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16 Days: The Integration of HIV and Gender-based Violence
While the number of new HIV infections has stabilized in recent years, in many parts of the world, women and girls continue to bear a disproportionate burden of the pandemic. In the Caribbean, for example, women account for more than half of people living with HIV, and young women are twice as likely to be HIV positive as young men.
The connection between sexual and reproductive health and rights and HIV is undeniable, as the majority of new infections are sexually transmitted. Biologically, women are more vulnerable to HIV infection during heterosexual sex than men, but that is only one part of the picture. Poverty, gender inequality, and violence are also significant drivers of new infections among women.
Violence is both a cause and consequence of HIV. Violence and the threat of violence dramatically increase the vulnerability of women and girls to HIV by making it difficult or impossible for women to abstain from sex, to get their partners to be faithful, or to demand a sexual partner use a condom. The risk of HIV transmission increases during violent or forced-sex situations, as the abrasions caused through forced penetration can facilitate entry of the virus. Similarly, women living with HIV often face stigma and violence because of their HIV-positive status.
For women, integration of HIV testing and counseling with sexual and reproductive health services is critical because new infections often occur within stable, heterosexual relationships. In Asia, for example, it is estimated that more than 90% of women living with HIV became infected from their husbands or partners while in long-term relationships.
While linking HIV testing and counseling to sexual and reproductive health services—which a substantial number of women already use and trust—seems obvious to some, there has been a damaging lack of coordination among agencies focusing on HIV/AIDS, violence against women, and reproductive health. Stronger harmonization among these agencies is needed to ensure a broader reach of HIV testing and care, particularly for women in long-term relationships who do not believe they are at risk.
In Guatemala, for example, IPPF/WHR Member Association APROFAM is working to bridge this gap. Social worker Maria Julia Alcantara has assuaged the anxieties of countless clients who are at risk of HIV/AIDS or who have already tested positive for HIV. The first HIV clients Alcantara counseled at APROFAM were pregnant women, many of whom discovered their status after being tested for HIV following a routine prenatal exam. Alcantara knew that these women—some of whom were having unprotected sex with their husbands, over whose sexual practices they had little control—were a critical group to reach with information on HIV.
For many women, APROFAM’s information session is the first time they learn definitively about how HIV is and is not transmitted, and how to correctly use a condom. Whether they come to APROFAM seeking counseling for violence, prenatal care, or contraception, reaching women with this information is critical.
As one APROFAM educator recounted, “I used to work in a clothing store on a corner where there were a lot of sex workers. Men from rural areas would come through and pay them for sex. Afterwards, the women would tell me that the men refused to use condoms…and I know that these men would go home and have sex with their wives, and that their wives didn’t know what their husbands were doing…but the man will always say it’s the woman’s fault because otherwise it would expose his own infidelity.”
Dealing with such complex dynamics is no easy task, but Alcantara and her colleagues recognize that any credible effort to address HIV/AIDS must also address violence and inequality. Many of our Member Associations are employing this comprehensive approach, but global donors and governments must follow suit and ensure that the realities of women’s lives are reflected in HIV/AIDS programs and funding.
To learn more about how sexual and reproductive health programs can better integrate HIV/AIDS testing and care into existing programs, click here for an article by IPPF/WHR Regional Director Carmen Barroso and Serra Sippel of CHANGE.
Stay tuned to The Bikini tomorrow to learn about the violence and discrimination that women living with HIV/AIDS too often face.