Gender-based violence syndemics in global health: A systematic review

Global guidance indicates that protections for gender and equity issues, such as gender-based violence (GBV), should be mainstreamed across sectors. One novel strategy that can be leveraged to illustrate the cross-cutting impacts of GBV is to investigate GBV syndemically. This systematic review identified, evaluated, and synthesized quantitative studies conducted in LMICs that tested syndemic theories involving GBV. A systematic search of the peer-reviewed literature was conducted in Medline, Global Health, Scopus, Anthro Source, Anthropology Plus, Web of Science, PsychInfo, and Gender Watch. Peer-reviewed empirical research published in English that used quantitative methods to test syndemic theories involving GBV in LMICs were included. 4068 references were retrieved, 2160 studies were screened against their titles/abstracts, and 227 studies were assessed for full text eligibility. Overall, 45 studies met the inclusion criteria. Most articles conceptualized GBV as an exposure that clustered with other epidemics. More than half of the evidence base investigated combinations of GBV, mental health, substance use, and HIV/AIDS. Research articles investigating the SAVA syndemic among men who have sex with men (MSM) and transgender women provided the strongest evidence, particularly in India. Notable analytical gaps pertained to GBV measurement challenges and statistical approaches to test contextual factors in LMICs. The current evidence base is predominantly focused on GBV syndemic models that inform response/harm mitigation efforts rather than prevention. Future research should concentrate on how the political environment perpetuates clustering and interactions, expanding the contexts studied beyond upper middle-income countries, and improving methodological rigor in terms of GBV measurement.