WUNRN
VIOLENCE AGAINST HIV POSITIVE WOMEN
International Community of Women Living with HIV/AIDS (ICW) and the Global Coalition on Women and AIDS (GWCA)
The term "violence against
women" (VAW) means any act of gender-based violence that results in, or is
likely to result in, physical, sexual or psychological harm or suffering to
women, including threats of such acts, coercion or arbitrary deprivation of
liberty, whether occurring in public or private life. Accordingly, VAW encompasses
but is not limited to the following:
·
Physical, sexual and psychological violence occurring in the family,
including battering, sexual abuse of female children in the household,
dowry-related violence, marital rape, female genital mutilation and other
traditional practices harmful to women, non- spousal violence and violence
related to exploitation;
·
Physical, sexual and psychological violence occurring within the general
community, including rape, sexual abuse, sexual harassment and intimidation at
work, in educational institutions and elsewhere, trafficking in women and
forced prostitution;
·
Physical, sexual and psychological violence perpetrated or condoned by
the State, wherever it occurs.
Other acts of VAW include violation of the human rights of women in
situations of armed conflict, in particular murder, systematic rape, sexual
slavery and forced pregnancy. Acts of VAW also include forced sterilization and
forced abortion, coercive/forced use of contraceptives, female infanticide and
prenatal sex selection.
Definition of Violence against women from
the
Already high levels of VAW are compounded by HIV/AIDS. However, most of
the research conducted to date has focused on violence and its role in
transmission. Here we consider the connection between violence and gender for
women that are already HIV positive.[1][1]
The link between HIV and violence
against women:
·
Assaults, battery and the rape of children, especially girls, are
reported to be frequent occurrences, and they perpetuate the spread of HIV
directly (in the case of rape) and indirectly through promoting intra-familial
fear that might prevent disclosure by a positive partner to a negative partner
or prevent negotiation of safer sex. Certain situations such as conflict,
migration and sex work can exacerbate the impact of violence on HIV positive
women;
·
Social tolerance of VAW prevents women from discussing the issue,
leaving or confronting an abusive situation or seeking help. Discrimination
associated with HIV heightens such tolerance;
·
Women may fear to leave an abusive relationship for fear of what will
happen to the children if they have no child-custody rights;
·
Women are often the first member of a household to discover their
status, through ante-natal testing. This can result in blame, violence and
rejection from partners or in-laws, family, friends and community. ‘When I was diagnosed I had a partner. The
relationship became more violent – he said I brought a new problem into the
family. The violence became more, he had other relationships. You get told off
because you have HIV.’ (ICW member
·
Exposure to re-infection by refusal to wear condoms, or the violation of
a woman's reproductive rights (e.g. if a woman is forced or coerced into
pregnancies and childbirth that she is not willing to undergo) can endanger her
life due to HIV-related complications;
·
Internalised stigma and discrimination may mean that people living with
HIV feel ashamed of themselves and of their status. This can undermine their
confidence to leave or confront an abusive situation. ‘He says “you have AIDS anyhow so you can’t compete with me. I have to
have a life. You have HIV and won’t be around. So understand my other
relationships”’. (ICW member
·
Myths and misconceptions and attitudes around HIV promote VAW. For
example, the belief that you can be cured by having sex with a virgin has led
to a high incidence of rape of young girls.
Accessing services:
·
Violence and fear of violence can lead to women feeling fearful to seek
care, treatment and support;
·
Fear of disclosure due to the threat
of violence or abandonment by partners, can be a barrier to accessing
treatment, especially where women have to travel a long distance to reach
health services, hospitals or clinics, and may need husbands' permission to
make or pay for the journey. The result can be that women seek help at the last
minute when they are really sick;
·
Fear of disclosure may prevent a
woman from accessing available PMTCT programmes, and using safer infant feeding
options, as a woman who doesn't breastfeed her child may be suspected of being
HIV positive.
Information
and experiences of services:
·
Many women do not know where to find information about VAW nor where to
report incidences or seek help;
·
Services are often limited with no referral systems in place to ensure
that appropriate counselling, treatments, advice and legal remedies are
available;
·
There are generally no shelters or safe houses for women;
·
The police often do not
take the issue seriously, particularly, rape in marriage. ‘I was nearly raped twice and the police said ‘but he did not penetrate
you – why are you here? He put it in such a way that made me feel guilty – you
were out late’. ‘Going to the police and being on trial is like being raped
again’ (ICW member
·
Marital rape is not recognised as a legal issue in most countries;
·
The culture of blame and discrimination against women living with HIV
that exists within society also permeates health care settings. Therefore, the
onus is placed on women to avoid violence by modifying their behaviour. ‘I put on weight from the treatment and
could not wear my [wedding] rings so I was abused. The counsellor said – “You
must wear your rings.” I am worried about being shot to death! She says you
must go back.’ (ICW member
·
HIV positive women also face pressure to
abort, be sterilised or take contraceptives in order to
access treatment services – all of which are forms of VAW.
Recommendations:
Given the limited information and analysis on the links between HIV,
gender and violence we firstly emphasise the need for research to address the
following questions:
·
How are local communities (i.e. families, community traditional, civic
and faith leaders) coping with HIV/AIDS and violence? What strategies have they
adopted to address violence and its links to HIV/AIDS?
·
How do young women understand and define the concept of violence in
their lives? What responses do they make and what opportunities do they have
for addressing this violence? How do poverty and culture combine to open up or
close down their options? More specifically, how do child custody laws and practices
affect women’s responses to violence; what role does access to or lack of
access to property/land/livelihoods play?
·
How does being perceived as being HIV positive, or disclosing a positive
serostatus, affect women’s experiences of sexual and other forms of
violence?
·
How do HIV/AIDS and other public services, policies and programmes
address issues of VAW? How do they contribute to VAW, including through mass
and routine testing?
·
How do services that deal with violence address the issues of women who
are already HIV positive?
In the mean time we urge policymakers and programmers to consider:
·
VAW and its relationship to HIV as rooted in unequal gender relations,
gender hierarchies and poverty, and not just within a public health framework;
·
The implications for VAW of public health policies relating to HIV/AIDS,
including HIV testing, treatment and partner notification policies;
·
The implications for VAW of legislation which has relevance to gender
relations, such as legislation related to equality within marriage, domestic
relationships, child custody;
·
Future directions for public services (legal/justice, medical and
social), in relation to VAW and HIV/AIDS;
·
The need to recognise differences in needs/approaches in different
contexts – drawing out comparisons while avoiding “one size fits all”
solutions;
·
The
need to increase the broad understanding of the complexities of VAW, including
physical, sexual, psychological, financial and institutional violence;
· Supporting safe spaces for HIV positive women to share
histories and seek mutual support. We also feel that if HIV
positive women have the space and time together they can break down the
barriers to discussing hidden or taboo areas. This could help challenge aspects
of 'internalised' acceptance of male violence and male 'right' to sexual access
to women, or, for example, the necessity of genital mutilation in order to
attract a husband.
================================================================
To leave the list, send your request by email to:
wunrn_listserve-request@lists.wunrn.com. Thank you.
[1][1] The Global Coalition on Women and AIDS has
produced an Issue Brief on violence against women, the focus of which is on
vulnerability to HIV and examples of work addressing the issues. See: http://womenandaids.unaids.org/themes/docs/UNAIDS%20VAW%20Brief.pdf.