charlotte Watts, Joanna Busza, John Porter
SEF
Small Enterprise Foundation

11. SASA!: Uganda Action Awareness Support Start Awareness Support Action
Learning about the community
Selecting Community Activists
Fostering ‘power within’ staff and community activists
Helping activists gain confidence
Informal activities
Encouraging critical thinking about men’s ‘power over’ women
Strengthening skills and connections between community members
Joining ‘power with’ others to support change
Trying new behaviors, celebrating change
Fostering the ‘power to’ make positive change
Start
Awareness
Support
Action
Action
Awareness
Support
involving community members, leaders and institutions to build critical mass

12. Common elements of successful interventions
Multiple, mutually reinforcing components
Derived from well conceptualised theory of change
Engages both men and women (either together or sequentially)
Includes skills building elements and opportunities to practice them
Incorporates diffusion strategies