Ke Hudai cha Bhitra ? ............ A women looking from outside at a school of Surkhet.Photo by : Pawan Neupane
Monday, July 7, 2008
Voilance against women & HIV
Today, half or more of the 40 million people infected with HIV in the world are women. Millions of those infected with HIV are young people aged 15-24 years who now account for half of all new infections.
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. Studies conducted in many countries indicate that a substantial proportion of women have experienced violence in
some form or another at some point in their life.
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.
Indirect or indirect causes that link VAW and HIV&AIDS :
Domestic violence : Violence, and threats of violence, limit women’s ability to negotiate safe sexual behavior
o Domestic violence includes any form of abuse by a lover, relative, spouse, friend, or roommate. In domestic violence situations, the abusive partner may use physical, emotional, sexual or economic abuse to control the actions, thoughts, and emotions of another person.
=> Sometimes a partner's HIV AIDS status is used as an excuse for abusive behavior. HIV AIDS-related abuse can include: revealing HIV status to others, threatening to leave a partner who is sick, forced unsafe sex, using a partner's HIV infection as an excuse for having sex outside the relationship, and withholding medical attention or medication.
=> Indirect transmission through inability to negotiate condom use: While the evidence is not
conclusive, research suggests that violence limits women’s ability to negotiate condom use. For example, in a study from the U.S.A, African-American women who had physically abusive partners were four times more likely to be verbally abused and nine times more likely to be threatened with physical abuse when they asked their primary partner to use condoms compared to those who did not have abusive partners
=> Violence as a consequence of being HIV positive: 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. Violence or fear of violence has also been implicated as a barrier to disclosure of HIV status among those women who do seek testing. Between 16 - 86 % of women in developing countries choose not to disclose their HIV status to their partners. On the other hand, disclosure of HIV status is considered to be important for ensuring that HIV positive individuals are able to
access a range of services including prevention of mother to child transmission (pMTCT), anti-retroviral
treatment (ART), and psychosocial support21
Sexual violence (rape, sexual abuse, incest) :
o Directly increase women’s risk for HIV
o Sexual abuse as a child may lead to increased sexual risk taking as an adolescent/adult.
o Women who test for HIV and share test results with partners may be at increased risk for violence.
=> 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. For many girls and young women, their fi rst sexual encounter is coerced, with younger girls more likely to experience sexual coercion at initiation than older ones.
ð
=> Direct transmission through sexual violence: 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. The biological risk of transmission in a violent sexual encounter is determined by type of sexual exposure (vaginal, anal or oral)c. HIV transmission risk is also generally higher in presence of other STI and with exposure to sexual secretions and/or blood. Risk of transmission is also increased with the degree of trauma, vaginal lacerations, and abrasions that occur when force is used. Where sexual violence occurs in girls and young women, risk of transmission is also likely to be higher because girls’ vaginal tracts are immature and tear easily during sexual intercourse. Evidence of direct transmission of STI and HIV following sexual violence is diffi cult to establish. Two studies from the U.S.A suggest that while women who are raped are at high risk for pre-existing STI, sexual assault itself presents a small but substantial additional risk of acquiring STI
=> 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, nonprimary partners (or partnerships outside marriage) or engaging in transactional sexd. For example, one study in South Africa showed that women who experienced intimate partner violence were two to three times more likely to engage in transactional sex than women who did not experience violence. Moreover, women who reported transactional sex and had non-primary partners had 1.5 fold higher odds of being HIV infected that those who did not report transactional sex.
Sexual abuse during childhood and forced sexual initiation during adolescence are also associated with
increased HIV risk-taking among women. For example, in the U.S.A, several studies show that experience of childhood sexual assault is associated in adults with early sexual initiation, anal sex, sex with unfamiliar partners, and low rates of condom use8. In Nicaragua, one study found that women who were severely 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 abuse9.
§ 16% of Cambodian women are physically abused by their spouse
3. Trafficking for sex
According to Maiti Nepal Transit home data, 70% of trafficking women that return, are HIV infected.
Most vulnerable women:
- Dalit women face the dual burden of being at the bottom of the caste hierarchy and being a woman are most affected by the combination of HIV and violence.
- Poor women
- Sex workers
- Women living in isolated area
- Forced marriage / child marriage
- Single woman / housewives/ Husband has migrate
- Infected women
Today, half or more of the 40 million people infected with HIV in the world are women. Millions of those infected with HIV are young people aged 15-24 years who now account for half of all new infections.
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. Studies conducted in many countries indicate that a substantial proportion of women have experienced violence in
some form or another at some point in their life.
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.
Indirect or indirect causes that link VAW and HIV&AIDS :
Domestic violence : Violence, and threats of violence, limit women’s ability to negotiate safe sexual behavior
o Domestic violence includes any form of abuse by a lover, relative, spouse, friend, or roommate. In domestic violence situations, the abusive partner may use physical, emotional, sexual or economic abuse to control the actions, thoughts, and emotions of another person.
=> Sometimes a partner's HIV AIDS status is used as an excuse for abusive behavior. HIV AIDS-related abuse can include: revealing HIV status to others, threatening to leave a partner who is sick, forced unsafe sex, using a partner's HIV infection as an excuse for having sex outside the relationship, and withholding medical attention or medication.
=> Indirect transmission through inability to negotiate condom use: While the evidence is not
conclusive, research suggests that violence limits women’s ability to negotiate condom use. For example, in a study from the U.S.A, African-American women who had physically abusive partners were four times more likely to be verbally abused and nine times more likely to be threatened with physical abuse when they asked their primary partner to use condoms compared to those who did not have abusive partners
=> Violence as a consequence of being HIV positive: 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. Violence or fear of violence has also been implicated as a barrier to disclosure of HIV status among those women who do seek testing. Between 16 - 86 % of women in developing countries choose not to disclose their HIV status to their partners. On the other hand, disclosure of HIV status is considered to be important for ensuring that HIV positive individuals are able to
access a range of services including prevention of mother to child transmission (pMTCT), anti-retroviral
treatment (ART), and psychosocial support21
Sexual violence (rape, sexual abuse, incest) :
o Directly increase women’s risk for HIV
o Sexual abuse as a child may lead to increased sexual risk taking as an adolescent/adult.
o Women who test for HIV and share test results with partners may be at increased risk for violence.
=> 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. For many girls and young women, their fi rst sexual encounter is coerced, with younger girls more likely to experience sexual coercion at initiation than older ones.
ð
=> Direct transmission through sexual violence: 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. The biological risk of transmission in a violent sexual encounter is determined by type of sexual exposure (vaginal, anal or oral)c. HIV transmission risk is also generally higher in presence of other STI and with exposure to sexual secretions and/or blood. Risk of transmission is also increased with the degree of trauma, vaginal lacerations, and abrasions that occur when force is used. Where sexual violence occurs in girls and young women, risk of transmission is also likely to be higher because girls’ vaginal tracts are immature and tear easily during sexual intercourse. Evidence of direct transmission of STI and HIV following sexual violence is diffi cult to establish. Two studies from the U.S.A suggest that while women who are raped are at high risk for pre-existing STI, sexual assault itself presents a small but substantial additional risk of acquiring STI
=> 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, nonprimary partners (or partnerships outside marriage) or engaging in transactional sexd. For example, one study in South Africa showed that women who experienced intimate partner violence were two to three times more likely to engage in transactional sex than women who did not experience violence. Moreover, women who reported transactional sex and had non-primary partners had 1.5 fold higher odds of being HIV infected that those who did not report transactional sex.
Sexual abuse during childhood and forced sexual initiation during adolescence are also associated with
increased HIV risk-taking among women. For example, in the U.S.A, several studies show that experience of childhood sexual assault is associated in adults with early sexual initiation, anal sex, sex with unfamiliar partners, and low rates of condom use8. In Nicaragua, one study found that women who were severely 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 abuse9.
§ 16% of Cambodian women are physically abused by their spouse
3. Trafficking for sex
According to Maiti Nepal Transit home data, 70% of trafficking women that return, are HIV infected.
Most vulnerable women:
- Dalit women face the dual burden of being at the bottom of the caste hierarchy and being a woman are most affected by the combination of HIV and violence.
- Poor women
- Sex workers
- Women living in isolated area
- Forced marriage / child marriage
- Single woman / housewives/ Husband has migrate
- Infected women
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