Addressing intimate partner violence and power in relationships in HIV testing services: Results of an intervention piloted in Nairobi Kenya.

Achieving the 90-90-90 treatment targets - 90 percent of people living with HIV know their status 90 percent of people who know their HIV-positive status are accessing treatment and 90 percent of people on ART have suppressed viral loads - will entail far more than expansion of clinical services. Truly impressive gains in ART use in the past five years - coverage leaped in East and Southern Africa from 24 percent in 2010 to 54 percent in 2015 for example - demonstrate what concerted international efforts can achieve. Moving forward however we are challenged to also provide access for underserved populations and implement test and treat guidelines. We will not get to 90-90-90 without also reaching those who are more vulnerable. PEPFAR UNAIDS and others recognize this and consequently include attention to structural factors such as gender inequality and gender-based violence in their strategies. Intimate partner violence matters not only because of its high prevalence - IPV is estimated to affect one in three women globally - but because of its deleterious effects all along the prevention treatment and care continuum. It is linked with HIV infection - women who experience IPV are more likely to acquire HIV than women who do not experience IPV. Indeed in this study prevalence of HIV was twice as high among women who experienced IPV in the past year compared to those who did not experience IPV. Not only is HIV prevalence higher among women experiencing IPV but these same women are less likely to link to treatment and care. IPV is associated with lower ART use lower ART adherence (Hatcher et al. 2015) and lower PMTCT adherence. Experience of intimate partner violence also makes viral suppression less likely. (excerpt)