Addressing violence against women and achieving the Millennium Development Goals
MDG 6: Combat HIV/AIDS, malaria and other diseases
As of 2003, women and girls represented approximately 50% of those living with HIV/AIDS globally. In sub-Saharan Africa, 57% of adults infected with the virus were women, and 75% of infected young people were women and girls (26). Traditional prevention strategies that rely on male compliance, such as condoms, do not always protect women and girls. This is especially true in societies where violence against women is condoned and where gender norms restrict or deny sexual autonomy for women and girls. Abused women and girls have a greater risk of contracting HIV infections and other STIs because they lack autonomy to decide when, with whom and under what circumstances they will have sex. Fear of violence can prevent women suggesting that their male partner use a condom, still less insisting on it (27,28). Violent or forced sex, especially among adolescent girls, may be more likely to lead to transmission of the virus through tears in the vagina or anal canal. Thus, violence against women is a significant factor impeding effective prevention of HIV in women and young girls.
Married women and women in other long-term partnerships can be at high risk in countries where HIV transmission is mainly through heterosexual sex (29). In Cambodia, India and Thailand, for example, studies have found that husbands represent the primary source of HIV infection for women. Risk in marriage is especially relevant where cultural norms condone male promiscuity or where husbands control the couple’s sexual activity. The majority of countries have no laws against marital rape (30). A study in South Africa found that women who had violent or controlling partners had an HIV infection rate 50% higher than that of other women, and that abusive men were more likely to be infected than non-abusive men (31). Similarly, a study in India found that sexual violence by men against their wives was associated with increased rates of STIs, as well as a greater likelihood of extramarital partners (32). National HIV prevention strategies should include components that aim to reduce violence against women, challenge social norms that condone such violence and empower women and girls to protect themselves against unwanted or forced sex.
Violence against women in the form of childhood sexual abuse has been shown to increase the probability of risky sexual behaviour later in life. Such behaviours include consensual sex at an earlier age, multiple partners, transactional sex, and heavy use of alcohol or drugs (6). These behaviours also increase the risk for HIV, other STIs and unintended pregnancies. HIV/AIDS awareness campaigns should include information about the relationship between violence against women and HIV/AIDS, and the HIV-related health risks of harmful traditional and formal practices.
Fear of violence is a reason why many women do not seek testing for HIV (33). In some cases, women whose positive status becomes known may be beaten, abandoned or thrown out of the home by their male partner or family. Since testing is a prerequisite for access to antiretroviral treatment, it is essential that women can be tested without fear of violence (34). AIDS treatment initiatives should address intimate-partner violence as an obstacle to both testing and treatment, and ensure confidentiality and support for women who seek either.