Gender – based violence can lead women to HIV
40 years after the onset of HIV, it is known that the infection not only has to do with the aspect of health, but also with the social dynamics. There are factors which expose some people to transmission more than others, and violence against women is one of the social phenomena which place them at a very specific risk regarding the virus.
Within the framework of the commemoration of November 25th, International Day for the Elimination of Violence Against Women, we spoke with two key members of AHF Latin America and the Caribbean, who spoke to us about the close relationship that exists between gender-based violence and the transmission of HIV.
Violence has many faces
Gender – based violence can be understood as that which is exercised within a system in which women and girls are in a subordinate situation, which subjects them to power relations and places them at risk of suffering various aggressions.
Physical violence is perhaps the most visible. The idea of violence is often associated with beatings, injuries and hospitalizations. However, it is not the only type of aggression that can be exercised against a woman.
There are also psychological, economic, institutional, and obstetric violence, and all of them cause gender violence and HIV to be closely linked, explains Guillermina Alaniz, director of Advocacy at AHF for Latin America and the Caribbean.
Violence is so structural, she adds, that in HIV issues it intervenes, for example, with the use of a condom. “When there is no real possibility of negotiating the use of condoms on equal terms, there is clearly gender-based violence that puts women at risk. Not to mention sexual violence, whether in childhood or adolescence and instances of rapes ”.
And on this last point, she clarifies: “Any sexual relationship without consent is rape; there is no sexual relationship without consent, there are rapes ”. This is a concept that most women have had a hard time understanding because of the education they have received from the earliest years of life, and it takes hold so deeply that it is difficult to question.
To this we must add an element that has begun to be discussed, with increasing force: the concept of romantic love.
In this regard, Krischna Sotelo, Advocacy coordinator for AHF Chile, tells about her experience with the topic: Working with female sex workers, both cisgender and trans, condom negotiation is highly incorporated into their work as sex workers, but the problem lies in the relationship with their partners.
“That is where the guard is lowered, when the blackmail of not using a condom is accepted, where violence can be experienced in a much more subtle way, but violence anyway because there may be manipulation, or there are cases of rape which are not reported. because they happen within a so-called loving relationship (which has nothing to do with love, but it is thought that this is the case) ”.
On the other hand, for women who are not sex workers there are very subtle cases of violence that have to do with romantic love, says Krishna. “Women think: “I can’t ask my partner for this, how am I going to pressure him to use a condom if it might be uncomfortable for him?”But I say why don’t women think about themselves? Why don’t you think about how uncomfortable it is going to be for someone to have a sexually transmitted infection?”
Obstetric violence encompasses all the actions, practiced by health personnel, which attack, humiliate, frighten or physically and psychologically harm a woman before, during and after childbirth. From verbal abuse to make a woman in labor “shut up” to an unjustified cesarean section, or even sterilization without consent, these are acts of obstetric violence.
Although it is a type of aggression that is committed against all kinds of women, both in public and private institutions, women with HIV have experienced these acts as part of the stigma and discrimination that is exercised against them. For example, medical personnel “reprimand” them for having become pregnant or try to force them to undergo sterilization due to their health condition.
This began during the early years of the HIV epidemic, but continues to this day despite the fact that antiretroviral treatment has been shown to be highly effective in preventing the virus from being transmitted from mother to fetus.
Let’s learn to recognize violence
To begin to stop the various types of violence against women, you have to know how to recognize them. For example, it is crucial to understand that if there is no consent to intimate contact, then there is sexual violence.
“If we, as women, cannot be deeply convinced of that because the system makes us doubt, if he is my boyfriend or if I drank too much, if we do not understand that none of that matters and that the only thing that matters is that we have the right to decide no matter the situation, only then will we be able to begin to eliminate from the social consensus that rapes are crimes committed with violence,” explains Guillermina.
And for this change to be possible, Krischna adds that comprehensive sexual education is a fundamental pillar, “because although women, as victims, we have to report and be aware that not having said “no”, doesn’t mean a “yes”, ‘men are the other part, they are the sexual offenders”.
So far, Krischna considers, it is women who have mainly done the work of awareness on the subject, and that, “besides being dismal, is insufficient because those who are committing sexual assaults are men against women. The work of comprehensive sexual education requires all of us, and these men and children must be led to break the cycle of rape culture.
HIV can be prevented after a sexual assault
There is an antiretroviral treatment that can be given to people who have been exposed to an HIV infection, to prevent the virus from establishing itself in the body. The so-called post-exposure prophylaxis (or PEP) originated to prevent infections in medical personnel who had accidentally been exposed to HIV during their work, but then its use spread to those who may have had contact with the virus for other reasons, and rape is one of them.
Currently, throughout the Latin American region PEP is available for rape victims, and is even part of a post-rape prophylactic kit that provides preventive treatment for other sexually transmitted infections and (in countries where its use is not prohibited) emergency contraception.
In some countries, explains Guillermina Alaniz, a formal complaint is required to access the rape kit and protocol (which consists of an evaluation to gather evidence of the aggression), but in other countries this is not a requirement to receive care.
“But beyond the availability of the PEP, these are topics that have been taboo for so long, that suffering a sexual attack is a situation in which most women find it very difficult to seek help at that time, not to mention reporting it”.
This is part of the structural violence that is carried out against women. “The first instinct, due to the patriarchal model that we have, is that women are seen as guilty: ‘but of course, with those clothes, with that attitude, if she was at that place’ … And all that becomes embedded into every woman from a very young age”.
Eliminating violence against women is a complex task that requires the involvement of all sectors of society. However, from HIV response strategies, there are concrete actions that governments can take so that infection by this virus ceases to be one of the multiple consequences of violence.
Currently, AHF Latin America and the Caribbean advocates for better training of emergency services for the care of sexual violence cases, in addition to providing more comprehensive information on the existence of the post-rape prophylactic kit, as women are currently not aware of it.“Just as campaigns are carried out over the phone in order to report gender violence, PEP campaigns must be carried out so that whoever needs it can request it,” says Guillermina Alaniz. “And that a formal complaint in order to access the kit stops being a requirement in these countries, because sometimes the person does not want to or cannot make a report. Since sometimes it is the aggressor who is accompanying her to be treated ”.
The phenomenon of gender violence is multidimensional and requires solutions with the same scope. The first step is to look at and recognize the existence of the problem, in order to improve the quality of life of women in all aspects of their development.
If you are a woman and you think you have been exposed to HIV, whether because of sexual assault or a violent relationship, at AHF Latin America and the Caribbean we offer free HIV tests and completely confidential and stigma-free care. Come to our closest office in your country or write to us on WhatsApp.