Male violence drives the spread of HIV in a number of ways -- through wars and the migration they cause, as well as through forced sex. As recent events in the Balkans, Rwanda, Burundi and East Timor have shown, wars can exert a terrible effect on civilian populations. Not only are families split up and husbands and wives separated, but in refugee camps and elsewhere women may find themselves the victims of unwanted demands for sex, or may have to trade sex in order to survive. Innumerable instances of rape by members of the armed forces and by paramilitary groups have been documented, and there is strong evidence that sexual violence, or the threat of it, is used as a means of terrorizing or subjugating both women and other men.

Millions of men a year are sexually violent towards women and girls, sometimes in their own family or household. Rape within the family is not always incest or the sexual abuse of a minor. A man can rape his wife to uphold his "manhood", though national legislation seldom recognizes forced marital sex as rape. A study of women aged eighteen to forty-four in one US city found that in the previous three-month period, 18% reported being beaten by a partner and 7% reported being forced to have sex. Worldwide, a recent report says that at least one woman in three has been beaten, coerced into sex or otherwise abused in her lifetime.

Sexual coercion outside the home runs the gamut from overtly violent rape to the coercive exploitation of young girls by older men, including those offering "sugar daddy" gifts. Men also rape other men, particularly in prison settings, but also in any setting where an older or stronger man or boy has power over a younger or weaker one.

There are some other less obvious links between violence and HIV. Even when it takes a non-sexual form or exists merely in the form of threats, violence helps spread HIV because it deters discussion about preventing HIV and other sexually transmitted infections. Women and men who have been victims of sexual violence, particularly when young, are less likely to believe they can negotiate safer sex practices with a partner. Studies of sexual violence during adolescence in Brazil, South Africa and the U.S. found that sexual coercion and violence in adolescent dating relationships is associated with lower rates of condom use.

The origins of male violence are complex. A large proportion of men in prison and men who are violent toward women have either been witnesses of violence or victims themselves. Lack of a father figure or meaningful male role model also plays a part. Other factors contribute, such as the sense of disempowerment that comes from unemployment or poverty, when some men lacking a meaningful role in the family or community turn to violence as a way of feeling like a "real" man.

The White Ribbon Campaign All-male discussion groups that promote men's awareness about domestic violence show promise as a prevention approach. Such groups can be organized in the workplace, in sports locker rooms, or among military recruits. In 1991, a group of Canadian men decided that men had to take responsibility for this kind of violence and adopted a white ribbon as a symbol of their opposition to violence against women. In the first two months of the campaign, as many as 100,000 men wore the ribbon, with leading Canadian men in business, media, entertainment and sports lending their names to the campaign. Important links with women's groups have been forged by following the simple strategy of listening to and respecting women. The White Ribbon Campaign now has chapters in Australia, Finland, Norway, the US and Latin America. It urges men around the world to wear a white ribbon, or hang a white ribbon from their house, their vehicle, or at their workplace each year for a week as a public pledge never to commit, condone or remain silent about violence against women.