Gender-based violence among adolescent girls and young women: conceptualization and measurement to inform public health programs in low and middle-income countries

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Sandstrom, Emma
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Adolescent girls and young women (AGYW), particularly those engaged in transactional sex (TS) and sex work (SW), experience disproportionate rates of gender-based violence (GBV). While public health scholarship and practice acknowledge that GBV may render an individual more susceptible to adverse health outcomes, this understanding often conceptualizes experiences of GBV at the individual as opposed to the structural levels where risk and vulnerability are often shaped. This study aimed to identify whether any gaps exist in how the structural drivers of GBV are both examined and addressed in public health research and prevention programming. Using Relational Gender Theory and the Ecological Framework of Violence to position gender as a multidimensional structure, an integrative review of 31 peer-reviewed articles on GBV interventions in HIV prevention programs targeting AGYW in low- and middle-income countries was conducted. Results revealed a predominant focus on sexual and physical violence perpetrated by partners, with limited attention to emotional and economic forms in approaches to defining and measuring GBV. Interventions primarily targeted individual-level factors, neglecting broader community and structural drivers. A secondary quantitative analysis of existing data examined the association between sex activity typology and GBV among cisgender AGYW engaged in casual sex (CS), TS, and SW in Dnipro, Ukraine. Nearly a quarter of the sample reported experiences of lifetime GBV (24.3%). SW participants had the highest rates of lifetime and recent experiences of GBV, followed by TS and CS participants. After adjusting for confounders, TS participants were 1.8 times (95% CI: 1.3 to 2.5, p < 0.001) more likely to experience lifetime GBV than CS participants, while SW participants were 3.9 times (95% CI: 2.9 to 5.3, p < 0.001) more likely. By applying a robust gendered lens, this project uncovered an opportunity to broaden both the conceptualization and operationalization of GBV within HIV prevention programming and research. Examining experiences of GBV among AGYW in Dnipro, Ukraine reiterated the disproportionate burden of GBV these populations face, particularly those engaged in SW. To effectively address GBV, public health discourse needs to move towards critically engaging with how GBV and power operate across the broader structural context.
Adolescent girls and young women, Gender-based violence, HIV prevention, Transactional sex, Sex work, Low- and middle-income countries