HIV/AIDS: Another expression of gender based violence Taking Action Addressing the problem

Women and HIV/AIDS

The proportion of HIV-positive women has significantly increased, and this process is most visible in countries where the virus spreads mainly through heterosexual intercourse, as is the case in Central America and the Caribbean. Gender Based Violence and HIV/AIDS Fact Sheet. PAHO. 2005

In 1997 women constituted 41% of HIV positive people, in 2002 this number had risen to almost 50 % [1].In 1997 women constituted 41% of HIV positive people, in 2002 this number had risen to almost 50 % [1]. By the end of 1999, women constituted 25% and 30% of HIV positive adults in Latin America and the Caribbean, respectively. Currently, these percentages have increased to 30% and 50% [2].By the end of 1999, women constituted 25% and 30% of HIV positive adults in Latin America and the Caribbean, respectively. Currently, these percentages have increased to 30% and 50% [2]. [1] UNAIDS World Report on the Global AIDS Epidemic. UNAIDS/WHO [2] Resumen mundial de la epidema del VIH/SIDA. UNAIDS/WHO

In the Caribbean, approximately 3,000 children are born annually to HIV positive mothers. As the number of HIV-infected women increases, so does the number of infected children. Bilali, C. Eighteen Years of the HIV/AIDS Epidemic in the Caribbean: A Summary. CARE Presentation.

Young women are the most affected group in the world: They represent 67 % of all new cases of HIV among people aged 15 to 24 in developing countries. State of the World Population. United Nations Population Fund. 2005

Violence against women is a major human rights and public health problem world wide...it increases female vulnerability to HIV. Global Coalition on Women and AIDS Backgrounder.

Gender based violence is both a cause and a consequence of HIV/AIDS, and vice versa

1.Gender based violence increases a woman’s risk of being infected with HIV. 2.Women face different forms of violence once they test positive for HIV.

Gender based violence and the increased risk of HIV infection among women 1

Many overlapping factors put women at greater risk of contracting HIV/AIDS. These include: Biological factors Economic factors Cultural factors

Biological factors Women are physiologically 2 to 4 times more susceptible to HIV. Women are physiologically 2 to 4 times more susceptible to HIV. Semen carries more HIV than vaginal secretions. Semen carries more HIV than vaginal secretions. Women have a larger mucosal surface where lesions can occur, facilitating infection. Women have a larger mucosal surface where lesions can occur, facilitating infection. Gender and HIV/AIDS. PAHO. 2005

Biological factors When sex is forced, risk of infection increases from bleeding and tearing. When sex is forced, risk of infection increases from bleeding and tearing. Vaginal membranes remain exposed to infectious fluids for hours after sex. Vaginal membranes remain exposed to infectious fluids for hours after sex. STIs often go undetected and untreated in women, increasing a woman’s vulnerability to HIV. STIs often go undetected and untreated in women, increasing a woman’s vulnerability to HIV. Violence against Women, HIV and Microbicides. Global Campaign for Microbicides. Fact Sheet #10

Economic factors Women often lack access to fair- wage jobs, have minimal education and work experience, and are deprived of property rights. This makes them economically dependent on their partners, and thus more vulnerable to abuse. Violence against Women, HIV and Microbicides. Global Campaign for Microbicides. Fact Sheet #10

Economic factors The power imbalance created by economic dependency and violence can leave women unable to negotiate condom use or to leave the partners that put them at risk of HIV infection. Violence against Women, HIV and Microbicides. Global Campaign for Microbicides. Fact Sheet #10

Economic factors Poverty forces many women into subsistence sex work, transactional relationships or situations of human trafficking that make it difficult or impossible to negotiate condom use. State of the World Population. United Nations Population Fund. 2005

Cultural factors In many cultures, male dominance is demonstrated and maintained through sexual coercion or violence. In many cultures, male dominance is demonstrated and maintained through sexual coercion or violence. The sexual exploitation of women and girls is one of the most extended forms of gender violence and an ongoing factor in the spread of HIV/AIDS. The sexual exploitation of women and girls is one of the most extended forms of gender violence and an ongoing factor in the spread of HIV/AIDS. Gender Based Violence and HIV/AIDS, Gender and HIV/AIDS. Fact Sheets PAHO. 2005

Cultural factors Girls and women are often taught to regard their bodies as property of men. Girls and women are often taught to regard their bodies as property of men. Women are often powerless and face threats of violence, and therefore experience little or no control over when and how sex happens in their lives. Women are often powerless and face threats of violence, and therefore experience little or no control over when and how sex happens in their lives. Violence against Women, HIV and Microbicides. Global Campaign for Microbicides. Fact Sheet #10

Cultural factors Women and girls often lack negotiating power and social support for insisting on safer sex or rejecting sexual advances. State of the World Population. United Nations Population Fund. 2005

Cultural factors Many societies expect women to be faithful even when men are not. A woman’s partner puts her at higher risk of HIV when he has multiple sex partners. Violence against Women, HIV and Microbicides. Global Campaign for Microbicides. Fact Sheet #10

Among HIV-positive women, many are married and have had only one partner— their husband State of the World Population. United Nations Population Fund. 2005

Cultural factors Women who are exposed to childhood sexual abuse are more likely to engage in HIV- related risk behaviors such as early sex, more partners and drug and alcohol use. Violence against Women and HIV/AIDS. Information Sheet. Global Coalition on Women and AIDS

In Nicaragua, one study found that women who were sexually abused in their childhood and adolescent years made their sexual debut more than two years earlier, and reported a higher number of sexual partners than those who had experienced moderate or no sexual abuse. Olson, A, Ellsberg M, Berglund S et al. “Sexual abuse during childhood and adolescence among Nicaraguan men and women: A population based anonymous survey” Child Abuse & Neglect. 24 (12):

Violence as a consequence of being HIV positive 2

A woman disclosing her HIV status may be put at risk of violence or abandonment. Violence Against Women and HIV/AIDS: Setting the Research Agenda. Meeting Report, Geneva, October 2000

Violence or fear of violence has been implicated as a barrier for women: Intimate Partner Violence and HIV/AIDS. The Global Coalition on Women and AIDS. Information Bulletin Series, Number 1. In seeking HIV testing and treament.In seeking HIV testing and treament. In disclosing their HIV positive status.In disclosing their HIV positive status.

HIV positive women face increased discrimination and violence as a result of their status.

Ridicule, insults and harassment Ridicule, insults and harassment Physical assault Physical assault Being forced to change residence Being forced to change residence Exclusion from social events Exclusion from social events Exclusion from family members Exclusion from family members Loss of financial support from their families Loss of financial support from their families Cited in Amnesty International. Women, HIV/AIDS and Human Rights These acts of discrimination and violence can include:

Recommendations for Action

Laws must be reformed to protect women’s equal rights, especially in the areas of: Domestic violence and spousal rape Domestic violence and spousal rape Sexual Violence Sexual Violence Marriage and divorce Marriage and divorce Land and property rights Land and property rights Access to social services Access to social services Legal Reform Recommendations adapted from Human Rights Watch, “A Dose of Reality”, 2004

Programs designed to address woman’s rights violations and improve enforcement of women’s rights must continue to be implemented, including: HIV/AIDS programs that combat discrimination and violence against women HIV/AIDS programs that combat discrimination and violence against women Training for judges, police and other officials on women’s rights Training for judges, police and other officials on women’s rights Improved data collection on violence against women and sexual abuse of girls Improved data collection on violence against women and sexual abuse of girls Systems for protecting confidential HIV test results and other patient information Systems for protecting confidential HIV test results and other patient information Programmatic Reform

Public education campaigns on women’s rights that disseminate information in local languages about: Domestic violence and spousal rape Domestic violence and spousal rape Sexual Violence Sexual Violence Marriage and divorce Marriage and divorce Prevention of STIs and HIV/AIDS Prevention of STIs and HIV/AIDS HIV/AIDS testing and treatment HIV/AIDS testing and treatment Public Education

Donor organizations should support NGO and government initiatives to support women’s rights. They are also well positioned to use their political influence to encourage governments to implement laws and policies that protect women’s rights. Donors and International Organizations

The disproportionate impact of AIDS on women and girls is no accident. It is the direct result of the pervasive and ongoing abuses of their human rights Human Rights Watch, “A Dose of Reality”, 2004