“He used to force me to have sex with him. He would beat me and slap me when I refused. I never used a condom with him. . . . When I got pregnant I went for a medical check-up. When I gave birth, and the child passed away, they told me I was HIV positive. I cried. The doctor told me, “Wipe your tears, the whole world is sick (Just die quietly domestic violence in Uganda)”.
The above is an account by the one of many women from diverse regions, ethnic groups, religious backgrounds, and economic classes, whose experiences tell one story: that domestic violence has played a critical role in rendering them vulnerable to HIV infection.
The human disaster of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) has devastated the African continent, and disproportionately affects African women, who account for the majority of infected people in the sub-Saharan region.
At present UNAIDS (2005-2007) estimates that Worldwide, 17.3 million women aged 15 years and older are living with HIV/AIDS (48%) of the global total. However according to UNAIDS, 76% of all HIV positive women live in sub-Saharan Africa, where women comprise 59% of adults living with HIV. In sub-Saharan Africa, nearly three out of four (74%) young people aged 15–24 years living with HIV are female.
“There are so many factors that make women vulnerable to HIV infection, but in regard to violence against women, it mainly revolves around cultural factors. For instance in our society women are nurtured to be housewives while the men are given the freedom to be outside the home. And in most cases these men have more sexual partners outside the home and at the same time they have sex with their wives at home. Sex outside the home is not always protected because most of these men go for women when they are drunk while others deliberately refuse to use protection. This means you will have one man infecting as many women as possible, “says Dr.Rita Nassanga, a medical doctor at Mild May Aids Clinic in Kampala.
On the other hand women are also vulnerable because of their biological make up. The biological risk of HIV transmission will be affected by the type of sexual exposure, the presence of STDs.
UNAIDS estimates that in 2007, 15.4 million [13.9–16.6 million] women living with HIV numbered 1.6 million more than the 13.8 million [12.7–15.2 million] in 2001 while for, the 15.4 million [14.3–17.0 million] estimated to be living with HIV in 2007 compared with 13.7 million [12.6–15.2 million] in 2001.
As the AIDS scourge continues to claim so many lives of women there is growing evidence around the world showing a link between violence against women and HIV/AIDS.
According to a study done by Harvard School of Public Health on HIV/AIDS and Gender Based Violence (August 2006), HIV infection as relevant to GBV is primarily acquired through sexual relations, which themselves are greatly influenced by socio-cultural factors, underlying which are gender power imbalances.
And where there are unequal power relations between men and women, with women as the subordinates these barriers reinforce marginalization of women and any co-existing gender inequality. Such unequal power relations increase women’s risks and vulnerability to exploitation and therefore acquisition of HIV infection.
According to UN declaration on elimination of violence against women (1993), violence against women is defined as “any act of gender-based violence that results in, or is likely to result in, physical, psychological or sexual harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life”.
These acts include domestic violence, spousal battering, and sexual abuse of female children, rape and sexual assault (including marital rape), traditional practices harmful to women (such as female genital mutilation), forced prostitution, intimidation or sexual harassment.
Gender based violence, or the fear of it, may interfere with the ability to negotiate safer sex or refuse unwanted sex. Furthermore, violence against a woman can interfere with her ability to access treatment and care, maintain adherence to ARV treatment, or carry out her infant feeding choices.
A large proportion of women and girls who are subjected to violence are at a high risk of acquiring HIV/AIDS or sexually transmitted diseases. Violence against women makes women victims of HIV/AIDS because it makes it almost impossible for them to negotiate safe sex which includes using condoms, abstaining from sex or being faithful to one partner.
The degree to which women are able to control various aspects of their sexual lives is clearly a critical question for health promotion and the prevention of AIDS.
“The low status of women in society defined under the cultural system makes women become victims of violence and these acts of violence makes them vulnerable to HIV infection in turn. If you are subordinated, you are socially weak and this makes you vulnerable to risks. Most women also depend on men economically and this makes it difficult for them to stand up against violence and there are no options, “says Mr.Mubarak Mabuya, a principal gender officer.
The global epidemiological statistics on HIV infection points out some factors that are associated with the increased infection among women. These include lack of financial autonomy, education or gainful employment, which force women into early sex or early marriages, at a time when the genital mucosa is at the highest risk of trauma.
Others are socio-cultural beliefs and practices, such as wife inheritance and wife sharing, and masculinity, which may be associated with risk-taking social and sexual behaviour.
There is need for concrete action if the current figures of infected women are to be mitigated and eventually reversed. This includes raising awareness in society and taking concrete action at the national level to reduce violence against women as it increases vulnerability of women to HIV/AIDS.
“The solution to the problem must have an interdisciplinary approach. For instance when a woman is raped she will need medical attention, access to justice and psycho-social care and support. However what is critical is to invest in prevention instead of waiting for the violence to occur. When it occurs the response must be multi-sectoral with involvement of social, justice, civil society and the whole community,” Mubarak recommends.
“Sensitization of the community and raising awareness about violence against women can also help to address the problem. There is also need to strengthen legislation because what the law says can not be disputed. When people are aware of the existing law (addressing the problem) people will probably refrain from acts of violence while those who break the law will be punished.”
There is need to increase programs that address the linkages between violence against women and HIV through bilateral and multilateral funding mechanisms. There is also need to increase funding for research and evaluation of program strategies to reduce violence against women and its links to HIV, including through the UN Trust Fund to End Violence against Women.
Finally there is a ray of hope that the upcoming global HIV /AIDS implementer’s conference yet to take place in Kampala (3-7 June) will discuss and come up with concrete ideas to strengthen the global response to HIV/AIDS.