Data Based Conceptual Model of GBV and Women's Risk for HIV Contraction and Progression

Purpose: Construct a biobehavioral model of the linkages of Gender Based Violence and HIV acquisition and progression through biological and behavioral risk factors including the physiological stress and immune system dysfunction linkages, STI and vaginal wall physiology, forced anal sex, mental health (depression, PTSD, suicidality), and behavioral risks resulting from violence such as substance abuse, inconsistent condom use, and multiple partners.

Methods: Deductive processes from systematic reviews along with data from a large Case (N = 543 abused) Control (N = 358) study of women in the US Virgin Islands and the US mainland (Baltimore, MD) and a different study of  women living with AIDS (N = 200) in San Francisco was used to construct the conceptual model.    

Results: Women are at risk for HIV/AIDS through the contextual factors of attitudes toward women and the use of violence, direct risk through actual forced vaginal and anal sex by violent HIV+ partners, and indirect pathways of stress and immune system dysfunction from cumulative trauma (multiple forms of GBV, repeated acts of Intimate Partner Violence - IPV), increased risk of STI's increasing the penetrability of the vaginal wall both physically and physiologically, and behavioral risk such as inability to negotiate safe sex through fear of being beaten, having multiple partners, inconsistent condom use and mental health problems such as PTSD, depression, and substance abuse.  Once they have contracted HIV, they are at increased risk for progression of AIDS through decrease delay to testing related to IPV, decrease delay linkage to care related to IPV (IPV increases risk X3), decrease loss to follow up related to IPV (IPV X2), decrease ARV use (IPV < ½ as likely) and consistent use and increased viral suppression (IPV >2X failure; recent trauma > 4X failure).  They are also at increased risk for mortality from homicide by the violent partner and suicide.  

Conclusion:  Gender based violence, especially intimate partner violence complicates prevention of HIV increases transmission and enhances progression of the disease through multiple complicated direct and indirect biobehavioral pathways all of which provide opportunities for interventions.