HIV and AIDS

Women and HIV

Sexual violence and the threat of HIV

According to a 1993 Canadian survey, four of every ten women (or forty percent) have experienced at least one incident of sexual violence since the age of 16. Sadly, more than half of these victims have experienced repeated sexual violence.

The effects of sexual violence can be devastating. Although the presence, frequency, duration, and magnitude of post-traumatic symptoms may vary among women, many may experience fear of pregnancy and the transmission of sexually transmitted diseases.

In recent years, survivors of sexual violence have a new concern: possible exposure to HIV. The possibility of becoming infected—or re-infected—with HIV is a source of concern and anxiety for many survivors, exacerbating the psychological, social emotional, and physical trauma they experience. What's more, sexual violence and HIV can affect the lives of all women, whether directly or indirectly.

The issues of HIV and sexual violence have been addressed separately for some time, but it's only been recently that they have been connected in research and in writings. It's clear there is a need for more information in this area, particularly among professionals who respond to survivors of sexual violence. When asked to comment on HIV and sexual violence, counselors from across Canada identified the need for more information on various issues and in particular, the assessment of HIV and the connection between HIV and sexual violence.

What is sexual violence?

Sexual violence refers to any any unwanted or non-consensual sexual touching, act, or exploitation achieved through physical force, threat, intimidation and/or coercion. Sexual violence covers a gamut of acts from sexual harassment through to child sexual abuse, sexual assault, and murder. (See Definitions of Sexual Assault, Voluntary Consent, Sexual Harassment, and Stalking for more information.)

For the purposes of this discussion, sexual violence will be limited to acts that increase a woman's risk of HIV:

• sexual assault
• historical sexual assault (childhood sexual abuse and repeated sexual assault)
• partner abuse (sexual assault and other acts of sexual violence against women in their relationships, whether heterosexual or lesbian)

As mentioned, sexual violence and HIV affect the conditions of all women's lives—directly or indirectly. Attitudes such as racism, sexism, heterosexism, and homophobia all increase women's risk of sexual violence and HIV. These attitudes:

• decrease women's access to employment and education, thereby increasing poverty among women
• increase women's dependency on men
• reduce women's power and choice in their relationships and in other aspects of their lives
• reduce the availability of and access to gender-specific information and services for women
• reduce the availability of and access to information and services for immigrant women, women from ethno-cultural, Aboriginal, and rural communities, sex trade workers, lesbians, and women with disabilities

The above reinforces that all women are at risk of sexual violence, regardless of race, age, culture, sexual orientation, socioeconomic status, or ability. The risk is higher among young women and women with disabilities. Sex trade workers and street-involved women are also at increased risk of sexual violence.

HIV/AIDS and women

In the 1980s, at the time of the early AIDS epidemic, HIV primarily affected men who have sex with men (MSM) and those who received blood and blood products. While MSM continue to make up the greatest number of new HIV infections, the current epidemic, measured from 1997, primarily affects injection drug users, MSM, and increasingly, women and Aboriginal people. The number of cases in all risk groups remains high.¹

One of the fastest growing rates of HIV is among women. Since the mid-1990s, the proportion of AIDS cases and new HIV infections among women has steadily increased. In Canada, before 1995, women accounted for almost 10 percent of new infections among HIV tests where gender was known. By 1996, this figure had more than doubled to 21.5 percent.

Despite this steady growth of HIV and AIDS in women, women's needs and experiences have often been forgotten when it comes to HIV/AIDS prevention, education, and treatment. What does this mean? Women are often tested and diagnosed later than men, resulting in earlier death. Particularly with respect to immigrant women, incarcerated women, sex trade workers, lesbians, women with disabilities, and women from ethno-cultural, Aboriginal, and rural communities, services, resources, and information are lacking and risk education strategies have failed to consider the conditions under which they live.

Why is this? Well, generally speaking, traditional HIV education assumes that women have control over their sexual decisions. This assumption ignores the imbalance of power between men and women on both an individual and on a societal level. To be effective and powerful, HIV prevention and education must acknowledge this power differential and must also endeavor to include information on sexual violence and other forms of violence against women.

Connections between HIV/AIDS and sexual violence against women

Drawing connections between HIV and sexual violence is a rather complex thing, and although connections can be classified, one should note that women's experiences often do not fit neatly into one category or another. Women are often repeatedly subjected to sexual violence. Consequently, they can experience more than one of these connections at the same time or at different points in their lives.

Sexual assault	Survivors of sexual assault may have been put at risk of contracting HIV through direct transmission from their attacker. Several factors are considered when assessing the level of risk.
Historical sexual assault	There is increased risk of HIV among women who have a history of sexual assault—specifically those who have experienced childhood sexual abuse and/or repeated sexual assault. Sadly, these women can develop a variety of mechanisms to cope with sexual violence and the associated post-traumatic effects, including risk activities that can increase women's vulnerability of exposure to HIV: Exchanging sex for drugs, money, or shelter Having multiple sex partners Having a sexual relationship with a partner at high risk for HIV Engaging in intravenous drug use and sharing needles Using drugs during sexual activity
Partner abuse	Women in abusive relationships may experience physical, emotional, psychological, verbal, or sexual abuse and they often live in fear of their partner. Abusive partners often control finances, contact with others, access to employment and education, and women's sexual and reproductive choices. Such conditions increase women's risk of HIV because of: the fear and threat of further violence, rejection, abandonment and/or loss of economic support if they attempt to negotiate safer sex or refuse sex violent/rough sex or sexual assault by an abusive partner being forced to have sex with other person(s), or to participate in degrading sexual acts being forced into prostitution by an abusive partner having unprotected sex with a partner who is having sex outside the relationship

Women living with HIV

Women living with HIV—and in particular, HIV-positive women in abusive relationships—face face unique challenges connected to HIV and sexual violence. Consider, for example, that disclosure of a woman's HIV status to her partner can increase her vulnerability to physical and sexual violence by giving her partner further control over the relationship. Her partner may threaten to reveal her HIV status to others. In addition to the several other reasons an HIV-positive woman may choose to stay in an abusive relationship, she may also stay because of a reduced sense of self-worth and because she believes no one else would want to enter into a relationship with her.

Women living with HIV also fear rejection and emotional, physical, or sexual violence from friends, family, co-workers, and the community. Lesbians, incarcerated women, and women from ethnocultural and Aboriginal communities may be at increased risk for stigmatization and violence as a result of disclosing their HIV status.

Women living with HIV also fear HIV re-infection and the impact this could have on future health. As a result of sexual violence, women living with HIV may be at risk of re-infection with a different strain of HIV—one resistant to available treatments. Because HIV may affect the progression and severity of symptoms of other sexually transmitted diseases, HIV-positive women also fear acquiring another STD.

As with women in the general population, women living with HIV experience high rates of sexual violence and must contend with the post-traumatic effects as well as with the numerous physical and emotional challenges of living with HIV.

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1. It's Your Health: HIV/AIDS. © Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2004