By Neelanjana Mukhia

Increasingly we see evidence on the prevalence of rape and how rape increases women’s and girls’ risk to HIV.  It confirms for us that rape and sexual violence is endemic; in 2002 WHO said 1 in 5 women will be raped or will be a victim of attempted rape in the world.  International women’s human rights instruments have resulted in legislation on violence against women in many countries, however, many are not implemented, enforced, and resourced, with the same zeal as say, the prevention and containment of the H1N1 virus, aka the swine flu.  We have to ask ourselves why that is.

Good news is, there is increasing recognition that violence against women and HIV are intertwined health and human rights crises. Some of us are frustrated that this link was not acknowledged and acted upon much earlier. Many of us feel if states, multilateral and bilateral agencies had fulfilled their longstanding commitments to promote, protect and fulfil women’s and girls’ human rights, specifically our right to be free from violence and the threat of violence we might not have seen the rapid growth of the pandemic amongst women and girls. Case in point – sub Saharan Africa – where women and girls make up a majority of those living with HIV and where young women are 4-6 times more at risk of HIV than young men.

In recent years there has been progress, especially by the Joint United Nations Programme on HIV/AIDS (UNAIDS). Most notably, in 2007, UNAIDS for the first time costed interventions to prevent and respond to violence against women and girls in an effort to estimate resources needed for the global AIDS response. Earlier this year, UNAIDS included violence against women and girls as one of 8 Priority Areas in the Joint Action for Results: UNAIDS Outcomes Framework 2009-2011.
However, this does not mean our work is done.

HIV and VAW: it cannot be just about sexual violence
Yes, the link between sexual violence and HIV transmission is the easiest to make. Nevertheless, studies show that physical, social and economic violence also contributes to women’s inability to refuse sex or negotiate safe sex thereby increasing their risk to HIV. This is not news to us. Those of who are working to secure women’s and girls’ sexual and reproductive health and reproductive rights have know for decades that gender inequality and violence restricts our ability to decide whom we marry, whether, how many and when we have children. We know that women’s and girls’ control over our own bodies and reproductive lives is denied or limited through all forms of violence (and the threat of violence), and not just sexual violence. Despite this, too many limit the link between violence against women and HIV to sexual violence.

HIV and VAW: It cannot be just about prevention
While we should welcome the attention to and potential action on violence against women as it intersects with HIV we demand that this not be limited to prevention interventions. Indeed, all HIV prevention programmes have to integrate a response to violence if they seek to stem the growth of the pandemic. Some of these programmes include, investment in research, availability, affordability of women controlled prevention technologies, universal access to female condoms, universal access to post exposure prophylaxis to survivors of violence, zero tolerance of violence in schools and other educational institutions, investment in community based programmes that challenge negative and restrictive gender norms and violence against women, investment to increase women’s and girls’ access to justice, etc.

As we celebrate this important, though overdue, attention we have to remember the flip side of the relationship between violence against women and girls and HIV. The side which affects HIV positive women and their ability to live healthy and productive lives. Just as loudly as we say, violence is a cause of HIV; we must say HIV is a cause of violence against women and girls. Actual or perceived HIV status makes HIV positive women easy targets of violence or threats of violence hampering their access HIV services. Human Rights Watch’s research (Hidden in the Mealie Meal), clearly demonstrates how violence and the fear of violence severely inhibits women’s ability to access and adhere to ARV treatment. If we are serious about universal access to treatment and are interested in ensuring those who receive treatment are able to adhere to it, we must integrate a response to violence against women in HIV testing, counselling and treatment programmes. The Women Won’t Wait campaign has been calling for scaled up training of health care providers, particularly providers of HIV voluntary counselling, testing and treatment, to recognise and respond to signs of violence. HIV voluntary counselling and testing, and treatment interventions must include protocols, systems and services to respond to violence against women and girls. The same goes for PMTCT (and plus) programmes. Research shows that women’s risk of violence increases during pregnancy, and it is essential that pregnant women generally and especially those that access PMTCT are screened for violence and provided a package of services (see box). 

Male circumcision and women’s rights
The WWW campaign believes that prevention strategies for both men and women must be invested in so that these are available, accessible, affordable and of high quality. There is already a gap between prevention strategies for men and women; and a scaled up roll out of MC must not widen this gap. Women controlled prevention methods including female condoms, must be made available with equal commitment and vigour.  Among other things, in rolling out male circumcision, it will be important to monitor rates of gender-based violence, as well as coercive sex that may occur during the period of wound healing/recommended abstinence post surgery and thereafter.

Criminalization of HIV exposure and transmission will harm women
As we continue to advocate for attention to, action on and resources for a gender sensitive AIDS response we must remain vigilant about moves that wittingly or unwittingly violate or have the potential of violating human rights. The recent trend to criminalize HIV exposure and transmission violates rights of HIV positive women and men and has the potential to undermine or even reverse gains made by the global AIDS response. When governments say they are doing this to respond to the epidemic of violence women and girls, we must remind them to fulfill their longstanding and binding commitments to promote, protect and fulfill women’s human rights instead. 

Finally, as activists we have to consistently advocate for the rights of all women, those of us who are HIV positive, in sex work, with disabilities, who have sex with women, etc. It is only when we advocate for the rights of all of us will we secure our own.

Neelanjana Mukhia works with ActionAid as the international women’s rights policy and campaign coordinator and manages the international secretariat for the Women Won’t Wait. End HIV and Violence Against Women. Now. Campaign
www.womenwontwait.org. 

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Read all our daily blogs during the 16 days of Activism:

25 Nov - Intensify efforts in ending all forms of violence against women and girls (Shamillah Wilson, South Africa)
26 - Are All Defenders Equal? (Cynthia Rothschild, New York, USA)
27 - Give me back my movement! (Everjoice J. Win, Zimbabwe)
28 - An essential package of services to deal with two interlinked human rights and rights crises. (Neelanjana Mukhia, India)
29th - Questions of accountability and violence against women and girl and HIV&AIDS. (Shamillah Wilson, South Africa)
30th - Female Condoms: Now More Than Ever. (Kimberley Whipkey, USA)
1st Dec - Violence of Judgementalism (Meena Saraswathi Seshu, India)
2nd - Violence Against Women, Disasters and Climate Change (Jacqui Patterson, USA)
3rd - Silenced Links: Violence and HIV in Women. A current look at Latin America and the Caribbean. (Mabel Bianco, Argentina)
4th - Sexist Violence. Some Data to take into consideration. (Nirvana Gonzalez Rosa, Puerto Rico/Chile)
5th - Sex Workers. Sex Worker Rights. (Aziza Ahmed, USA)
Rights Not Rescue. Experiences of Sex Workers in Southern Africa. (Vicci Tallis, South Africa)
6th -   Women, Violence and the Criminalisation of HIV/AIDS in Africa (Chineze J. Onyejekwe and Norah Matovu Winyi)
7th - Violence against lesbians, gays, bi- and transsexual women. (Vicci Tallis, South Africa)
8th - Violence against women in conflict situations. (Mary Wandia - Kenya and Neelanjana Mukhia - India)
9th - Today the enemy is homosexual. Tomorrow it could be you. (Christine Butegwa, Uganda)
10th - Our work isnt done - response to VAW as a consequence of HIV (Neelanjana Mukhia, India)
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The Women WON'T wait. End HIV and Violence Against Women. NOW. Campaign is an international coalition of organizations and networks working to promote women's health and human rights in the struggle to address HIV and AIDS and end all forms of violence against women and girls.

Members of the Campaign are: Action Aid; African Women’s Development and Communications Network (FEMNET); Association for Women’s Rights in Development (AWID); Akina Mama wa Afrika; Center for Women’s Global Leadership (CWGL); Center for Health and Gender Equity (CHANGE); Fundación para Estudio e Investigación de la Mujer (FEIM); GESTOS-Soropositividade, Comunicação & Gênero; International Community of Women Living with HIV&AIDS Southern Africa (ICW-Southern Africa); International Women’s AIDS Caucus; International Women’s Health Coalition (IWHC); Latin American and Caribbean Women’s Health Network; Open Society Initiative for Southern Africa (OSISA); Program on International Health and Human Rights, Harvard School of Public Health; SANGRAM; VAMP; and Women and Law in Southern Africa (WLSA).

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