Violence Against Women: Cause And Consequence of HIV

Neelanjana Mukhia

Increasingly we see evidence on the prevalence of rape and how rape increases women's and girls' risk to HIV. It confirms for us that rape and sexual violence is endemic.

Increasingly we see evidence on the
prevalence of rape and how rape increases women’s and girls’ risk to HIV. It confirms for us that rape and sexual
violence is endemic; in 2002 WHO said one in five women will be raped or will
be a victim of attempted rape in the world.
International women’s human rights instruments have resulted in legislation
on violence against women in many countries, however, many are not implemented,
enforced, and resourced, with the same zeal as say, the prevention and
containment of the H1N1 virus, aka the swine flu.  We have to ask ourselves why that is.

Good news is, there is increasing
recognition that violence against women and HIV are intertwined health and
human rights crises. Some of us are frustrated that this link was not
acknowledged and acted upon much earlier. Many of us feel if states, multilateral
and bilateral agencies had fulfilled their longstanding commitments to promote,
protect and fulfill women’s and girls’ human rights, specifically our right to
be free from violence and the threat of violence we might not have seen the
rapid growth of the pandemic amongst women and girls. Case in point – sub
Saharan Africa – where women and girls make up a majority of those living with
HIV and where young women are 4-6 times more at risk of HIV than young men.

In recent years there has been
progress, especially by the Joint United Nations Program on HIV/AIDS (UNAIDS).
Most notably, in 2007, UNAIDS for the first time costed interventions to
prevent and respond to violence against women and girls in an effort to
estimate resources needed for the global AIDS response. Earlier this year,
UNAIDS included violence against women and girls as one of 8 Priority Areas in
the Joint Action for Results: UNAIDS Outcomes Framework 2009-2011.

However, this does not mean our work
is done.

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HIV and VAW: it cannot be just about
sexual violence
Yes, the link between sexual
violence and HIV transmission is the easiest to make. Nevertheless, studies
show that physical, social and economic violence also contributes to women’s
inability to refuse sex or negotiate safe sex thereby increasing their risk to
HIV. This is not news to us. Those of who are working to secure women’s and
girls’ sexual and reproductive health and reproductive rights have know for
decades that gender inequality and violence restricts our ability to decide whom
we marry, whether, how many and when we have children. We know that women’s and
girls’ control over our own bodies and reproductive lives is denied or limited
through all forms of violence (and the threat of violence), and not just sexual
violence. Despite this, too many limit the link between violence against women
and HIV to sexual violence.

HIV and VAW: It cannot be just about
prevention
While we should welcome the
attention to and potential action on violence against women as it intersects
with HIV we demand that this not be limited to prevention interventions. Indeed,
all HIV prevention programs have to integrate a response to violence if they
seek to stem the growth of the pandemic. Some of these programs include,
investment in research, availability, affordability of women controlled
prevention technologies, universal access to female condoms, universal access
to post exposure prophylaxis to survivors of violence, zero tolerance of
violence in schools and other educational institutions, investment in community
based programs that challenge negative and restrictive gender norms and
violence against women, investment to increase women’s and girls’ access to
justice, etc.

As we celebrate this important,
though overdue, attention we have to remember the flip side of the relationship
between violence against women and girls and HIV. The side which affects HIV
positive women and their ability to live healthy and productive lives. Just as
loudly as we say, violence is a cause of HIV; we must say HIV is a cause of
violence against women and girls. Actual or perceived HIV status makes HIV
positive women easy targets of violence or threats of violence hampering their
access HIV services. Human Rights Watch’s research (Hidden in the Mealie Meal),
clearly demonstrates how violence and the fear of violence severely inhibits
women’s ability to access and adhere to ARV treatment. If we are serious about
universal access to treatment and are interested in ensuring those who receive
treatment are able to adhere to it, we must integrate a response to violence
against women in HIV testing, counseling and treatment programs. The Women
Won’t Wait campaign has been calling for scaled up training of health care
providers, particularly providers of HIV voluntary counseling, testing and
treatment, to recognize and respond to signs of violence. HIV voluntary counseling
and testing, and treatment interventions must include protocols, systems and
services to respond to violence against women and girls. The same goes for
PMTCT (and plus) programs. Research shows that women’s risk of violence
increases during pregnancy, and it is essential that pregnant women generally
and especially those that access PMTCT are screened for violence and provided a
package of services (see box). 

Male circumcision and women’s rights

The WWW campaign believes that
prevention strategies for both men and women must be invested in so that these
are available, accessible, affordable and of high quality. There is already a
gap between prevention strategies for men and women; and a scaled up roll out
of MC must not widen this gap. Women controlled prevention methods including
female condoms, must be made available with equal commitment and vigor. Among
other things, in rolling out male circumcision, it will be important to monitor
rates of gender-based violence, as well as coercive sex that may occur during
the period of wound healing/recommended abstinence post surgery and thereafter.

Criminalization of HIV exposure and
transmission will harm women
As we continue to advocate for
attention to, action on and resources for a gender sensitive AIDS response we
must remain vigilant about moves that wittingly or unwittingly violate or have
the potential of violating human rights. The recent trend to criminalize HIV
exposure and transmission violates rights of HIV positive women and men and has
the potential to undermine or even reverse gains made by the global AIDS
response. When governments say they are doing this to respond to the epidemic
of violence women and girls, we must remind them to fulfill their longstanding
and binding commitments to promote, protect and fulfill women’s human rights
instead. 

Finally, as activists we have to consistently
advocate for the rights of all women, those of us who are HIV positive, in sex
work, with disabilities, who have sex with women, etc. It is only when we
advocate for the rights of all of us will we secure our own.
HI

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