The Prevention and Management of HIV and Sexual and Gender-based Violence: Responding to the Needs of Survivors and Those-at-risk
This publication by the Population Council provides a framework for understanding how to implement a human rights based approach to prevent and manage HIV and sexual gender-based violence. The publication discusses the double-burden of SGBV and HIV, provides examples of comprehensive programmes on SGBV and HIV prevention, the challenges of using an integrated approach, and what the next steps are for SGBV and HIV prevention and management.
Sexual and gender-based violence is a pervasive global health problem, rooted primarily in the context of women’s and girls’ subordinate status in society. Sexual violence in particular poses significant risks to women’s health, including physical injuries, psychological trauma, unwanted pregnancy, and sexually transmitted infections (STIs), including HIV.
The human rights framework holds that all people, including women and people living with HIV, have the right to live without stigma, discrimination, and violence, and with self-determination. In recent years, global health advocates have used this framework to bolster support for issues of sexual and gender-based violence and associated health consequences.
Several international multilateral organizations, such as UNIFEM, UNICEF, WHO, many European Governments, and the African Union, have also spoken out against SGBV, particularly in the context of conflict settings. The UNAIDS “Agenda for Accelerated Country Action” specifically recommends that violence against women and girls is recognized within a human rights context, and, furthermore, addressed within the context of HIV.
The Double Burden of SGBV and HIV
Many risk behaviors are common to both HIV and sexual violence. Forced sex in childhood or adolescence increases the likelihood of later engaging in unprotected sex, having multiple partners, participating in sex work, and substance abuse, all behaviors likely to increase risk of HIV acquisition. People who experience forced sex in intimate relationships often find it difficult to negotiate condom use, which in turn makes these women more vulnerable to HIV infection.
Experience of sexual coercion is also associated with low self-esteem and depression—factors that can themselves be associated with many of the risk behaviors for HIV infection. Moreover, being infected with HIV can also increase the risk of suffering sexual violence. A Population Council project in Tanzania showed that HIV-positive women (aged 18-29 years) were ten times more likely to report suffering partner violence than young HIV-negative women.
HIV and SGBV prevention programs should operate at several levels to prevent and respond to SGBV. These can include building condom negotiation skills (behavioral), increasing access to emergency HIV prophylaxis (biomedical), and developing laws and policies that positively impact gender norms (structural). At the provider level, services related to SGBV and HIV require similar psycho-social skills among service providers: discretion and confidentiality; recognizing and countering cultural norms that discriminate against women; and interacting objectively and compassionately with patients on issues related to sexuality and intimate relationships. The medical skills required to provide HIV and SGBV services do differ, however; consequently, providers should be adequately trained in both HIV and SGBV care. (2011)