The impact of COVID-19 Pandemic on Domestic Gender Based Violence Against Female HIV and Tuberculosis Patients in Timor-Leste: A Qualitative Study

Background Globally, there is still widespread of violence against women and girls. Timor Leste reports high prevalence of gender-based violence with 30% women have experienced intimate partner (IPV) or non-partner sexual violence. Several studies reported about the increase of domestic violence gender-based violence (D-GBV) against girls and women worldwide during the COVID-19 pandemic lockdowns. To our knowledge, there are limited numbers of research examining the occurrence of D-GBV against girls and women living with HIV/AIDS and TB during the pandemic in developing countries. This study is commissioned to understand whether women living with these two diseases experienced D-GBV during the lockdowns in Timor Leste. Material and Methods This is a qualitative phenomenology study utilizing purposive sampling technic to identify and enroll participants. The study was conducted in eight municipalities from early October 2022 to end of February 2023. It considered eight independent variables – physical violence, verbal violence, phycological violence, sexual violence, sexual harassment, social-economic violence, IPV, stigma and discrimination – to identify the occurrence of D-GBV. The study included 42 in-depth interviews (IDIs) with 19 HIV participants and 23 TB participants, and three focus group discussions (FGDs). Data analysis was performed with NVIVO version 12.1 pro by identifying codes, themes, and categories. Result The D-GBV were widely reported from all municipalities. Psychological, socio-economic, verbal, and physical violence were mostly reported from participants. The COVID-19 pandemic exacerbated D-GBV, and impeded participants to apply coping mechanisms in dealing with the violence. Stigma and discrimination were prevalent in all study municipalities. The main causes of the violence were economic factors, jealousy and denial, tradition/cultural issues, and failure to perform household work. The participants reported using various coping mechanisms to deal with D-GBV, including (1) seeking external support or avoidance and (2) staying and facing the perpetrator at home. The study identified a triple vulnerability for female HIV and TB patients from experiencing various forms of D-GBV during the period of lockdown. Discussion and Conclusion While this study focused on females living with HIV/AIDS and TB only, its findings have amplified the qualitative information on the magnitude of D-GBV in Timor-Leste. The findings from this study suggest the need to pay more attention to women living with HIV and TB in order to help them to not only survive the disease(s) but also to protect them from domestic and gender-based violence. The triple vulnerabilities identified in this study reveal the weaknesses of system to combat D-GBV, stigma and discrimination against female TB and HIV patients in Timor Leste. It is recommended to train clinician working in the area of infectious diseases and reproductive health on D-GBV subject. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Global Fund ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study obtained the ethics approval from National Health Institute- Health Research Ethics Committee, MOH-Timor Leste, with Ethic Approval number : 229/MS-INS/GDE/X/2022). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors