Gender Based Violence and HIV Infection: Overlapping Epidemics in Brazil

Submitted by: Kristin Kay Gundersen 
Co-Authors: Jamila K. Stockman, Kiyomi Tsuyuki, Daniela Knauth, and Regina Maria Barbosa

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 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, please contact Kristin Kay Gundersen:
kkgundersen@ucsd.edu

Follow SVRI and WBG Development Marketplace Awards
@theSVRI @WBG_Gender and #GBVSolutions #16Days

 

Key Words: Gender-based Violence | Violence Against Women | Women | HIV | Brazil | South America

_________________________________________________________________

Kristin Kay Gundersen, M.S.W. is a Research Program Manager in the Division of Global Public Health at the University of California, San Diego, overseeing multiple research studies on intimate partner violence (IPV) and various health outcomes among vulnerable populations. Ms. Gundersen has an extensive background in managing and implementing mixed methods research studies and community-based interventions, both nationally and internationally. Formerly, a Research Fellow at the University of Southern California (USC), her research focus included trauma, sexual violence, and rape culture. She holds a Master of Social Work from USC with a concentration in community, organization, policy, and administration and a Bachelor’s degree in Psychology and Social Behavior from the University of California, Irvine. Additionally, Ms. Gundersen is the co-founder of a nonprofit organization that seeks to empower survivors of gender-based violence globally. 

Jamila K. Stockman, Ph.D., M.P.H. is an Associate Professor of Medicine and Global Public Health at the University of California, San Diego (UCSD) and Director of the Disparities Core of the UCSD Center for AIDS Research. As an epidemiologist by training, her research focuses on the intersecting epidemics of intimate partner violence and sexual violence, HIV acquisition and transmission, and substance abuse among marginalized populations in the United States, Latin America and the Caribbean. Dr. Stockman is also involved with various domestic violence steering committees and community-based organizations working to address the deleterious effects of violence and HIV in families and relationships. 

 Kiyomi Tsuyuki, Ph.D. M.P.H. is an Assistant Project Scientist in the Division of Global Public Health, Department of Medicine at the University of California, San Diego. Dr. Tsuyuki has a PhD in Community Health Sciences from the University of California, Los Angeles (UCLA) with a minor in Sociology, and an MPH in Health Behavior & Health Education from the University of Michigan, Ann Arbor with a concentration in women’s and reproductive health. She is a trained health demographer with research focus on elucidating the multi-level effects of socio-structural inequity on co-morbid substance use disorders, violence, and HIV/STI prevention and treatment. Dr. Tsuyuki has almost 10 years of experience conducting research with colleagues in Brazil.

 Daniela Riva Knauth, Ph.D. is a Professor of Social Medicine at the Federal University of Rio Grande do Sul, Porto Alegre. She is a trained medical anthropologist with expertise in gender and the sexual and reproductive health of people living with HIV. Dr. Knauth’s research is on the forefront of identifying contexts of risk for heterosexual HIV transmission in Brazil, with a focus on risk dynamics and barriers to care among both women and men. She has successfully participated in numerous research collaborations with Dr. Regina Maria Barbosa over the past 16 years, including publishing peer-reviewed manuscripts and conducting studies among women living with HIV to understand contextual nuances of the epidemic in Porto Alegre and São Paulo, Brazil. 

Regina Maria Barbosa, M.D., Ph.D. M.P.H. is Vice President and Director of the largest AIDS NGO in Brazil – ABIA – and Professor and Senior Researcher at the Population Studies Center (NEPO) at the University of Campinas (UNICAMP), São Paulo, Brazil. Dr. Barbosa is a nationally recognized leader in sexual and reproductive health and rights research among women in Brazil.  Her research over the past 32 years has significantly contributed to understanding the role of gender and power in the sexual relationships, women’s access and right to access various forms of contraception (e.g., female sterilization, emergency contraception, female condom), and investigating the socio-structural barriers for women living with HIV to access these contraceptives. Dr. Barbosa has pioneered this work among women living with HIV/AIDS, adolescents, and lesbians. 

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