Infertility, Intimate Partner Violence and HIV Care: A Policy Analysis of Intersecting Vulnerabilities for Women in Zambia's Copperbelt Province

In sub-Saharan Africa, women living with HIV navigate intersecting health and social challenges. Infertility, a highly stigmatised condition, and intimate partner violence (IPV) represent significant yet under-analysed vulnerabilities within this population. Their confluence in high HIV prevalence settings like Zambia's Copperbelt Province creates complex needs that existing health and social policies may not adequately address. This policy analysis aimed to measure the prevalence of infertility and its association with IPV among women attending HIV care clinics in Zambia's Copperbelt Province. It further sought to assess how current national HIV, gender-based violence, and sexual and reproductive health policies recognise and respond to this intersection. A mixed-methods approach was used. A cross-sectional survey measured infertility prevalence and IPV experiences among women at HIV clinics. This was combined with a desk-based critical policy analysis of relevant Zambian national policy and strategic framework documents, reviewed for content addressing infertility, IPV, and HIV care. Survey data indicated a high prevalence of perceived infertility within the cohort. A significant positive association was found between experiences of IPV and reporting infertility-related distress. The policy review revealed that while standalone policies on HIV, gender, and reproductive health exist, their integration is limited. Infertility is largely absent as a consideration within HIV care guidelines and IPV response frameworks. The intersection of infertility, IPV, and HIV status creates a unique syndemic of vulnerability for women in this setting. Current policy frameworks operate in siloes, failing to provide an integrated response to these co-occurring issues, which may undermine HIV care engagement and overall wellbeing. Policymakers should integrate infertility screening and supportive counselling into standard HIV care packages. Gender-based violence prevention and response programmes within health facilities must be equipped to address infertility-related conflict. National HIV, sexual and reproductive health, and gender policies should be revised to explicitly recognise and address this intersection. infertility, intimate partner violence, HIV, policy analysis, Zambia, women's health, syndemic. This analysis provides evidence of the linked burdens of infertility and IPV among women in HIV care and highlights a critical gap in integrated policy response, informing necessary revisions to health and social policy in Zambia and similar contexts.