Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study
Introduction Women living with HIV (WLHIV) in conflict zones are at high risk of sexual and physical violence due to instability, stigma and proximity to military personnel. Given sustained ongoing conflict, this study evaluated the relationship between displacement and gender-based violence (GBV),...
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BMJ Publishing Group
2025-05-01
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| author | Stefan David Baral Carrie Lyons Althea Wolfe Mary Anne Roach Gnilane Turpin Omar Syarif Pim Looze Katarzyna Lalak Jean de Dieu Anoubissi Yi-Chi Chiu Alexandra Volgina Sophie Brion Keren Dunaway Olena Stryzhak Daria Ocheret Laurel Sprague Carlos Garcia de Leon Moreno Katherine B Rucinski |
| author_facet | Stefan David Baral Carrie Lyons Althea Wolfe Mary Anne Roach Gnilane Turpin Omar Syarif Pim Looze Katarzyna Lalak Jean de Dieu Anoubissi Yi-Chi Chiu Alexandra Volgina Sophie Brion Keren Dunaway Olena Stryzhak Daria Ocheret Laurel Sprague Carlos Garcia de Leon Moreno Katherine B Rucinski |
| author_sort | Stefan David Baral |
| collection | DOAJ |
| description | Introduction Women living with HIV (WLHIV) in conflict zones are at high risk of sexual and physical violence due to instability, stigma and proximity to military personnel. Given sustained ongoing conflict, this study evaluated the relationship between displacement and gender-based violence (GBV), including experiences of sexual violence, abuse by healthcare workers and reproductive coercion among WLHIV in Ukraine. These forms of violence are conceptualised as severe forms of enacted stigma that are downstream outcomes of social, cultural and political norms, as well as social and structural stigmas related to misogyny and HIV.Methods Data were collected in Ukraine in 2020 as part of the People Living with HIV Stigma Index 2.0, led by 100% Life, the largest organisation for people living with HIV in Eastern Europe/Central Asia. WLHIV were recruited throughout Ukraine through limited chain referral and venue-based sampling. All participants completed a sociobehavioural questionnaire. Self-reported outcomes included sexual violence, violence in healthcare settings and reproductive coercion related to pregnancy, sterilisation and contraception. Displaced participants comprised WLHIV who were asylum seekers/refugees or internally displaced. Log binomial regression models estimated adjusted prevalence ratios (aPR) and 95% CIs for associations between displacement and GBV outcomes.Results A total of 1062 cisgender WLHIV completed the questionnaire, among whom 144 (13.6%) were displaced. Displaced WLHIV had higher proportions of lifetime experience using drugs (66.7% vs 22.0%, p=<0.01), selling sex (28.5% vs 12.2%, p=<0.01) and facing HIV-related stigma/discrimination (47.9% vs 34.4%, p=<0.01). Displaced WLHIV were significantly more likely to have experienced sexual violence (aPR: 2.74, 95% CI: 1.67 to 4.51), violence in healthcare (aPR: 2.57, 95% CI: 1.49 to 4.43), pregnancy coercion (aPR: 2.60, 95% CI: 1.41 to 4.78), sterilisation coercion (aPR: 4.26, 95% CI: 1.17 to 15.43) and contraception coercion (aPR: 2.48, 95% CI: 1.00 to 6.15) compared with non-displaced WLHIV.Conclusion As the war in Ukraine continues, humanitarian and health systems can use these findings to guide integration of GBV referrals and scale-up of trauma-informed care and antiexploitation training into Ukrainian programming. Moreover, additional surveillance methods, including community-led monitoring, can support routine documentation of experiences of coercion and abuse in healthcare settings. Broadly, transformative approaches are needed to tackle structural causes of gender inequality, HIV and violence. |
| format | Article |
| id | doaj-art-156df42a90cd410e8ff6f4630e61dd13 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-05-01 |
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| series | BMJ Global Health |
| spelling | doaj-art-156df42a90cd410e8ff6f4630e61dd132025-08-20T03:52:52ZengBMJ Publishing GroupBMJ Global Health2059-79082025-05-0110510.1136/bmjgh-2024-016478Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional studyStefan David Baral0Carrie Lyons1Althea Wolfe2Mary Anne Roach3Gnilane Turpin4Omar Syarif5Pim Looze6Katarzyna Lalak7Jean de Dieu Anoubissi8Yi-Chi Chiu9Alexandra Volgina10Sophie Brion11Keren Dunaway12Olena Stryzhak13Daria Ocheret14Laurel Sprague15Carlos Garcia de Leon Moreno16Katherine B Rucinski17Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAGlobal Network of People Living with HIV (GNP+), Amsterdam, The NetherlandsGlobal Network of People Living with HIV (GNP+), Amsterdam, The NetherlandsGlobal Network of People Living with HIV (GNP+), Amsterdam, The NetherlandsGlobal Network of People Living with HIV (GNP+), Amsterdam, The NetherlandsGlobal Network of People Living with HIV (GNP+), Amsterdam, The NetherlandsGlobal Network of People Living with HIV (GNP+), Amsterdam, The NetherlandsInternational Community of Women Living with HIV (ICW), Nairobi, KenyaInternational Community of Women Living with HIV (ICW), Nairobi, KenyaPositive Women, Kyiv, UkraineUNAIDS, Geneve, Geneva, SwitzerlandUNAIDS, Geneve, Geneva, SwitzerlandUNAIDS, Geneve, Geneva, SwitzerlandJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAIntroduction Women living with HIV (WLHIV) in conflict zones are at high risk of sexual and physical violence due to instability, stigma and proximity to military personnel. Given sustained ongoing conflict, this study evaluated the relationship between displacement and gender-based violence (GBV), including experiences of sexual violence, abuse by healthcare workers and reproductive coercion among WLHIV in Ukraine. These forms of violence are conceptualised as severe forms of enacted stigma that are downstream outcomes of social, cultural and political norms, as well as social and structural stigmas related to misogyny and HIV.Methods Data were collected in Ukraine in 2020 as part of the People Living with HIV Stigma Index 2.0, led by 100% Life, the largest organisation for people living with HIV in Eastern Europe/Central Asia. WLHIV were recruited throughout Ukraine through limited chain referral and venue-based sampling. All participants completed a sociobehavioural questionnaire. Self-reported outcomes included sexual violence, violence in healthcare settings and reproductive coercion related to pregnancy, sterilisation and contraception. Displaced participants comprised WLHIV who were asylum seekers/refugees or internally displaced. Log binomial regression models estimated adjusted prevalence ratios (aPR) and 95% CIs for associations between displacement and GBV outcomes.Results A total of 1062 cisgender WLHIV completed the questionnaire, among whom 144 (13.6%) were displaced. Displaced WLHIV had higher proportions of lifetime experience using drugs (66.7% vs 22.0%, p=<0.01), selling sex (28.5% vs 12.2%, p=<0.01) and facing HIV-related stigma/discrimination (47.9% vs 34.4%, p=<0.01). Displaced WLHIV were significantly more likely to have experienced sexual violence (aPR: 2.74, 95% CI: 1.67 to 4.51), violence in healthcare (aPR: 2.57, 95% CI: 1.49 to 4.43), pregnancy coercion (aPR: 2.60, 95% CI: 1.41 to 4.78), sterilisation coercion (aPR: 4.26, 95% CI: 1.17 to 15.43) and contraception coercion (aPR: 2.48, 95% CI: 1.00 to 6.15) compared with non-displaced WLHIV.Conclusion As the war in Ukraine continues, humanitarian and health systems can use these findings to guide integration of GBV referrals and scale-up of trauma-informed care and antiexploitation training into Ukrainian programming. Moreover, additional surveillance methods, including community-led monitoring, can support routine documentation of experiences of coercion and abuse in healthcare settings. Broadly, transformative approaches are needed to tackle structural causes of gender inequality, HIV and violence.https://gh.bmj.com/content/10/5/e016478.full |
| spellingShingle | Stefan David Baral Carrie Lyons Althea Wolfe Mary Anne Roach Gnilane Turpin Omar Syarif Pim Looze Katarzyna Lalak Jean de Dieu Anoubissi Yi-Chi Chiu Alexandra Volgina Sophie Brion Keren Dunaway Olena Stryzhak Daria Ocheret Laurel Sprague Carlos Garcia de Leon Moreno Katherine B Rucinski Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study BMJ Global Health |
| title | Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study |
| title_full | Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study |
| title_fullStr | Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study |
| title_full_unstemmed | Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study |
| title_short | Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study |
| title_sort | characterising the effects of displacement on gender based violence among women living with hiv in ukraine a cross sectional study |
| url | https://gh.bmj.com/content/10/5/e016478.full |
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