Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

Linkages between HIV/AIDS and GBV

Violence and the threat of violence can increase women and girls’ vulnerability to HIV by making it difficult or impossible to set the terms of an equal relationship. It is more difficult for women to refuse sex when in a relationship, to get their partners to be faithful, or to use a condom. Violence can also be a barrier in accessing HIV prevention, care, and treatment services. The linkages between sexual violence and HIV, especially among young women in high prevalence countries, are well-documented. UNFPA: An exhibition on gender-based violence

The Global AIDS Alliance explains how violence puts women and girls at risk of HIV as follows:

  • Violence against women is associated with an increased risk of acquiring sexually transmitted infections, a risk factor of HIV.
  • Violent sexual assault can cause trauma to the vaginal wall that allows easier access to HIV.
  • Fear of violence prevents women from negotiating safe sex.
  • A study in South Africa found that women who have been forced to have sex are almost six times more likely to use condoms inconsistently than those who have not been coerced.
  • Children who are sexually abused are more likely to engage in behaviors known to be risky for HIV as adults. They are also more likely to experience sexual or domestic violence.
  • Boys who witness or experience family violence are more likely to commit rape.
  • Men who are violent toward their intimate partners have been found to be more likely to have multiple sexual partners than men who are not violent toward their partners.
  • Abused women are at greater risk of acquiring HIV, and women living with HIV have more lifetime experience of violence than HIV-negative women.
  • A WHO study found that fear of violence was a barrier to HIV disclosure for an average of 25% of participating women. In some countries the proportion was as high as 86%.
  • Fear of violence prevents women from seeking voluntary counseling and testing for HIV, returning for their test results, or getting treatment if they are HIV positive or services to prevent mother-to-child HIV transmission.

Souce: Global AIDS Alliance 2009: Violence against Women and Girls & HIV/AIDS

Statistics of linkages between HIV/AIDS and violence against women and girls

A global review of 30,000 published and unpublished articles and UN studies shows that physical and sexual intimate partner violence (IPV) and childhood sexual abuse (CSA) increases the risk of HIV infection both directly via viral transmission and indirectly, through increasing the likelihood of subsequent risky sexual behaviour. As part of a larger, global burden of disease analysis the authors estimated the regional and global prevalence of IPV and CSA in women and men of all ages. Data from 96 countries show nearly 0-70% of ever-partnered women have experienced IPV, with 17 countries reporting national prevalence higher than 30%. Data from 45 countries shows up to 30% of ever-partnered men have experienced IPV, but only one country reported prevalence above 30%. Higher prevalence was reported in Africa and Latin America. Data from 63 countries show 0-70% of women were sexually abused as children, with prevalence more than 10% in 14 countries. Data from 42 countries shows 0-52% of men report childhood sexual abuse, with 8 countries reporting prevalence above10%. CSA prevalence was higher in high-income countries.

The authors concluded that the prevalence of IPV and CSA varies widely by sex, age, and global region, with women tending to report higher prevalences. Given the direct and indirect effects of violence on HIV risk, policy makers, service providers and those planning prevention services must integrate responses to violence into HIV programming.

Source: Preventing HIV by preventing violence: global prevalence of intimate partner violence and childhood sexual abuse; K. Devries, L. Bacchus, J. Mak, J. Child, G. Falder, C. Pallitto, C. Garcia-Moreno, C. Watts; London School of Hygiene and Tropical Medicine, Gender, Violence and Health Centre, London, United Kingdom/WHO, Reproductive Health, Geneva, Switzerland presented at the XVIII International AIDS Conference, July 18-23 2010, Vienna, AUSTRIA

For additional information see also UNWOMEN Virtual Knowledge Center to End Violence Against Women and Girls