The document presents findings from a systematic review of evaluated gender-integrated programs addressing the dual epidemic of HIV and gender-based violence (GBV) in low- and middle-income countries. It identifies 25 interventions, highlighting regional differences in strategies between sub-Saharan Africa and South Asia, and assesses their effectiveness in improving outcomes related to both GBV and HIV. The review concludes that tailored gender-integrated approaches can significantly impact health and violence outcomes by challenging unequal gender norms.

1. ADDRESSING THE DUAL EPIDEMIC OF HIV
AND GENDER-BASED VIOLENCE
Results from a Systematic Review of Evaluated Gender-integrated
Programs in Low- and Middle-income Countries
HEALTH
POLICY
P R O J E C T
PRESENTED BY Elisabeth Rottach,1
Sara Pappa,1
Arundati Muralidharan,2
Mahua Mandal,3
Jessica Fehringer,3
Madhumita Das,4
Radhika Dayal2
1
Health Policy Project, Washington, DC, United States, 2
Public Health Foundation of India, Gurgaon, India, 3
MEASURE Evaluation,
University of North Carolina, Chapel Hill, United States, 4
International Center for Research on Women, New Delhi, India
8th
IAS Conference on HIV Pathogenesis,
Treatment & Prevention
July 19–22, 2015, Vancouver, Canada
HEALTH
POLICY
P R O J E C T
The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for
International Development under Agreement No. AID-OAA-A-10-00067, beginning September
30, 2010. HPP is implemented by Futures Group, in collaboration with Plan International USA,
Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional
Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon
Alliance for Safe Motherhood (WRA).
The information provided in this document is not official U.S. Government information and does
not necessarily represent the views or positions of the U.S. Agency for International Development.
CONTACT US
Health Policy Project
1331 Pennsylvania Ave., Suite 600
Washington, DC 20004
www.healthpolicyproject.com
email: policyinfo@futuresgroup.com
Tel: +1.202.775.9680
Fax: +1.202.775.9684
SUMMARY
■■ The links between gender-based violence (GBV)
and HIV are well documented; however, there
is still a pressing need to identify effective
strategies for addressing this dual epidemic.
■■ We conducted a systematic review and
identified 25 evaluated gender-integrated
interventions that collectively addressed GBV
and HIV prevention.
■■ Regional differences were found, with sub-
Saharan African programs working with men
and adolescent girls and women, while South
Asian programs focused on key populations.
■■ These findings provide evidence that gender-
integrated programs can improve GBV and HIV
outcomes. GBV prevention strategies should
be tailored to the HIV epidemic in which the
programs operate.
CONCLUSIONS
Programs that aim to transform unequal gender
norms and dynamics can improve GBV and HIV
outcomes. The analysis documents the importance
of integrated GBV and HIV prevention programs.
GBV prevention strategies should be tailored to the
HIV epidemic in which the programs operate.
Acknowledgments
The authors would like to thank Brent Franklin
and Aria Gray of the Health Policy Project
Knowledge Management team for their assistance
with editing and preparing this poster.
References
For more information, see Muralidharan, A., J.
Fehringer, S. Pappa, E. Rottach, M. Das, et al.
2014. Transforming Gender Norms, Roles, and
Power Dynamics for Better Health: Evidence
from a Systematic Review of Gender-integrated
Health Programs in Low- and Middle-Income
Countries. Washington, DC: Futures Group,
Health Policy Project.
BACKGROUND
The links between gender-based violence (GBV)
and HIV are well documented; however, there is
still a pressing need to identify effective strategies
for addressing this dual epidemic. This study
draws from a USAID-funded systematic review of
evaluated gender-integrated health programs in
low- and middle-income countries, highlighting
effective and promising gender strategies that
have been used to improve GBV and HIV
outcomes. It also examines regional differences
between sub-Saharan Africa and South Asia.
METHODS
The search was based on scientific and grey
literature published between January 2008 and
June 2013. We abstracted relevant publications
to identify strategies for integrating GBV into
HIV prevention programs, and rated them on
effectiveness. We then conducted a thematic
analysis of the abstracted data.
RESULTS
The review found 25 evaluated gender-integrated interventions that collectively addressed GBV and HIV
prevention. Across all programs, common themes emerged:
■■ Focused largely on individual attitude and behavior change
■■ Frequently targeted either female or male population groups; a small minority of programs worked with
both males and females, or the community
■■ Used group education and peer groups to discuss and reflect on gender norms, and how norms influence
HIV risk behaviors and perpetuate violence
■■ Implemented over a relatively short time period—from three months to 2+ years
We identified regional differences that reflected the nature of the epidemic in two regions. In sub-Saharan
Africa, programs either worked with men to mitigate risky behaviors and reduce violence against their female
partners, or with adolescent girls and women to empower them and reduce their vulnerabilities to HIV and
violence. In South Asia, programs focused on supporting key populations, primarily female sex workers.
We developed a scale to rate the strength of evidence for each intervention—“effective,” “promising,” or
“unclear”—based on the combined ratings of an intervention’s impact on health outcomes and the rigor of
its evaluation design. Twenty-two programs were rated as either effective or promising.
Eighteen programs demonstrated changes in HIV prevention behaviors. Common outcomes included
■■ Safer sex practices
■■ Reduced numbers of sexual partners
■■ Increased HIV testing and/or uptake of voluntary counseling and testing services
■■ Increased report of correct and/or consistent use of condoms
■■ Girls’ increased ability to refuse sexual intercourse
■■ Decreased alcohol use
■■ Decreased report of transactional sex
■■ Increased risk reduction communication with partners
■■ Decrease in teachers asking for sex in exchange for favors
Three programs demonstrated changes in health status.
■■ Avahan (India): Reduction in HIV prevalence; reduction in sexually transmitted infection (STI) prevalence
■■ Stepping Stones (South Africa): Decrease in incidence of herpes
■■ Online Sex Education (Colombia): Decreased STI prevalence
Seventeen programs demonstrated changes in violence-related outcomes. Common outcomes included
■■ Decreased self-report of intimate partner violence perpetration
■■ Decreased report of GBV perpetration
■■ Decreased justification of GBV
■■ Decreased violence by police
■■ Managing conflicts through negotiation rather than anger
■■ Reduced trauma symptoms
COMMON GENDER-INTEGRATED STRATEGIES USED (SUB-SAHARAN AFRICA)
Targeting Men Targeting Adolescent Girls and Women
■■ Fostering critical reflection on gender norms, and
how inequitable norms influence HIV risk behaviors,
including violence
■■ Promoting equitable gender norms, attitudes, and
behaviors through social and behavior change
communication
■■ Raising awareness of gender roles and norms and
how they influence women’s lives
■■ Providing life skills education
■■ Increasing access to social networks and safe spaces
■■ Promoting women’s livelihoods and economic status
COMMON GENDER-INTEGRATED STRATEGIES USED (SOUTH ASIA)
Supporting Female Sex Workers
■■ Collectivizing, or bringing together, sex workers to form community-based organizations to advocate for their
health and other needs
■■ Enhancing sexual negotiation and risk-reduction skills
■■ Undertaking community mobilization and advocacy efforts with relevant stakeholders (like the police and brothel
owners) to reduce stigma and violence
STRENGTH OF EVIDENCE # OF PROGRAMS
Effective 13
Promising 9
Unclear 3