Abused women more likely to contract HIV: McGill study

A McGill University study has found that women who are victims of domestic violence are three times more likely to contract the human immunodeficiency virus (HIV).

The article published in 'The Lancet HIV' reveals that there is a strong link between gender-based violence and HIV epidemics in some of the most affected countries. Among women living with the virus, those who have experienced domestic violence in the past year are 10 per cent less likely to have an undetectable viral load, the final step in treatment.

"About one in four women will experience physical or sexual violence in their lifetime," said McGill University projessor and Canada Research chair in population health modelling Mathieu Maheu-Giroux. "In some countries, more than 40 per cent of women have experienced this kind of abuse in the past year."

The data shows that the areas most affected are often experiencing a combined epidemic of domestic violence and HIV. In sub-Saharan Africa, the proportion of people living with HIV in the general population is high. Several countries in the South African cone are also affected, such as South Africa, Lesotho and Eswatini.

"Some areas of southern Africa may have HIV prevalences of 20 to 30 per cent. That's almost one in five or even one in three adults living with HIV," said the researcher. "In Canada, this proportion is less than one per cent."

Although the impact of domestic violence on HIV has been explored for some twenty years, access to new data has made it possible to examine the causality between the two phenomena in greater depth.

"Studies conducted since the early 2000s were only able to identify who was living with HIV. Today, new biomarkers allow us to know whether the infection was recently acquired or not. We can then determine what comes first: HIV infection or violence," said Maheu-Giroux.

Despite the studies, the causal structure between violence and HIV remains unclear. In cases of sexual violence, the risk of mucosal damage or abrasion is increased, which has a direct impact on HIV acquisition.

In contrast, physical violence does not directly affect the risk of contracting the virus, but can have a major impact on mental health.

"Where we see a difference is really in the viral load. It's thought that the mental health consequences could have a negative effect on adherence to treatment. If you don't take your pills, for example, the viral load can rebound," said the professor

UNAIDS TARGETS 95 PER CENT

In order to reduce the risk of transmission to their partners and increase their life expectancy, people living with HIV need to take a regimen of antiviral therapy, which makes their viral load undetectable.

"It doesn't cure HIV, but it will be so low in the blood that laboratory methods won't detect it. Studies have shown that if you don't detect HIV in the samples, the probability of it being transmitted to sexual partners is zero," said Maheu-Giroux.

The Joint United Nations Programme on HIV/AIDS, also known as UNAIDS, currently coordinates the global response to the virus with the aim of ending the AIDS epidemic by 2030.

The organisation's goals are that 95 per cent of people living with HIV are diagnosed, 95 per cent are on treatment, and 95 per cent of those treated have a suppressed viral load.

"By multiplying, we arrive at about 85 per cent of all people living with HIV who can no longer spread the virus. Several mathematical studies say that if we reduce the number of infectious people to 15 per cent, we will succeed in controlling the epidemic and eliminating HIV as a threat to public health," said the researcher.

He adds that the existence of an intersection between the two epidemics thus calls for more integrated interventions rather than having two separate vertical programmes.

"Because gender-based violence is so prevalent around the world, including in Canada, there is an urgent need to address domestic violence and HIV as mutually reinforcing threats to women's health and well-being," said Salome Kuchukhidze, a doctoral student in epidemiology and lead author of the paper, in a news release.

This report by The Canadian Press was first published in French on Jan. 15, 2023.