Decades of hard-won progress against HIV could unravel within years — and for women, a largely overlooked social determinant has been quietly shaping their risk all along. Understanding how intimate partner violence quantifiably contributes to HIV burden, and what funding withdrawal means for the epidemic's trajectory, has urgent implications for global health planning and the communities most exposed to both threats.
Drawing on the Global Burden of Disease 2023 framework — encompassing data from 204 countries and territories spanning 1990 to 2023 — this analysis quantified HIV incidence, prevalence, and mortality disaggregated by age and sex, while simultaneously modelling the population-attributable fraction of HIV burden linked to intimate partner violence (IPV). IPV prevalence time-series data were combined with effect-size estimates to isolate IPV's contribution to women's HIV risk. Additionally, a non-parametric stochastic frontier approach was applied to forecast how declining development assistance for health might alter antiretroviral access and epidemic outcomes through 2030. The dual modelling of a social risk factor alongside a financing scenario within a single GBD framework is methodologically notable.
This study sits at the intersection of epidemiology, social determinants research, and health economics — a combination rarely achieved at this scale. The IPV-HIV linkage is biologically and behaviorally plausible: IPV reduces women's ability to negotiate condom use, increases sexual violence exposure, and disrupts healthcare-seeking behavior. However, causal attribution remains inherently difficult in observational population-level data; population-attributable fractions depend heavily on the quality of IPV prevalence estimates, which vary substantially across low-income settings. The funding-cut forecasts introduce a second layer of modeling uncertainty, as they rely on assumptions about how financial shocks translate into treatment coverage gaps. Nevertheless, this analysis is far from incremental — it represents one of the most comprehensive attempts to bridge structural gender-based violence data with HIV epidemiological projections at a global scale. For health-conscious readers, the core message is systemic: HIV risk for women is not solely a biomedical problem but a structural one, and austerity in global health financing may reverse gains that took a generation to achieve.