title: Addressing gender inequality and intimate partner violence as critical barriers to an effective HIV response in sub-Saharan Africa.
abstract: BACKGROUND
  In Africa, women and girls represent 57% of people living with HIV, with gender inequality and violence being an important structural determinant of their vulnerability. This commentary draws out lessons for a more effective combination response to the HIV epidemic from three papers recently published in JIAS.
  
  
  CONCLUSIONS
  Hatcher and colleagues present qualitative data from women attending ante-natal clinics in Johannesburg, describing how HIV diagnosis during pregnancy and subsequent partner disclosure are common triggers for violence within relationships. The authors describe the challenges women face in adhering to medication or using services. Kyegombe and colleagues present a secondary analysis of a randomized controlled trial in Uganda of SASA! - a community violence prevention programme. Along with promising community impacts on physical partner violence, significantly lower levels of sexual concurrency, condom use and HIV testing were reported by men in intervention communities. Remme and her colleagues present a systematic review of evidence on the costs and cost-effectiveness of gender-responsive HIV interventions. The review identified an ever-growing evidence base, but a paucity of accompanying economic analyses, making it difficult to assess the costs or value for money of gender-focused programmes.
  
  
  CONCLUSIONS
  There is a need to continue to accumulate evidence on the effectiveness and costs of different approaches to addressing gender inequality and violence as part of a combination HIV response. A clearer HIV-specific and broader synergistic vision of financing and programming needs to be developed, to ensure that the potential synergies between HIV-specific and broader gender-focused development investments can be used to best effect to address vulnerability of women and girls to both violence and HIV.
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; janet.seeley@lshtm.ac.uk.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D017954:Africa South of the Sahara / Q000453:epidemiology; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D011247:Pregnancy; D012742:Sex Offenses; D012959:Socioeconomic Factors; D013179:Spouse Abuse
keywords: gender inequality; interventions; intimate partner violence; sub-Saharan Africa