Determinants of Sexual Violence and Its Association with Viral Load Suppression Among Women in Sub-Saharan Africa

Sexual violence is a major public health concern, particularly in sub-Saharan Africa (SSA), where women living with HIV (WLWHs) experience substantial vulnerability. This study aimed to (1) estimate the weighted prevalence of reported lifetime sexual violence, (2) identify factors associated with sexual violence among WLWHs, and (3) understand its association with viral load (VL) suppression. We conducted a secondary analysis of cross-sectional data from Population-based HIV Impact Assessment (PHIA) surveys conducted between 2015 and 2019 in eleven SSA countries. Logistic regression models were used to identify factors associated with sexual violence and to assess its association with VL suppression. Our analysis included 9923 WLWHs, with a median age of 36 years. The weighted prevalence of reported lifetime sexual violence among the analytical population was 19.23% (n = 1515). Higher education (aOR = 1.32, 95% CI: 1.09–1.61), employment (aOR = 1.27, 95% CI: 1.04–1.56), and multiple sexual partners (aOR = 1.32, 95% CI: 1.14–1.52) were associated with higher odds of reported sexual violence. Sexual violence was not significantly associated with VL suppression in the adjusted analysis (aOR = 0.92, 95% CI: 0.67–1.27). Our findings highlight the burden of sexual violence among WLWHs and suggest that attention to sexual violence within HIV care may warrant consideration.