The effect of intimate partner violence on women's risk of HIV acquisition and engagement in the HIV treatment and care cascade: an individual-participant data meta-analysis of nationally representative surveys in sub-Saharan Africa

Background: Achieving the 95-95-95 targets for HIV diagnosis, treatment, and viral load suppression (VLS) to end the HIV/AIDS epidemic hinges on eliminating structural inequalities, including intimate partner violence (IPV). Sub-Saharan Africa (SSA) has among the world's highest prevalence of IPV and HIV. We aim to examine the impact of IPV on recent HIV infection and women's engagement in the HIV care cascade. Methods: We pooled individual-level data from nationally representative surveys with information on physical and/or sexual IPV and HIV in SSA (2000-2020). We used Poisson regressions with robust standard errors to estimate adjusted prevalence ratios (aPR) of past year experience of IPV on recent HIV infection (measured using recency assays), past-year HIV testing, antiretroviral therapy (ART) uptake, and VLS among ever-partnered (currently/formerly married or cohabitating) women. Models were adjusted for women's age, age at sexual debut, residence type, marital status, education, and the survey's identifier (proxy of country and year). Findings: Fifty-seven surveys were available from thirty countries, encompassing 280,259 (N) individuals. One-fifth of women reported physical and/or sexual IPV in the past year. Six surveys had information on recent HIV infection and seven had data on ART uptake and VLS. Women experiencing past year IPV were 3.22 times (95%CI: 1.51-6.85, N=19,179) more likely to have a recent HIV infection, adjusting for potential confounders. Past year IPV was not associated with HIV testing (aPR=0.99, 95%CI: 0.98-1.01, N=274,506) or ART uptake (aPR=0.96, 95%CI:0.90-1.03, N=5,629). Women living with HIV (WLHIV) experiencing IPV in the past year were 9% less likely to achieve VLS (aPR=0.91, 95%CI: 0.85-0.98, N=5,627). Interpretation: Past year IPV was associated with recent HIV acquisition and lower VLS among WLHIV. Preventing IPV is inherently imperative but eliminating IPV could also be crucial to ending HIV/AIDS.