Priti A. Prabhughate, Technical Specialist, Gender and HIV
Today is World AIDS Day, a day to reflect on progress and challenges faced by people living with HIV worldwide. One such challenge, which ICRW is exploring, is violence.
While we know many factors contribute to the spread of HIV, we know that women who experience violence are more vulnerable to transmission and, conversely, women living with HIV are more likely to experience violence. A double-edged sword that leads far too many women to live under vulnerable circumstances.
For both medical and social reasons, women around the world are more likely to contract HIV than men.
Women who are forced into non-consensual sex, such as rape, are particularly vulnerable as forced sex often involves trauma and tearing, a factor which increases transmission rates. Additionally, experiencing violence, or simply the fear one may be subject to violence, can restrict a woman’s ability to negotiate with a partner to use condoms, which can be an effective tool to prevent HIV transmission. In Soweto, South Africa, research found that women who experienced violence or controlling behavior from their partners were 1.5 times more likely to be HIV infected.
Fear of violence, stigma and discrimination can even prevent women and girls from getting tested for HIV, delaying the onset of medical attention that could improve their lives.
Further driving home women’s vulnerability, violence and discrimination also affects women who have tested HIV positive.
Many women and girls living with HIV experience violence or discrimination that results in them skipping out on medical treatment, which lowers their chances of living a healthier life and increases the chance that it may be passed on to the next partner.
And while the perceived threat of violence is enough to prevent women living with HIV from adhering to medication, we know that violence women experience has a major effect as well. For example, a WHO report found that as many as 69% of women living with HIV in some countries report experiencing violence from a husband or partner. Additionally, fear of violence or discrimination can prevent women from disclosing their HIV status to their partner, further undercutting public health officials’ efforts to prevent the transmission of HIV.
Thus violence faced by women is both a cause and consequence of HIV. The dynamics of HIV transmission and treatment are intricately linked to the deep-rooted gender norms and societal inequalities women around the world face. HIV programs worldwide have adapted a public health approach, with a prime concern to decrease HIV incidence and mortality. Though effective in curbing the epidemic, the public health approach needs to address structural factors of skewed gender norms, gender-based violence and women’s unequal status as integral and necessary components to address HIV among women and sustain the progress made with regards to decreasing prevalence and improving treatment of HIV.
Consequently HIV programs need to expand in their approach to adopt a rights-based approach that places women’s health and gender-related vulnerabilities at its core, like providing comprehensive care to women that not only address women’s HIV risk, but also address a range of health, mental health and economic needs. Programs must create a space to address the men in women’s lives to address harmful norms and male behavior that compromises a woman’s ability to negotiate safety. For programs to make - and sustain- a long-term impact on the health and lives of women infected/affected by HIV, policies and national programs need to be committed to adopting a gender lens in its HIV funding, spell out gender programming in its policies, and programs and ensure capacity training of various services providers, and policy makers on gender issues.
HIV and violence against women are clearly interlinked. Women who experience violence face an increased risk of contracting HIV and, if HIV-positive, women are more likely to face violence and discrimination from partners, family, or the community. We must work to stamp out gender-based violence at its roots, tackle the stigma and discrimination that often results from disclosing HIV status, and ensure that women can live safe, healthy lives, regardless of whether or not they are HIV positive.
Until then, far too many women worldwide are still at risk of losing their lives.