Intimate Partner Violence and its Links to HIV/AIDS. 3/10

Women and girls are particularly vulnerable to contracting HIV infections

Afro AIDS Info

Introduction
Women and girls are particularly vulnerable to contracting HIV infections1. One of the reasons for this is the world-wide problem of gender-based violence, perpetrated against women and girls, more often than not by people who are known to them2.

A recent study in the United States has also found a strong correspondence specifically between the occurrence of Intimate Partner Violence (IPV) and HIV infection3, while studies from Kenya, South Africa, and Tanzania reported that women who were infected with HIV had a higher probability of reporting IPV than those who were uninfected4. In Rwanda, women who have suffered from any kind of abuse in their marriages are up to 3.46 times as likely to be sero-positive compared to their counterparts who have not experienced any abuse5.

What is Intimate Partner Violence (IPV)?
Violence committed by a woman’s intimate partner includes physical violence, sexual violence as well as psychological violence1.

Physical violence constitutes any physical attack such as a slap, a punch, a kick, physical attack with a weapon as well as murder, while sexual violence consists of rape, intimidation and threats, harassment, unwanted touching and making someone take part in pornography. A women or girl is considered to be psychologically abused when she is humiliated, intimidated, isolated from her friends and family and prevented from earning a living, when her earnings are taken away by the abuser, or when she is denied the necessary resources.

Intimate Partner Violence (IPV) is the type of violence against women that causes the most deaths and is also the most widespread form of gender-based violence6.

Prevalence of IPV
Although most people would assume that something like rape is committed by strangers, more often than not, women and girls are forced into sex by people that are familiar to them such as their intimate partners, members of their family and other people they know such as school teachers and authority figures in their lives1,2.

The exact numbers from different studies vary, but the upper limits from extensive studies conducted in countries across the globe show that more than 50% of women have experienced abuse by their intimate partners1,6,7.

The close connection between IPV and HIV
IPV is acknowledged as a significant source for the deterioration of a woman’s capacity to influence her reproductive and sexual health6. There are both direct and indirect risks of HIV to women who are faced with sexual violence2,3 and the problem is exacerbated when the perpetrator is an intimate partner.

The direct risks include perpetrators who are HIV-positive, exposing them directly to the virus during an act of rape2,3.

Indirect risks are linked to the behaviour of the perpetrators of violence as men who are abusive towards their wives and who are often more likely to exhibit other unsafe sexual practices such as having multiple partners and refusal to use a condom5.

If a girl experiences sexual violence, she is more likely to exhibit unsafe sexual behaviour and where people experience sexual violence in intimate relationships, their power to negotiate safe sex is often diminished2,3,6.

Women who are living with HIV often become victims of violence and abuse2. The fear of violence will prevent many women from seeking information and treatment offered by HIV/AIDS prevention campaigns2. This same fear also prevents women from disclosing their positive status to their partners1.

What are the opportunities to address IPV in HIV preventative programmes?
Health professionals as well as policy makers need to be made aware of the close linkage between IPV and HIV so that legislature can be adapted accordingly3.

The links between IPV and HIV require further investigation in order to find the best method of attending to both issues7. Understanding the factors that allow women to demand protected sex will allow policy makers and health professionals to use these facts to decrease the number of HIV infections9.

Apart from the health burdens imposed by IPV, there are also high financial costs associated with IPV8. Domestic violence can be addressed as part of HIV preventative strategies as well as stand-alone initiatives aimed at addressing the deeper causes of gender-based violence such as the need of men to prove dominance and power over women2.

Programmes that pay more attention to gender attitudes and sexual norms related to masculinity and femininity might help to address some of the factors that lead to IPV. Examples of such programmes which have already been implemented include Men as Partners (MAP) and the Stepping Stones programmes1.

Women who test positive for HIV should be screened for IPV and receive necessary counselling and treatment1,3.

Although most studies have shown contraception use to decline among women who have experienced IPV, a recent study conducted in sub-Saharan Africa showed an increase in female controlled contraceptives among the victims of IPV. This suggests that the wider distribution of female controlled contraceptives may prove an effective route of contraception, although it does not protect them from sexually transmitted infections and HIV. Thus, it leads to the conclusion that only interventions directed at both males and females will be effective 4.

Programmes aimed at targeting IPV should address the underlying factors that cause such violence, including: gender inequality, multiple partners, alcohol abuse and poverty7.

A study conducted by the University of Botswana in 2005 concluded that a woman’s dependence and feeling of powerlessness reduces her capacity to negotiate condom use. This study also found that men with multiple partners were more prone to refusal to use condoms9.

Communication about HIV/AIDS between intimate partners should be strongly encouraged by all HIV prevention initiatives9.

References

Reviewed by: Hendra van Zyl