STAFF BLOG: THE LINK BETWEEN HIV/AIDS, GENDER INEQUALITY AND VIOLENCE AGAINST WOMEN

BY SARAH GOSPER, RESEARCH ASSOCIATE AT THE EQUALITY INSTITUTE

1/12/2016

Today is World AIDS Day. Across the globe, millions of people are affected by HIV/AIDS; according UNAIDS, at least 17.8 million of these people are women, constituting 51% of all HIV positive adults. Adolescent girls and young women aged 15-24 are particularly affected. In fact, worldwide, almost two-thirds of all young people living with HIV are young women or adolescent girls, and more than half of all new infections are among young women.[i]

Data from 2015 indicates that the sex ratio of new infections is indeed heavily skewed, with more than 236,000 young women newly infected compared with 115,000 men.[ii]

There are significant regional differences, however, in both new HIV infections among women and the proportion living with HIV (over 15) as opposed to men. The gaps are even more notable among young women versus young men:

  • In sub-Saharan Africa, 7 in 10 new infections among 15-19 year olds are among girls;
  • Adolescent girls and young women account for 25% of new infections among adults; [iii]
  • In Asia-Pacific, women account for 32% of new infections, and 41% among young women aged 15-24;
  • In the Eastern Europe and Central Asia, women account for 31% of new HIV infections, and young women aged 15-24 comprise 46% of new infections;[iv] and
  • In South Africa, adolescent girls are 8 times more likely than their male peers to have HIV.[v]

Violence against women and girls significantly increases their risk of HIV infection. Globally, one in three women will experience physical and/or sexual violence at least once in their lifetime. Such violence manifests in many different forms, including: intimate partner violence; sexual assault or rape; trafficking; and forced or early marriage. Women and girls living in conflict zones experience social instability which further increases their risk of sexual and other forms of gender-based violence.[vi]

Gender inequality and deeply rooted, harmful social norms drive violence against women and girls. The links between HIV/AIDS, gender inequality, and gender-based violence, lie in the patriarchal nature of society and ideals of masculinity that are based on the control of women and that celebrate male strength and toughness. Such norms and attitudes permit men to have multiple partners and control their sexual encounters. Further, these specific ideals translate into risky sexual behaviours, predatory sexual practices and other acts of violence against women and girls, that ultimately increase their risk of HIV infection.

We know that there is a direct, causal link between intimate partner violence and HIV. In fact, women and girls in general are more likely to be infected with HIV if they have experienced any form of intimate partner violence or sexual violence. Coercive sex is common in intimate relationships and the fear of and actual violence affects women’s expectations in relationships, their ability to negotiate terms and conditions of sexual intercourse and whether condoms are used.[vii] The context in which this violence is perpetrated therefore increases the risk of HIV infection. Research from a variety of settings supports this reality:

  • A study from South Africa showed that 12% of new HIV infections among young women were directly attributed to intimate partner violence;[viii]
  • Research from Uganda found that any lifetime experience of intimate partner violence among women aged 15-49, increased the odds of being HIV positive by 55%;[ix]
  • Findings from a study in India among married women showed that physical and/or sexual violence perpetrated by husbands was associated with a nearly four-fold increase in the prevalence of HIV infection;[x] and
  • Additional data from India suggests that women suffer from ‘double jeopardy’, in that their abusive partner is both more likely to become HIV infected through increased participation in high-risk extra-marital sexual behaviours (for example with sex workers) and once infected is more likely to transmit the infection to a female partner, than is a non-abusive, HIV infected man.[xi]

We also know that childhood experiences of abuse are also associated with a greater likelihood of engaging in risky behaviour, such as sex without a condom, having multiple sexual partners, and trading sex for money or good, all of which increase the risk of HIV infection. Studies from Guatemala and Ukraine have found that girls from minority populations, such as orphans and street-based adolescent girls, are especially vulnerable.[xii]

Further, there are other key sub-populations who face intersecting vulnerabilities that increase their exposure to violence and risk of HIV infection. Among adolescent girls, this includes being young and female, as well as factors relating to sexuality, drug use, homelessness, sex work, and disability. Moreover, adolescent girls are especially vulnerable to early, coerced and intergenerational sex.[xiii]

Female and transgender sex workers are disproportionately vulnerable to HIV infection, because of violence perpetrated by clients, intimate partners, pimps, and police. Sex workers often experience forced, unprotected sex, including high-risk anal and gang rape; stigma and discrimination that prevents access to HIV testing, treatment and other health services; and police seizure of condoms which undermines condom use. These factors compound female sex workers' risk of exposure to HIV infection. As a heavily marginalised community, transgender sex workers are especially vulnerable to violence, and they face both higher rates of rape and HIV infection.[xiv]

The current evidence base strongly supports the notion that men’s violence facilitates HIV transmission.[xv] This means that solely reducing sexual-risk behaviours in abusive men is likely not sufficient to reduce the risk of transmission from HIV positive men to their female partners or non-partners. Effective programming must therefore be focused on challenging the harmful gender norms that facilitate and condone violence against women and girls.

HIV and violence against women and girls are intimately linked. If we want to see an end to HIV, we must take a holistic, comprehensive approach to the prevention of violence against women and girls. We know that by addressing the underlying factors that drive this violence, we will not only be more effective in preventing HIV, but will also bring about a number of other economic, social and health benefits.  


References

[i] UNWomen Facts and Figures: HIV and AIDS: http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures, Accessed 30/11/2016

[ii] UNFPA, What Works to Prevent HIV Among Adolescent Girls? http://www.equalityinstitute.org/what-works-to-prevent-hiv/, Accessed 30/11/2016

[iii] UNFPA, What Works to Prevent HIV Among Adolescent Girls? http://www.equalityinstitute.org/what-works-to-prevent-hiv/, Accessed 30/11/2016

[iv] UNWomen Facts and Figures: HIV and AIDS: http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures, Accessed 30/11/2016

[v] UNFPA, What Works to Prevent HIV Among Adolescent Girls? http://www.equalityinstitute.org/what-works-to-prevent-hiv/, Accessed 30/11/2016

[vi] UNWomen Facts and Figures: HIV and AIDS: http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures, Accessed 30/11/2016

[vii] UNFPA, What Works to Prevent HIV Among Adolescent Girls? http://www.equalityinstitute.org/what-works-to-prevent-hiv/, Accessed 30/11/2016

[viii] UNAIDS, Unite With Women Unite Against Violence and HIV: http://www.unaids.org/sites/default/files/media_asset/JC2602_UniteWithWomen_en_0.pdf, Accessed 30/11/2016

[ix] WHO and UNAIDS, 16 Ideas for addressing violence against women in the context of the HIV epidemic: http://apps.who.int/iris/bitstream/10665/95156/1/9789241506533_eng.pdf?ua=1, Accessed 30/11/2016

[x] WHO and UNAIDS, 16 Ideas for addressing violence against women in the context of the HIV epidemic: http://apps.who.int/iris/bitstream/10665/95156/1/9789241506533_eng.pdf?ua=1, Accessed 30/11/2016

[xi] Silverman, J. G. (2010) Key to prevention on HIV in women: Reduce gender-based violence, Lancet 376(9734):6-7.

[xii] UNAIDS, Unite With Women Unite Against Violence and HIV: http://www.unaids.org/sites/default/files/media_asset/JC2602_UniteWithWomen_en_0.pdf, Accessed 30/11/2016

[xiii] UNFPA, What Works to Prevent HIV Among Adolescent Girls? http://www.equalityinstitute.org/what-works-to-prevent-hiv/, Accessed 30/11/2016

[xiv] UNFPA, What Works to Prevent HIV Among Sex Workers? http://www.equalityinstitute.org/what-works-to-prevent-hiv/, Accessed 30/11/2016

[xv] Jewkes, R.K., Dunkle, K., Nduna, M., Shai N. (2010) Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010 Jul 3;376(9734):41-8