Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA, 94158, USA.
Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA.
BMC Public Health. 2019 Jul 8;19(1):897. doi: 10.1186/s12889-019-7192-4.
BACKGROUND: While gender-based violence (GBV) has been shown to increase women's risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear. Clarifying how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP) - will not only provide insights into how to best meet individual women's HIV care needs, but also inform public health oriented HIV epidemic control strategies. METHODS: Through a comprehensive scoping review, we synthesized and analyzed existing evidence regarding the influence of GBV on engagement in PrEP and the HIV care continuum among women living with HIV, including members of key populations (female sex workers, transgender women and women who use drugs). We explored PubMed, Scopus and Web of Science for peer-reviewed studies published in 2003-2017. Of the 279 sources identified, a subset of 51 sources met the criteria and were included in the scoping review. RESULTS: Studies were identified from 17 countries. The majority of studies utilized quantitative cross-sectional designs (n = 33), with the rest using longitudinal (n = 4), qualitative (n = 10) or mixed methods (n = 4) designs. Taken together, findings suggest that GBV impedes women's uptake of HIV testing, care, and treatment, yet this can vary across different geographic and epidemic settings. Substantial gaps in the literature do still exist, including studies on the impact of GBV on engagement in PrEP, and research among key populations. CONCLUSIONS: This scoping review contributes to our knowledge regarding the role GBV plays in women's engagement in PrEP and the HIV care continuum. Findings reveal the need for more longitudinal research to provide insights into the causal pathways linking GBV and HIV care and treatment outcomes. Research is also needed to illuminate the impact of GBV on PrEP use and adherence as well as the impact of GBV on engagement along the HIV care continuum among key populations. It is critical that programs and research keep pace with these findings in order to reduce the global burden of GBV and HIV among women.
背景：虽然已证实性别暴力（GBV）会增加女性感染艾滋病毒的风险，但 GBV 在艾滋病毒检测到护理连续体中的作用尚不清楚。阐明 GBV 如何成为获取艾滋病毒服务、治疗和护理（如抗逆转录病毒治疗（ART）或暴露前预防（PrEP））的障碍，不仅将提供如何最好地满足个别妇女艾滋病毒护理需求的见解，还将为以公共卫生为导向的艾滋病毒流行控制战略提供信息。
方法：通过全面的范围综述，我们综合和分析了现有证据，这些证据涉及 GBV 对感染艾滋病毒的妇女，包括重点人群（性工作者、跨性别妇女和吸毒妇女）成员参与 PrEP 和艾滋病毒护理连续体的影响。我们在 2003 年至 2017 年期间在同行评审的研究中搜索了 PubMed、Scopus 和 Web of Science。在确定的 279 个来源中，有一部分 51 个来源符合标准并被纳入范围综述。
结果：研究来自 17 个国家。大多数研究采用了定量的横断面设计（n=33），其余研究采用了纵向设计（n=4）、定性设计（n=10）或混合方法设计（n=4）。总的来说，研究结果表明，GBV 阻碍了妇女接受艾滋病毒检测、护理和治疗，但这可能因不同的地理和疫情环境而有所不同。文献中仍然存在大量空白，包括关于 GBV 对参与 PrEP 的影响的研究，以及在重点人群中的研究。
结论：本范围综述有助于我们了解 GBV 在妇女参与 PrEP 和艾滋病毒护理连续体中的作用。研究结果表明，需要更多的纵向研究来深入了解 GBV 与艾滋病毒护理和治疗结果之间的因果关系。还需要研究来阐明 GBV 对 PrEP 使用和依从性的影响，以及 GBV 对重点人群中艾滋病毒护理连续体参与的影响。为了减少全球妇女的 GBV 和艾滋病毒负担，方案和研究必须跟上这些发现的步伐。
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