Violence Against Women and HIV & AIDS: The Devastating and Deadly Intersection

1. Violence Against Women and HIV & AIDS: The Devastating and Deadly Intersection Findings and Recommendations from Zimbabwe, Nepal, and Liberia

2. Links between Violence Against Women and Girls and HIV & AIDS • Women in violent relationships are much less likely to seek HIV & AIDS related counseling, testing or treatment. They will also be less likely to disclose their status to their partner • Women who disclose their status are frequently beaten, lose their homes, jobs and children and are rejected or even physically abused by the community • Domestic violence and abuse are still largely viewed as a private matter which makes women less likely to access necessary health care, counseling, and services • Fear of violence often prevents women from negotiating condom use.

3. Links between Violence Against Women and Girls and HIV & AIDS (con’td) • Even when rape is reported, few survivors have access to PEP treatment, which can prevent HIV infection. • Incidence of sexual assault has increased due to the myth that having sex with a virgin will cure HIV & AIDS. • Rape often involves physical violence and is usually without a condom, thereby increasing the risk of HIV infection.

4. Today I am Representing the Voices of Women of……. • Zimbabwe • Liberia • Nepal

5. Zimbabwe • The harsh economic environment has grave implications for Zimbabwe’s capacity to deal with the twin pandemics of HIV&AIDS and VAW. • Unemployment has, in many instances, resulted in the reversal of roles in families as women became the breadwinners by engaging in cross border trade or working as migrant workers outside the country. • This has created fertile conditions for VAW as men’s traditional roles have been threatened.

6. Zimbabwe Economic conditions have resulted in an increase in commercial sex work, as well as transactional sex. • Sex workers are a marginalised and often criminalised population. • They are more vulnerable to HIV infection and violence because they are demonized, discriminated against, as well as made invisible in decision-making processes. • A SAFAIDS study of sex workers in Zimbabwe found that a staggering 86 percent of women were HIV-positive and 34 percent had an STIs

7. Nepal • Cultural perceptions of women’s sexual and reproductive obligations in marriage rob women of bodily autonomy, while unequal property rights, the payment of bride price, and women’s inability to take their children from the fathers’ homes render women unable to leave abusive relationships. • In addition to coping with violence and disease, many women must also contend with the uncertain future their children face as children of parents with AIDS. As a result, many economically dependent women stay in high-risk, violent marriages. • Widows also face imposing obstacles: many are stripped of their property and left to struggle to support themselves and their children while they are at their weakest. These factors and more combine with violence, or the threat of violence, to create an environment within which women are trapped into having unprotected sex with HIV-positive men and are unable to seek information or treatment.

8. Nepal • “He would beat me to the point that he was too ashamed to take me to the doctor. He forced me to have sex with him and beat me if I refused. This went for every [wife]. Even when he was HIV-positive he still wanted sex. He refused to use a condom.” --Babita • “He used to force me to have sex with him. He would beat me and slap me when I refused. He never used a condom with him . . .. When I got pregnant I went for a medical check-up. When I gave birth, and the child had passed away, they told me I was HIV-positive. I cried. The doctor told me, “Wipe your tears, the whole world is sick.”

9. Liberia • Female relatives of perceived enemies were raped and tortured. Women were forced to cook for the troops, then were tortured and violated as enemy collaborators. During the various conflicts women were used as sex slaves with the sole purpose of satisfying the sexual desire of the fighting forces. • One family tells of their ordeal where the grandmother, mother and granddaughter were gang raped after witnessing the execution of the grandmother’s only son. Today all three females are HIV positive.

10. Liberia • During the 2002-2003 civil crises, Famatta was gang raped by a general and his body guards. • She reported the rape to her father but he felt powerless to help her. • A few months after the rape, Famatta began to feel ill; suffering from chronic diarrhea. She was pregnant. When she visited the hospital, she was diagnosed HIV positive. • Her partner abandoned her and her twin sons. Famatta believes that she acquired HIV/AIDS as a result of the rape.

11. Liberia (cont’d) • The war is over but the violence against women in the form of rape, sexual assault and exploitation did not end with the civil conflict. In post war Liberia the culture of violence, particularly violence against women, is widespread. • Research carried out by IRC among Liberian refugees in Sierra Leona, reports that 74% of the respondents reported experiencing at least one incidence of SGBV before being displaced and 66% of them had experienced at least one incidence of SGBV since their displacement.

12. Recommendations • To truly eliminate VAW and HIV&AIDS, the strategy must be deep and systemic in nature, as societies and infrastructure must change in order to begin to remedy the structurally, culturally, and systemically perpetuated contexts and dynamics which support gender equality. In the meantime…… • Given the proliferation of women contracting HIV through situations where they are not in a position to negotiate safer sexual health choices, we must come up with comprehensive strategies which reach beyond ABC and that will protect women and over which they have more control. • Strategies must include increasing access to the female condom and advancing progress towards the availability of microbicides.

13. Recommendations (cont’d) • We must increase gender mainstreaming/incorporation of women’s rights-sensitive policy making into HIV prevention strategy • Laws against VAW in all its forms and contexts must be in place, (against sex workers, IPV, SBV, etc) communities and women & girls must be educated regarding their rights, and enforcement of laws must be assured. • Increased funding and programming must be dedicated to elevating integrated programming addressing the intersection of Violence Against Women and HIV&AIDS.

14. Recommendations (cont’d) • Substantial improvement is needed, at the country level, in terms of level of political will for addressing VAW and HIV&AIDS. • Sex workers, and other high risk/vulnerable groups, must be involved in planning and decision making related to prevention and impact mediation of VAW and HIV&AIDS. • Youth participation and leadership roles must be increased.

15. Recommendations (last) • Some traditional and cultural practices take precedence over national policies and laws. There is need to harmonise them in order to eliminate dual systems that often confer undue privileges on men. • More programmes, by men. that target men to influence behaviour and attitude change are needed. • There must be dedicated programs to address special needs of particularly vulnerable groups such as commercial sex workers, the LGBT community, people who are injecting drugs, and persons with disability. • Improvement is needed in the health and social sector’s capacity to address the needs of battered women and survivors of various forms of abuse with special attention to HIV risk.

16. Sample of Key Resources • Strengthening Resistance: Confronting Violence Against Women and HIV & AIDS www.cwgl.org • World Health Organization Multi-Country Study on VAW and HIV&AIDS www.who.int • Center for Health and Gender Equity-Global GBV/RH Directory www.genderhealth.org • Women Won’t Wait Coalition and the “Show Me the Money” Report www.womenwontwait.org • Harvard School of Public Health, Program on International Health and Human Rights http://www.hsph.harvard.edu/pihhr/ Please watch our website where we’ll soon post a comprehensive resource list! www.actionaidusa.org

17. Thank You Jacqui Patterson Jacqui.patterson@actionaid.org 202-370-9916