HIV/AIDS and Violence Against Women
Panel on Women and Health
March 3, 1999
Madam Chair, Ladies and Gentlemen . . . I very much welcome the opportunity to speak here today . . .
As the head of UNAIDS, I am normally used to emphasizing the relentless rise of the HIV/AIDS epidemic in many parts of the world. Not just in Africa where its continued expansion is of deep concern, but also in Asia and increasingly Eastern Europe and the former Soviet Union. I also tend to explore what we -- the world community -- can do about it.
Today, however, I would like to focus on a particularly insidious aspect of the AIDS epidemic. It is also one which is only now beginning to receive the international recognition it deserves. I am referring to violence against women and its impact on the merciless spread of this global disease.
Most countries have completely failed to deal with this issue. Gender-based violence is still a taboo subject. In many places it is considered a private matter, not to be discussed publicly. This, ladies and gentlemen, is an unacceptable situation.
Domestic violence, rape and other forms of sexual abuse are gross violations of human rights. They are also closely linked to some of today's most intractable health issues, including the spread of HIV, the virus that causes AIDS. But before I describe their health consequences, let me say a few words about the sheer scale of violence against girls and women.
The Scale of Violence Against Girls and Women
According to the World Health Organization, violence against girls and women throughout the world causes more death and disability among women in the 15 to 44 age group than cancer, malaria, traffic accidents and even war. Most recent studies from around the world suggest that between 16% and 52% of women have been physically assaulted by an intimate partner at least once in their lives. This kind of assault is often associated with sexual violence, including rape.
In the United States, for example, a woman is assaulted -- usually by her husband -- every fifteen seconds. In India, one study suggested that between 18% and 45% of married men acknowledge abusing their wives.
Marital abuse, however, is not the only threat. Many women and girls are victims of sexual coercion by male relatives, classmates or neighbours. School girls in Africa, for example, often resort to sex with older "sugar daddies" to help pay education fees. The fact that many of these men may have multiple partners or practise unsafe sex does not seem to prove a deterrent.
Coercion can take the form of wanton rape. In South Africa, for example, roving gangs of young men, many infected with HIV, engage in what they call "catch and rape". Professional women who are considered to have "risen above themselves" are particularly vulnerable. Similar situations have arisen in the West Indies, where gangs have been assaulting women and girls as part of initiation ceremonies. In Papua New Guinea, 40 percent of rape victims are girls under the age of fifteen.
Rape has also become a deliberate weapon of war in many conflicts such as Central Africa and the Balkans. This cruelly imposes on women and girls -- some of them less than ten years old -- not just pain and humiliation but the threat of sexually transmitted diseases, such as AIDS.
The trafficking of girls and women is yet another tragic context for sexual violence. Every year, hundreds of thousands of women and girls throughout the world are bought and sold into marriage, prostitution, and slavery. Young girls in Africa, the Middle East and Asia are regularly forced to take much older husbands, who already have other sex partners, thus aggravating the risk of HIV. The United Nations estimates that four million people are trafficked every year. Overall, however, as many as 200 million may be enduring a form of contemporary slavery today.
Most of the sex trade in women and children takes place in Asia. Nevertheless, Latin American, Caribbean and Eastern European women are becoming increasingly susceptible, especially in impoverished countries of the former Soviet bloc where HIV/AIDS is rising. In Western Europe alone, up to half a million women are being trafficked. Many come from Eastern Europe but also Africa and Asia, with traffickers now making as much from the human trade as from drug smuggling. Once in the hands of these traffickers, women and girls often have little chance of escape. Many are forced to engage in unsafe sex with their customers, severely exacerbating their risk of HIV.
HIV/AIDS and Other Health Consequences of Violence
So the scale of violence is frightening. So is the scale of HIV and AIDS, especially women. Increasingly, female vulnerabilty to HIV is showing up in the statistics. Today, of the estimated 33 million people are living with HIV or AIDS, 43% are girls or women.
Why are women so vulnerable to HIV? Biologically, females are far more likely to contract a sexually transmitted disease through intercourse than males. This makes the consequences of unprotected sex far more serious and life-threatening to women.
But women's vulnerability has social roots, not just biological ones. For millions of women and girls, their subordinate position in numerous societies can make it difficult if not impossible for them to protect themselves from HIV. They often cannot insist on fidelity, demand condom use, or refuse sex to their partner, even when they suspect or know he is already infected himself. And they often lack the economic power to remove themselves from relationships that carry major risks of HIV infection.
Violence is part and parcel of these dilemmas.
I have already outlined the settings in which physical and sexual violence can occur, from the bedroom to the refugee camp, and how it can result directly in HIV infection. But let us not forget. Even the threat of violence can lead to AIDS. It may not kill immediately, like a bullet, but it can kill slowly, by killing dialogue about sex and life. And by undermining women's ability to protect themselves.
Women, fearful of getting beaten or thrown out, are unlikely to ask their boyfriends to wear a condom, or question them about fidelity.
Their fears are justified. In Zimbabwe, for example, studies indicate a high level of abuse by men whose wives dare ask them to wear a condom during sex.
Let me say a few words about those at highest risk -- adolescents, particularly girls. Today, over half of all new HIV infections worldwide occur in those under 25 years old. Studies in Kenya show that nearly one girl in four between the ages of 15 and 19 is living with HIV. In many countries, girls are becoming infected much earlier than boys.
Many of these infections result from violence. In Santiago, Chile, three percent of young women report that rape was their first sexual experience. Even young children may contract HIV from forced sex, often with close acquaintances, such as family members or 'trusted' friends. Mothers often know that their children are being abused, yet are afraid to speak out.
But I want to stress that the health consequences of abuse are not limited to the obvious risk -- getting infected with HIV by the abuser. Children who are abused are wounded in their self-esteem; they feel dirty, ashamed, they lose faith in others. Later in life this may lead to many kinds of AIDS risk behaviour such as drug use, prostitution and unprotected sex. A recent US survey showed that young women who were sexually abused as children are twice as likely to place themselves at risk through unprotected sex with multiple partners.
For boys too, physical abuse as a social norm is carried over from generation to generation. Boys who watch their fathers abuse their mothers are more likely to become abusers themselves, thus perpetuating the cycle.
Which brings me to a point that often gets lost when we talk about violence and AIDS. Yes, girls and women are subordinate, and this is an enormous problem. But let us not lose sight of the other side of the coin -- what society sees as acceptable male behaviour. The international community may look on male violence against women as legally intolerable, but it is still considered an acceptable part of life in many societies, including by its victims.
Sexual violence as a social norm may even be strengthened by national courts. A recent rape case decision by an Italian court threatens to drag back women's rights twenty years by claiming that a woman wearing jeans must have taken them off willingly to have sex -- she cannot have been raped by the man she was accusing.
Fortunately there is also some good news on this front. In China, a woman successfully sued her husband for abuse. Although he claimed that whatever happens at home is a private matter, the court chose to recognize the woman's complaint. A Kenyan woman achieved a similar feat in a country where most abuse cases never get beyond the local police station because of family and social pressures.
Violence Arising from HIV
I would not want to conclude this brief look at the links between violence and HIV without mentioning one final point. Violence against women is not just a cause of the AIDS epidemic. It can also be a consequence of it. Nearly 14 million women today are infected with the virus that causes AIDS. Of those whose infection status became known to others, many suffered direct violence at the hands of their husband, family or community. As I am sure many of you will recall, a South African woman -- Gugu Dlamini -- was ruthlessly murdered by neighbours soon after she revealed her HIV status as part of her country's commemoration of World AIDS Day.
These so-called 'shame' killings are reported from around the world. Women known or thought to be infected may also face eviction from their homes, abandonment by their families, and dismissal from their jobs. Gender-based violence is not only physical, it is also psychological violence.
Ladies and gentlemen, gender violence clearly remains a subject of passionate debate in many parts of the world. Yet many governments are reluctant to fully support the kinds of measures needed to remedy this deplorable situation, especially in this new world of AIDS risk.
Strengthening the legal framework, both at the international and national level, is obviously crucial. In order to survive in a world with AIDS, we need to protect the sexual and reproductive rights of women. These include the right to decide when, with whom and under what circumstances to engage in sex.
While the International Criminal Court now recognizes rape and other forms of violence against women as a crime against humanity in time of war, governments urgently need to enforce national laws that criminalize gender violence and abuse. Only recently has rape in marriage been made a criminal offence in some Western countries.
Yet the best of laws will have little effect if there is not the will to enforce them. Nor will they have any impact if we do not seek to change attitudes, particularly among men and in local communities. This is where the real change will come from.
While such challenges may seem formidable, I believe that we at UNAIDS have been able to help make significant progress in the right direction.
On the AIDS front, we have already considerably expanded global capacity for monitoring the epidemic. For the first time ever, we have country-specific estimates and data which are key for local planning and action if we are to counter the growing spread of HIV especially among girls and young women.
On a political level, national and local leaders are beginning to speak out in a growing number of countries. The media, too, are taking up the issue in a far more aggressive fashion, particularly in countries such as Brazil, Zimbabwe and South Africa where HIV is dramatically on the rise. In India, one media project has been using video as a means of publicly 'outing' abusive husbands, resulting in a dramatic drop of violence.
With regard to prevention, we are noticing distinct achievements. The female condom, a woman-controlled prevention tool, is now much more widely available to women in developing countries. Millions are being sold -- and used -- at reasonable prices.
To give women even more of a choice, women's groups all over the world, with support from UNAIDS, have launched the Global Campaign for Women-Controlled Prevention Alternatives. This includes an international petition calling upon the US Government, the European Union and other national governments to accelerate research into vaginal microbicides and expand access to the female condom.
In a number of places, the HIV infection rates finally appear to be slowing down. Not only in industrialised countries but also in the developing world. In many places, the lower rates are being seen in young people who are much more aware of the need for protection, and appear increasingly to be taking appropriate precautions.
For millions of girls and women worldwide it is clear that violence, AIDS and human rights abuses are experienced as three strands of the same traumatic reality. At UNAIDS, we firmly believe that respect and concern for human rights, including the rights of the child as well as equality between men and women, must be at the core of a collective response to this disease. We therefore support ethical, legal and human rights networks at all levels and help governments to draw up supportive legislation.
We work to transform social values relating to male behaviour and attitudes toward the girl-child, as both are crucial for preventing violence against women and the spread of HIV. Here UNAIDS has been active in helping develop education and information programmes on human sexuality and reproductive health for the media, but also in schools and in the workplace in countries such as Uganda and Tanzania. These education programmes need to break down the belief that aggression is inherent in male sexuality and that violence against women is a demonstration of power.
Many UNAIDS activities are geared to women's reproductive health rights as well as their economic and social rights. We aim to help women state their needs more positively. It is vital that women be made less fearful about speaking out.
The Steps We Need to Take
Ladies and gentlemen, it would be a mistake for any of us to underestimate the magnitude of the effort required to bring this epidemic under control. But I believe that it would be an even greater mistake to believe that we can do nothing.
If we are to help reduce the impact of violence on AIDS, we need a more effective global response.
First, and above all, we need more political commitment at the highest level to help bring about the social and legal changes needed to better support women and girls.
Second, only a dedicated, more inclusive approach involving broad partnerships with governments, local communities, and the media can help bring about such changes.
Third, we need to break the silence. How can we ever win this battle without openness about sexuality and about AIDS? How can we win without singling out violence as a force driving the epidemic?
Fourth, current resources for HIV prevention are grossly inadequate. An assessment by UNAIDS showed that in 1997 only $160 million were spent on AIDS prevention in sub-Saharan Africa. This is completely inadequate to halt the epidemic, let alone help change attitudes among men with regard to prevention, non-violence and women's rights.
Fifth, we must use our resources for approaches and interventions that work. Concerning violence toward women, for example, we need to encourage more effective, and imaginative approaches, for their protection, and above all develop policies and programmes that will make a difference. This is a challenge both for governments and communities.
In conclusion, ladies and gentlemen, as part of our UN campaign to end violence against women, we must help make the voices of millions of vulnerable women heard. If we are to empower women and enhance their protection, we must especially make those heard who are living in the shadow of violence and AIDS.
And we, men, must shoulder our own responsibility. Allow me to speak personally as a male. We men need to explore more honestly what our responsibilities should be with regard to curbing male violence toward women. And we need to act on them. Because let there be no mistake. Studies show that at least one in five men from all layers of society perpetrate some form of physical violence or sexual abuse against a partner during his lifetime. These acts are unacceptable. And it is up to all of us to say so.
This article was provided by United Nations. It is a part of the publication Commission on the Status of Women, Forty-third Session.