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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 Beijing Platform for Action 1995

 

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 Swaziland)

·         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 South Africa)

·         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 Swaziland);

·         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 South Africa)

·         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.







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[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.