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Strategic Interventions:
Intersections between Gender-Based Violence & HIV/AIDS

By Bernedette Muthien

This article examines the intersections between gender violence (GBV) and HIV/AIDS respectively in South Africa, given the extent of both, and what services if any are available to address both. More significantly, what is the impact of HIV/AIDS on (largely female) survivors of gender violence (rape/sexual assault and domestic violence), what are their needs, and how can these be met.

Southern Africa is at present confronted with two key epidemics: HIV/AIDS and GBV. When GBV is combined with HIV/AIDS, these two scourges are even more lethal than each when viewed as mutually exclusive. Since the prevalence of HIV/AIDS in South Africa is at least 10% of the population nationwide, it can be assumed that women who are subjected to coercive sexual intercourse, from stranger rape to sexual intercourse in relationships subject to domestic violence (DV), are at greatest risk of being infected with HIV, in part due to their lack of power to negotiate safer sex practices. The UN Population Council asserts that women's "HIV status is strongly associated with partner violence":
HIV-positive women were 2.68 times more likely than HIV-negative women to have experienced a violent episode by a current partner… young HIV-positive women (18-29 years) were ten times more likely to report partner violence than young HIV-negative women. [Horizons, 2001: 3]

The two distinct fields of GBV and HIV/AIDS respectively are traditionally dichotomised. This means for example that a survivor of GBV would first need to access an organisation dealing with the violence, and then a separate organisation dealing with HIV/AIDS (for voluntary counselling and testing, for example). Even organisations working on GBV specifically are dichotomised according to the type of violence they deal with. This specialisation by service providers adds to the burden, emotional and financial, of the survivor of GBV, who has to travel to, and seek support from, various disparate organisations, which often are not in communication with one another.

GBV evolves in part from women's subordinate status, and is crosscutting: 25% of women are abused (Medical Research Council, 1999); one in every four deaths is due to femicide (MRC, 2003); 52,860 rapes and attempted rapes were reported during 2000 (South African Police Services); with statistics highly conservative due to the extent of under-reporting.

The 49th World Health Assembly of 1996 declares violence against women a public health priority. The Provincial Department of Health also affirms "that violence (including sexual violence against women, men and children) is one of the most pervasive and common public health problems and deserves to be prioritised in the allocation of resources and in the services available to such survivors."

If all forms of GBV are to be combated more effectively, and both the risk and treatment of HIV infection addressed in relation to the critical intersections between GBV and HIV, it is important to view GBV as inclusive and multivariegated. Service provision should address GBV as holistic and all forms of GBV as intrinsically interrelated, and should necessarily incorporate HIV and other STIs.

In addition, due to women's subordinate status in society, women's choices are severely limited. In a patriarchal system women are disempowered both by the oppressive system and by their own internalisation of its values, and hence women often tend to remain in relationships that are violent physically, psychologically and/or economically. Even treatment of HIV/AIDS is gendered, with women bearing the costs of HIV, as carers of the sick and orphans, and are more exposed to infections due to their physiology, and more vulnerable to violence due to power dynamics and the different roles women take on in communities which prejudice them. Socio-economic factors increase poor women's risks of HIV infection and vulnerability to GBV. Thus economic status, geographic location (urban-rural), access to education and information, exacerbate women's subordinate status in society, and the choices available to combat both GBV and HIV/AIDS.

Service providers unanimously note that infant and child rape has been prevalent long before the 1980s when HIV/AIDS became public knowledge, and that this is found in all countries.

For the first time a survey of this kind included specific questions on same-sex GBV, intended to determine the extent of rape of lesbians and bisexual women by men on account of their sexuality, or "curative rape", known to be pervasive from anecdotal evidence. We discovered that the spectrum of GBV also applies to same-sex relationships. The silence and stigma about sexualities (homophobia and heteronormativity), is compounded by the silence and stigma about GBV, with services largely heteronormative and geared towards heterosexual women. This may be compounded by the political implications of debunking conventional idealisms about lesbian relationships, and adds multiple burdens on queer women. Hence GBV organisations should cater for women of all sexualities, and queer organisations should address GBV.

While no one concrete strategy emerges, respondents identified the following strategies, which has been sorted into three different levels:
Macro level: Increased government commitment, government resource allocation, and an interdepartmental government approach. Education (and broader sexualities training) from an early age. Educators should be trained to screen for and prevent generic abuse, and be trained to not be abusers themselves. Sensitising health care and social services workers. An intersectoral partnership between government, NGOs and research institutions. Laws should be implemented.
Meso level: Development of educational programmes and materials, especially for youth; improved crisis intervention and more holistic service provision; monitoring and combating negative media stereotypes. Campaigns should ensure that services and resources are available.
Micro level: Training in sexualities and STIs; destigmatisation of issues; and greater community and individual involvement. Respondents from rural and peri-urban areas noted how critical it is that resources reach them, including the "deep rural" areas (where there are absolutely no services like accessible roads, running water, nearby police stations or health care services).

The report has been written on behalf of the Gender Project, Community Law Centre, University of the Western Cape. Muthien is an independent scholar-activist, based in South Africa and works in the areas of gender, human rights and conflict resolution. This report served as critical impetus for action on these issues for various organisations, with a number of GBV service providers now incorporating both HIV and sexualities in their existing programmes.

For the full report, or further information,
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