Dealing with gender-based violence could help curb HIV/AIDS in Southern Africa

We use the term gender-based violence to include sexual and non-sexual physical violence and emotional abuse, both with a gender basis. We include the various forms of child sexual abuse within the definition of gender-based violence; and we recognise that both its victims and perpetrators can be female or male.

 A sizeable literature now links gender-based violence to HIV infection. Sexual violence can lead to HIV infection directly, as traumatic abrasions and lack of lubrication increase the risk of transmission. Gender-based violence also heightens HIV/AIDS risk indirectly by increasing the likelihood of high-risk behaviour. Several studies have shown that people with a history of childhood sexual abuse are more likely to be HIV positive and to behave in risky ways. Re-victimization compounds the risk. Perpetrators of gender-based violence are at particularly high risk of HIV infection, as they are more likely to force unprotected sex with people who have been victimized before, and who therefore are more likely to be infected. Considering gender-based violence perpetrators and victims together, perhaps as much as one third of the southern African population is currently involved in the vicious circle of gender violence, HIV and AIDS.

 A number of trials have shown successful reduction of gender-based violence and its consequences for HIV risk. Interventions among survivors of gender-based violence to support their recovery, improve negotiating skills, and increase condom use can reduce their risk of getting HIV (secondary prevention). Coping groups, education, counselling and adherence to anti-retroviral therapy can reduce further spread of HIV from infected gender-based violence survivors (tertiary prevention).

 Dealing with gender-based violence could have a positive effect on the HIV epidemic. Those responsible for AIDS prevention policy need to recognize:

• the full concept of gender-based violence,
• its direct and indirect implications for HIV prevention,
• the importance of perpetrator dynamics,
• that complex problems need complex interventions,
• that HIV prevention programmes must include efforts to curb gender-based violence.

In the short term, national resources should be committed to configure locally relevant actions aimed at reducing gender-based violence and its effects on HIV/AIDS risk. These actions should be implemented in stages in order to measure progress and make adjustments. Effective interventions are likely to include a structural component such as access to credit or earnings, and an awareness component covering survivors of gender-based violence, its potential victims and its perpetrators.