ArticleThe lancet. HIV2024
The contribution of intimate partner violence to vertical HIV transmission: a modelling analysis of 46 African countries.
Article in The lancet. HIV, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Reduced Adherence to Antiretroviral Therapy in Pregnant Women With HIV With Intimate Partner Violence in the United States.Open forum infectious diseases · 2026Article
- Sexual and reproductive health issues facing young people with perinatal HIV infection.AIDS (London, England) · 2025Article
- Persistent burden and health inequalities of disease in women of childbearing age attributable to Intimate Partner Violence, 1990-2021.Frontiers in psychiatry · 2025Article
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Abstract
backgroundAddressing gender inequities could be key to the elimination of vertical transmission of HIV. Women experiencing intimate partner violence (IPV) might be at an increased risk of vertical transmission due to their vulnerability to HIV acquisition and barriers to access to and retention in care. Sub-Saharan Africa, where IPV burden is among the highest globally, accounts for most new paediatric HIV infections. We aimed to examine the proportion of excess vertical transmission attributable to IPV in this region.
methodsIn this modelling analysis, we created a probability tree model of vertical HIV transmission among women aged 15-49 years in 46 African countries. We estimated the proportion of vertical transmission attributable to past-year physical or sexual IPV, or both, as an age-standardised population attributable fraction (PAF) and as excess vertical transmission risk per 1000 births among women experiencing IPV. We incorporated perinatal and postnatal vertical transmission among women who acquired HIV before pregnancy, during pregnancy, and during breastfeeding. Fertility, HIV prevalence, HIV incidence, antiretroviral therapy (ART) uptake, and ART retention varied in the model by women's IPV experience. The model was parameterised using UNAIDS' 2023 Spectrum model data, WHO's Global Database on Violence Against Women, and the peer-reviewed literature. Uncertainty intervals (95% UI) were calculated through 1000 Monte Carlo simulations.
findingsAcross 46 countries 13% (95% UI 6-21) of paediatric HIV infections in 2022 were attributed to IPV, corresponding to over 22 000 paediatric infections. The PAF ranged from 4% (2-7) in Niger to 28% (13-43) in Uganda. The PAF was highest among girls aged 15-19 years (20%, 8-33) and lowest among women aged 45-49 years (6%, 3-9). In southern Africa, where women's HIV prevalence is highest (23%), IPV led to 11 (5-20) additional infections per 1000 births among women affected by IPV.
interpretationIPV might be responsible for one in eight paediatric HIV infections in sub-Saharan Africa. Ending IPV could accelerate vertical transmission elimination, especially among young women who bear the highest burden of violence.
fundingCanadian Institutes of Health Research, Canada Research Chair, and Fonds de recherche du Québec-Santé. TRANSLATIONS: For the French, Georgian and Spanish translations of the abstract see Supplementary Materials section.
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