March 5, 2010

HIV/AIDS and Sexual Violence: An Unspoken Partnership

Posted in Child Sexual Abuse, Current Events, Intimate Partner Violence at 9:41 pm by sacetalks

The United Nations HIV/AIDS program UNAIDS has announced that HIV/AIDS is now the world’s leading killer of women of reproductive age. The organization is also addressing the specific issue of violence against women as a factor in transmission. UNAIDS notes that as many as 70% of women worldwide have experienced violence, which limits a woman’s ability to negotiate safer sex — and unprotected sex a woman doesn’t want is sexual assault.

Some researchers have been looking at the problem for quite some time, searching for ways that women can protect themselves from HIV transmission without relying on a partner’s condom use. One promising area is the search for a microbicide that could be applied vaginally and anally to protect against HIV. This could be applied by a woman without her needing to tell a partner she was using it, thus giving her some protection even if her partner refuses to allow it. Although probably not as effective as condoms (male or female), a microbicide would reduce a woman’s risk, particularly if her partner refuses to use condoms. Other options for women include female condoms, but some partners will refuse to allow a woman to use them. Cervical protection is another possible method currently under research.

However, microbicides, female condoms, cervical barriers, and other woman-centred prevention methods do not address the underlying social and systemic roots that influence such high transmission rates. UNAIDS is recognizing this by putting forward a five-year programming plan that includes anti-violence work as part of HIV-prevention strategies. The organization hopes that by reducing rates of sexual violence and intimate partner violence, they will also bring about a reduction in HIV infection rates for women.

This move by UNAIDS reflects the reality of HIV/AIDS. In southern Africa, three women are living with HIV to every one man who has the disease. Around the world, women are more susceptible to infection, not only because of their physiology but also because of their social status and the violence committed against them. Women everywhere are forced into unprotected sex, sometimes through physical force, but often because of coercion, intimidation, fear, poverty, and social expectations that a woman must satisfy her husband’s sexual demands, regardless of her desire or consent.

Approaches to prevention can also target women unfairly. In some places, virginity testing is seen as a solution to the AIDS crisis. Girls and women may not pass these tests–every woman’s body is different, and there is no way to tell if a woman has had sex simply by examining her genitals. However, “failing” one of these tests might leave a woman vulnerable to social stigma, abuse, or sexual assault (because she is seen as a loose woman), and she may not be able to marry and may experience economic deprivation. Additionally, many women are infected by their husbands, who are often not held to the same standard of chastity and monogamy as women. Some people also wrongly believe that sex with a virgin will cure HIV/AIDS, making young women and children vulnerable to sexual assault by abusers seeking a cure. Other practices, including FGM, widow cleansing, and early/child marriage, also contribute to women’s exploitation and abuse as well as their likelihood of contracting HIV, although they are sometimes framed as being prevention strategies. HIV prevention too often becomes an excuse to control, abuse, and constrain women instead of genuinely protecting them from infection.

But even good, science-based prevention programs may not be serving women well if they are not addressing the underlying social factors that lead to high infection rates in women. Women need more than education on condom use and safer sex practices — they need to be safe from violence of all kinds and have economic and social independence so that they are not forced into or to stay in abusive relationships. Women living with HIV* also need these protections so that they can make choices for their sexuality without risking being infected with other strains of the virus or other STIs. Until we see this widespread social change, women are likely to continue to bear the brunt of the HIV epidemic.

*UNAIDS has also recognized that there are problems with how women living with HIV are served by some support organizations and that women who have tested positive may experience violence because of their HIV status.
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