1. The Interface between Intimate Partner Violence and HIV/AIDS in South Africa

2. Introduction
Rape is often assumed to occur as a violent attack by strangers.
In reality, most forced sex is committed by individuals known to the victim such as the intimate partner, male family members, acquaintances, and individuals in position of authority
Violence against women is well recognized as a gross violation of human rights and a public health problem, an epidemic that often overlaps with the AIDS epidemic.

3. As a young black, South African woman from a country faced with harsh cold realities, I find myself unfortunately confronted by so many challenges
I had wished to be standing here in front of you fellow social workers and colleagues from around the world to share a rainbow picture of my country today
We all know that SA is a rainbow nation
Unfortunately when it comes to HIV and Domestic violence, the picture is bleak for SA
SA being a patriarchal society, women still face a number of hardships
Though we got our freedom in 1994, women in SA are still not free
SA has the highest HIV statistics in the world
The highest cases reported of DV in the world
The highest crime rate

4. It is impossible to talk about HIV/AIDS without talking about domestic and sexual violence.
Globally, between 10 and 69 % of women report physical abuse by an intimate partner at least once in their lives.
Between 6 and 47 % of adult women worldwide report being sexually assaulted by intimate partners in their lifetime.
Between 7 and 48 % of girls and young women age years report their first sexual encounter as coerced (WHO 2002; Garcia- Moreno; Watts 2000 and Heise et al. 1999)

5. The high rates of HIV infection in women have brought into sharp focus the problem of violence against women.
There is a growing recognition that women and girls’ risk of and vulnerability to HIV infection is shaped by deep-rooted and pervasive gender inequalities, violence against them in particular

6. Data on Men, gender and health
In South Africa almost one-third of sexually experienced women (31%) reported that they did not want to have their first sexual encounter and that they were coerced into sex (Pettifor, Rees, & Stephens, 2004)
A study of over 1,500 women in South Africa indicates that “women with violent or controlling male partners are at increased risk of HIV infection” (Dunkle et al, 2004).
Conviction rates for domestic and sexual violence are amongst the worst in the world. Only one in nine victims reports rape and fewer than ten per cent of reported rapes lead to conviction.

7. In sub-Saharan Africa, the HIV/AIDS epidemic disproportionately affects women’s lives both in terms of rates of infection and the burden of care and support they carry for those with AIDS-related illnesses. In many countries HIV prevalence among girls under eighteen is four to seven times higher than among boys
A study from South Africa revealed that young women are much more likely to be infected than men and make up 77 per cent of the 10 per cent of South African youth between the ages of who are infected with HIV/AIDS

8. Where and how do intimate partner violence and HIV/AIDS intersect?
Direct transmission through sexual violence:
The biological risk of transmission in a violent sexual encounter is determined by type of sexual exposure (vaginal, anal or oral).
Risk of transmission is also increased with the degree of trauma, vaginal lacerations, and abrasions that occur when force is used.
Forced or coercive sexual intercourse with an HIV infected partner is one of the routes of transmission for HIV and sexually transmitted infections (STI) to women.

9. Indirect transmission through sexual risk taking:
There is growing evidence that the relationship between violence against women and HIV infection in women and girls may be indirectly mediated by HIV risk-taking behaviours.
Studies show that women’s experience of violence is linked to increased risk-taking including having multiple partners, non primary partners (or partnerships outside marriage) or engaging in transactional sex.

10. While the evidence is not conclusive, research suggests that violence limits women’s ability to negotiate condom use.
In a study from South Africa, women who experienced forced sex were found to be nearly six times more likely to use condoms inconsistently than those who did not experience coercion and, in turn, women with inconsistent condom use were 1.6 times more likely to be HIV infected than those who used condoms consistently.

11. On the other hand, another study from South Africa found that women who were physically abused prior to the past year were 1.5 times more likely to ask their current partners to use condoms than women who were not abused
Victims are often unable to negotiate the use of safer sex practices with coercive partners

12. Violence or fear of violence has been implicated as a barrier to women seeking HIV testing.
In Uganda, research indicates that women were afraid to ask for money or permission from their husbands to attend HIV/AIDS facilities or seek information and in some cases explicitly forbidden from taking HIV tests.
fear of violence has also been implicated as a barrier to disclosure of HIV status among those women who do seek testing. Between % of women in developing countries choose not to disclose their HIV status to their partners.

13. Abusers may rape or sexually assault their victims as part of their pattern of control, making it unlikely that the abuser will use a condom.
In fact, some abusers may intentionally infect their partners with HIV in an attempt to keep the victim from leaving Abusive partners who engage in sexual activity outside the relationship, potentially expose victims to STD’s including HIV.
Abusive partners may force victims to engage in sexual activities with others

14. It is difficult to get reliable statistics on violence against women in South Africa.
Although the number of reported cases is very high, many cases go unreported.
The incidence of battery or domestic violence is particularly hard to measure because the police do not keep separate statistics on assault cases perpetrated by husbands or boyfriends With reported incidents of sexual offences, that boils down to 187 sexual offences incidents per day.
If the suggestions of the 1 in 9 campaign are true, only 1 in 9 incidents of sexual offences are reported because of stigma, fear of retaliation and a lack of faith in the police.
This means that potentially there were actually over 6 hundred thousand sexual offences incidents, which translates to 1684 per day, which is over 70 per hour, which means at least one every minute

15. Ways in which Abusers Use Their Own or Victims' HIV+ Status as a Weapon of Coercion
Threats to reveal HIV+ status to children, family, friends, employer.
Threatening to use victim’s HIV+ status as grounds for paternal custody.
Reinforcing a victim’s guilt about the HIV+ status of children.
Sexually humiliating or degrading the victim for having HIV. Telling the victim s/he is "dirty" or undesirable.
Isolating the victim on the basis that s/he poses a threat of infection to others.

16. Threatening or refusing to assist the victim when she is sick.
Abusers may use victim’s HIV+ status as an excuse for their violence.
Abusers who are HIV+ may fake illness in order to convince victims not to leave or to woo them back if they have left.
Abusers who are HIV+ and who require care giving may be successful at manipulating victims into providing care.

17. Conclusion
It’s important to end intimate partner violence to reduce women and girls’ vulnerability to HIV/AIDS.
The evidence on the linkages between violence against women and HIV/AIDS highlights that there are direct and indirect mechanisms by which the two interact.
Coercive sex poses a direct biological risk for HIV infection resulting from vaginal trauma and lacerations

18. Women with a history of violence may not be able to negotiate condom use;
Women who experience violence may be in partnerships with older/riskier men who have a higher likelihood of being infected with STI and HIV; and
Violence or fear of violence may deter women from seeking HIV testing, prevent disclosure of their status, and delay their access to AIDS treatment and other services.
Health services including those focused on AIDS provide an important and potential entry point for identifying and responding to women who experience violence

19. Programs targeting gender attitudes and norms are essential
Behaviour change communication strategies (BCC): BCC interventions are recognized for their potential in creating public awareness and challenging individual and collective beliefs and attitudes towards an issue.
Public Awareness
Strengthening laws and policies
Economic empowerment of women

20. Thabo Mbeki
A true measure of intellectual competence is the ability to take a challenge and establish knowledge
The message here is simple Colleagues, let’s use each and every experience to learn, grow and be better, when we are better, we will surely do better.
The same we stood together to fight apartheid
The same way we stood together to put together a spectacular, victorious successful world cup
Will be the same way we conquer the scourge of HIV/AIDS, to create a warm and safer environment for our children
SA can still turn the tide against HIV and Domestic violence
Together, divided we fall

21. Story by Loren Eiseley
A young girl was walking along a beach upon which thousands of starfish had been washed up during a terrible storm. As she walked, one by one she picked the star fish up and threw them back into the ocean. After a while a man approached her and said, “Why are you doing this? Look at this beach; you can’t save all these starfish. You can’t begin to make a difference”
The girl looked at the man and then she bent down, picked up another starfish, and hurled it as far as she could into the ocean. Then she looked up at him and said “Well, I made a difference to that one”

22. President John F Kennedy
Let us think of education as the means of developing our greatest abilities, because in each of us there is a private hope and dream which, fulfilled, can be translated into benefit for everyone and greater strength for our nation

23. Let us not be about titles, Dr’s Prof’s etc, but let’s be about educated people who make a difference in the world. Let us work together to realize the dream of a better south Africa, which translate to a better world for all. Let’s strive for a world that is free of AIDS, Domestic violence, Child abuse, poverty, inequality etc. It might not be possible for me and you today but can’t we make it possible for our grand children. If you do your bit and I do mine, we can make a difference

24. THANK YOU