The Link Between Violence Against Women and Quality of HIV Programming in 8 African Countries

Background: Effective and quality HIV programming is linked to reduced risk to violence. This study explored negative stereotypes of hegemonic masculinity and the social structures linked to it. An exploration of 8 Sub-Saharan African countries found 3 country-specific definitive social structures impacting the stereotypes, i.e., Enabling; Restrictive; and Hindering structures.

Methods: A meta-analysis of data from 2013-2017 of relationship between violence and comprehensive combination HIV prevention strategies, political commitment, rule of law, enforcement of legal gender equality, religious and traditional support for respect and dignity of women, uptake of gender-specific prevention services, Domestic Violence (DV) reports and HIV trends. 175 articles were identified and 80 met inclusion criteria.

Results: Stereotypes of hegemonic masculinity exist in all 8 countries studied. Politics, religion and tradition influence risk reduction, e.g., enforcement of legal gender equality, political commitment and accountable judiciary ensure women can report abuses. Male dominance beliefs; traditions e.g. precarious toxic masculinity, forced marriage, genital cutting; and gender of breadwinner are linked to violence-related risks. Compared to all 8 countries, Rwanda, Ethiopia and Kenya have a hindering structure promoting significant risk reduction with institutions fostering increased rule of law, political commitment, enforcement and risk-reduction consciousness. However, HIV criminalization and stigma subvert risk-reduction goals. Uganda and Tanzania have a restrictive structure characterised with legal loopholes, irregular enforcement and ambivalent political commitment to address acts of violence against women. In Senegal, South Africa and Nigeria political, religious and traditional factors blatantly backing traditional negative stereotypes of hegemonic masculinity foster violence enabling structures entrenching repressive acts and hate crimes against women. Clinical trials and male medical circumcision (MMC) in the 8 countries are poorly received. Negotiating for safer sex by women is circumscribed as a threat to male dominance.

Conclusions: Justice dispensation, economic autonomy, religion and traditional backing contribute effectively to risk-reduction. Contexts hindering violence prevail where state-led commitment thrives and these have far reaching benefits e.g., more people engage in clinical trials, TB prevention, Hepatitis screening and immunization. Political and legal commitment are key in violence risk reduction. Effective and quality HIV programming in the countries studied is possible if it is designed to address hegemonic masculinity practices too.