Integrated violence prevention programmes are needed to reduce the risk of women contracting HIV
iolence against women is an indicator of historically unequal power relations between men and women. This leads to discrimination against women, which often forces them into positions of subordination and in some cases violence. A large number of women have been identified who were infected by HIV due to sexual violence against them.
An estimated 33.2 million people are living with HIV/ AIDS worldwide. The disease has caused an estimated 2.1 million deaths, including 330,000 among children. According to a recent UN-WOMEN report, violence against women and girls is a major cause and consequence of HIV infection. It is one of the key drivers behind the increasing number of women and girls living with HIV and AIDS. Young women are especially at risk as a result of sexual violence, trafficking for sexual exploitation and child marriage. Forced sex increases the risk of contracting the virus as a direct result of physical trauma. Sexual abuse in childhood is associated with risk-taking behaviour later in life, increasing an individual’s lifetime risk of contracting HIV.
The circumstances underlying the correlation between violence against women and HIV/ AIDS are a complex weave of social, cultural and biological conditions. Fear of violence is an undermining factor in terms of seeking treatment. Women may hesitate to be tested for HIV because they are afraid that disclosing their HIV positive status may result in physical violence, ejection from their homes or social isolation. Studies from many countries have found these fears to be well-founded.
Violence against women is also used as a weapon during times of conflict. Such violence increases women’s vulnerability to HIV infection. During conflict and post-conflict periods, women become disproportionately defenceless against HIV infection due to the breakdown of law and order and sexual abuse by military personnel, forced movement away from home and the loss of families and livelihood. Women can also be subjected to repeated assaults, such as gang rape, where exposure to multiple assailants increases their risk of infection.
Limited economic security may increase a woman’s likelihood of engaging in high-risk behaviour such as commercial sex work or transactional sex. Many economically dependent women stay in high-risk and violent marriages. Widows also face major obstacles and many are stripped of their property and left to struggle to support themselves and their children while they are at their weakest. These factors combine with violence, or the threat of violence, to create an environment in which women are trapped into having unprotected sex with HIV-positive men and are unable to seek information or treatment on HIV infection and AIDS.
In Pakistan, data are lacking on the violence experienced by people living with HIV. However, some education and health sector organisations have done some research on this topic on a very small scale. Violence is an important public health problem affecting people living with HIV in Pakistan. This issue needs to be addressed scientifically by the government and non-governmental organisations at the national level.
A comprehensive response to violence against women and HIV and AIDS, highlighted by the Global Collation of Women and AIDS ( GCWA), stresses mobilising leadership at global, national and community levels with the aim of generating action to ensure that legal and policy changes occur to make violence against women unacceptable.
With an HIV prevalence rate of 0.1 per cent, Pakistan faces an intense epidemic among some populations and is at high risk for an HIV/ AIDS epidemic. In Pakistan, the social structures and conditions include widespread poverty, significant power imbalances between men and women, low levels of education and literacy and challenges in the areas of governance and human rights. Gender inequalities may also play a significant role in the further spread of HIV in the country. Pakistani women, in general, have lower socioeconomic status, less mobility, poor access to information and less decision-making power than do Pakistani men. This inequality contributes to their vulnerability to HIV.
The practice and tendency of seeking any kind of laboratory test is very low in the country for many reasons, including poverty, illiteracy, poor health-seeking behaviour, lack of medical laboratories in rural areas and unreliable results produced by some laboratories. A test for HIV/ AIDS is hardly initiated by doctors, police or the families of the victims until there are serious symptoms in the patient.
A comprehensive strategy to tackle violence against women and HIV and AIDS, highlighted by the Global Collation of Women and AIDS ( GCWA), stresses mobilising leadership at global, national and community levels with the aim of generating action to ensure that legal and policy changes occur to make violence against women unacceptable. Disseminating information on these topics to researchers, health practitioners and communities at large can build successful efforts and encourage partnerships among groups working on this issue.
Pakistan has a population of 221 million people and is the sixth most populous country in the world. The spread of HIV incidence represents a focused epidemic in high-risk groups. Several factors such as poverty, illiteracy, lack of awareness, drug use and frequent migration make the Pakistani population vulnerable to contracting HIV. Data on the number of people living with HIV, the number of new HIV/ AIDS registrations and mortality in people with HIV in Pakistan is limited. This is because of the social stigma attached to the disease; most people with HIV hesitate to register themselves for treatment. The epidemic in Pakistan is primarily concentrated in a few population groups, including people who inject drugs and sex workers.
The Declaration of Commitment approved at the UN General Assembly Special Session (UNGASS) on HIV and AIDS in 2001 calls on nations to ensure the development and accelerated implementation of national strategies for women’s empowerment, the promotion and protection of women’s full enjoyment of all human rights and reduction of their vulnerability to HIV and AIDS through the elimination of all forms of discrimination, as well as all forms of violence against women and girls, including harmful traditional and customary practices, abuse, rape and other forms of sexual violence, battering and trafficking in women and girls.
The writer is a playwright and freelance journalist. He can be reached at pashajaved1gmail.com and his blogging site: soulandland.com