1. How does violence increase women’s vulnerability to HIV?
Charlotte Watts
Gender, Violence & Health Centre
London School of Hygiene & Tropical Medicine

2. Many forms of violence, many forms of risk
Direct transmission through sexual violence
Including potential increases in transmission associated with genital trauma
Lack of control of sexual relations
Difficulties to negotiate condom use / safe injection
Child sexual abuse leading to later high risk behaviours
Difficulties accessing testing, treatment and care services
Child sexual abuse
Sexual violence
Intimate partner violence
Physical abuse
Psychological abuse
Economic abuse
Violence against sex workers, IDUs
Trafficking into sex work

3. Biological evidence of linkages between violence and HIV infection
South Africa - women with violent partners more than 50% more likely to be HIV infected than other women
Tanzania - the odds of reporting violence are 10 times higher for young, HIV-positive women compared to young, HIV-negative women
Goa, India – among married women, the risk of incident STI was 3 times higher than married women whose partners had not been violent.
Rakai, Uganda - girls who reported forced/coerced sex had a higher risk of HIV infection
Estimates of disclosure-related violence
0.4%-4% in U.S.
3.5%-14.6% in SSA

4. Percentage sexually experienced women reporting forced first sex
Source: Who Multi-Country Study on Domestic Violence and Women’s Health 2005

5. Prevalence of sexual violence against women
Source: Who Multi-Country Study on Domestic Violence and Women’s Health 2005

6. Clustering of risk behaviours
Men - growing evidence that men who are abusive to their partners are also more likely to:
Have more sexual partners
Have an STI
Have problematic use of alcohol
Refuse to use a condom

7. Violence against sex workers & other vulnerable groups common
Source: Jenkins 1996

8. Violence against women fundamentally undermines current HIV response
Abstinence / monogamy
coerced first sex common, particularly for early first sex
coercion in primary partnerships common
Behaviour change / delay starting sex
sexual violence is widespread
many women not able to influence partners sexual behaviour
fear of violence and social norms condoning forced sex undermines possibility of negotiation
Condom use
Women experiencing or fearing violence may find
impossible to negotiate
HIV testing, treatment & care
Fear of & experiences of violence undermine women’s ability to benefit