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Violence and the threat of HIV/AIDS

Written by Rosemarie Muganda

Caroline lives in Kibera slums with her husband and one child. This HIV positive 23 year old vividly remembers the day she was raped while collecting firewood a few years ago. Then only 17 years of age she became pregnant and ran away from home to live with an aunt. After delivering, the baby became ill frequently and died. She was later married off to a young man she had never met. In fact she was put on bus and sent to Nairobi where the man met her and took her to his house in Kibera slums. When she had her second child she fell ill frequently and was informed that she had the HIV virus and that she may have passed the virus to her baby too. Between sobs she narrates how her husband forbade her to go back to the clinic where she believes she would have got enough information to enable her decide what to do with her life. In another part of the country, the story of two girls sexually abused and infected with HIV/AIDS by their father gripped the nation for several months. The violence visited upon these little girls would change their lives in ways they still cannot understand. Yet this is only the tip of the ice berg. These three cases represent a growing trend as violence takes a much more deadly turn than ever anticipated.

Over the past few years, we have seen an unprecedented rise in incidences of sexual and physical violence against women and girls.

Although boys also suffer, girls are three times more likely to experience violence. According to the Centre for the Study of Adolescence (CSA) three out of 10 girls aged between 15-19 years have experienced sexual or physical abuse while one in four children below the age of 13 years have been sexually propositioned mostly by an adult. There is also an increase in the number of young girls being sexually and physically abused with children in difficult circumstances such as orphans and the very poor more likely to bear the brunt of this brutality.

Violence takes various forms and includes rape, incest, defilement, indecent assault as well as harmful traditional practices such as Female Genital Cutting and early and forced marriage which can have significant negative effects on the sexual and reproductive health of those affected.

Apart from the physical and psychological trauma often associated with these kinds of brutal acts, the deadly link between women's rights abuses and the spread of HIV/AIDS is slowly gaining recognition in Kenya, but not before many women have suffered and even lost their lives to the pandemic. The threat of HIV/AIDS and the clear link with violence has become a deadly reality as the number of women and girls affected either directly or indirectly increases. Sexual violence results in serious life-long consequences, which negatively impact on the physical, psychological and social development. These may include the threat of early pregnancy, maternal mortality, physical disabilities, STIs including HIV/AIDS, and psychological trauma. The later can contribute to delinquent behaviour resulting in poor performance in school as well as risky sexual behaviour.

The relationship between the abuse of women's rights and increased vulnerability to AIDS is acutely clear in Kenya where more than half of those infected with HIV are women. Infection rates among adolescent girls and young women in most parts of the country are significantly higher than those of their male counterparts, clearly indicating the horrible reality that young women are subjected to high levels of abuse and discrimination. According to a study conducted by the Centre for the Study of Adolescence (CSA), nearly two in 10 girls who have been raped become pregnant, almost three out of 10 suffer a Sexually Transmitted Infection (STI) and nearly four in 10 suspect they may have contracted HIV.

Violence puts the lives of girls at risk of HIV infection in many different ways. Girls who suffer sexual abuse are on average more likely to begin sexual activity earlier than other girls and are also more likely to become pregnant early.

Stigma and discrimination also affects women more than men. Women often cite fear of violence as a reason for not seeking services. In many instances domestic violence prevents women from freely accessing HIV/AIDS information, from negotiating condom use, and from resisting unprotected sex with an HIV-positive partner, yet no meaningful steps are taken to prevent such abuse especially by government. A group of HIV positive women told me recently how disclosing one's status can have serious repercussions for them and how the fear of violence prevented many from disclosing their status to partners who in most cases may have brought the scourge into the marriage bed.

But even when they are able to seek services, accessibility may be made difficult by several factors. This is the case with Post Exposure Prophylaxis (PEP) for women exposed to HIV through rape. The Ministry of Health has recently developed guidelines for PEP, but the services are only available in a few selected facilities, mainly in urban areas while most health workers are unaware of the existence of such guidelines and cannot provide the services. This means that the majority of women who live in the rural areas are unable to access such services.

Long believed to provide a safe haven for women, marriage can pose a serious threat to women. Evidence indicates that women especially at risk are those in a heterosexual marriage or long-term union in communities where men commonly engage in sex outside the union and women face abuse if they demand condom use. Early marriage often predisposes young women to HIV infection as most are married off to older men with longer sexual histories and multiple sexual partners.

Every day, in many parts of this country, women and girls are beaten in their homes, forced into prostitution by circumstances and sexually abused by family members and "caretakers," deprived equal rights to property and other economic assets and even assaulted for not conforming to gender norms. Some are "inherited" by male in-laws when they become widows, often joining polygamous families where their vulnerability to HIV infection increases.

These acts of discrimination and violence are clear paths for HIV infection. According to UNAIDS women living with AIDS confront not only stigma, but also the deprivations caused by violations of their rights. Given the scale and severity of these abuses, laws, policies, and programs to combat HIV/AIDS by protecting the rights of women and girls in this country do not go far enough.

*Rosemarie Muganda is the Director of the Centre for Adolescent Studies

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