The links between violence against women and vulnerability to HIV infection are well known. But what interventions should we put in place to combat violence and its HIV related outcomes? This was a question addressed at a side session at the International AIDS Conference today. The solutions are far from clear cut. Links between violence against women and HIV go beyond the way that sexual violence, or rape, increases biological vulnerability to HIV infection.
Economic abuse, physical violence (particularly by intimate partners) and psychological abuse lead to situations where women can’t control how, where, when and with whom sex takes place. Fear of violence or actual violence from partners can prevent women finding out their HIV status or accessing treatment and care services. Child sexual abuse can lead to higher risk taking behaviour in adulthood. To compound matters men who are violently abusive are more likely to have more sex partners, sexually transmitted infections, suffer from alcoholism and to refuse to use condoms. WHO studies show in many regions young women have high levels of forced first sex – the earlier sex occurred the more likely it was to be forced.
Sex workers, transgendered women, women who inject drugs and lesbians are targets of violence from the state and community not just their intimate partners. This is an area that is often neglected in interventions to address violence. Policy makers who champion the criminalisation of sex work undermine their own HIV prevention policies as sex workers are often driven underground where work is more dangeropus and opportunities to access medical services more difficult.
Suggestions made at the conference session for preventing violence included;
• integrating action against violence into HIV programmes,
• promoting gender equality particularly with men to make them take responsibility
• finding male champions in positions of power in the community or faith structures
• quality and comprehensive sexual and reproductive health education before sexual debut,
• policy and law reform,
• sensitisation of healthcare providers,
• encouraging domestic violence services to integrate HIV work
• decriminalising sex work.
However, the evidence for these interventions is weak and few promising programmes have been taken to scale – so it is clear that more research is needed.
Law and policy reform won’t work if it is not enforced or the enforcers are the perpetrators of violence. Similarly placing the responsibility for combating violence in the hands of healthcare workers is problematic in settings where they are the perpetrators of abuse for example in the forced STI and HIV testing of sex workers or sterilisation of women living with HIV.
The link between HIV, violence and conflict was not a focus for the presentations.
Finally the session failed to comprehensively address structural interventions to assist men who wish to assert a style of masculinity outside the norm. Something that has been picked up in the latest issue of the Institute of Development Studies In Focus Series on Men, Sex and HIV: Directions for Politicising Masculinities. It also failed to suggest services for troubled men to address the personal difficulties that may drive their aggression.