Deputy Director and Senior Fellow, Global Health Policy Center and Senior Fellow, Americas Program
What is the relationship between gender based violence and global health?
Rates of gender based violence in Latin America are among the highest in the world, with serious health consequences for the region’s women, who are the most frequent victims. Violence directed by men towards women, because they are women, leads to injuries, the development of chronic conditions, psychological distress, and, in some cases, death. In Latin America, as in other parts of the world, gender-based violence regularly takes the form of domestic violence. Women who are pregnant are especially vulnerable; beyond physical injuries, pregnant victims of gender-based violence are more likely to give birth to underweight children. High rates of human trafficking in Latin America are also indicative of gender-based violence, reflecting efforts on the part of criminal organizations to coerce vulnerable women into forced labor arrangements, including sex work.
The Inter-American Development Bank estimates that between 30% and 50% of the region’s women involved in intimate partnerships have suffered psychological abuse, such as insults or threats, in the context of their relationships, and that 10 to 30% have suffered physical violence by male family members. In Bolivia, a 2003 study revealed that 53% of women had experienced physical violence by a spouse or partner, and 15% of women reported experiencing sexual abuse in the family context. A 2004-2005 study in Peru demonstrated that that 41% had experienced physical abuse, and 10% had experienced sexual violence, at the hands of male partners. More than 50% of women in Nicaragua reported being victims of intimate partner violence over their lifetimes, according to a 1999 study.
Beyond the negative health effects associated with gender-based violence, women who are the victims of psychological, physical, or sexual attacks by spouses, partners, or other family members have been documented to earn less than their peers who do not suffer abuse, leading to their greater impoverishment over time. Within Latin America, governments increasingly recognize the negative social and economic effects of gender-based violence and are taking steps to address the problem. For example, the Inter-American Convention on the Prevention, Punishment, and Eradication of Violence Against Women (Convention of Belém do Pará) affirms that every woman “has the right to be free from violence in the public and private spheres,” and has been ratified by 32 governments in the Americas. The government of Costa Rica has implemented a National Plan of Action regarding violence against women, and in 2009 Guatemala hosted the Latin America launch of the U.N. campaign “Unite to End Violence Against Women,” with satellite activities in Venezuela, Colombia, Bolivia, Peru, and Ecuador.
Looking ahead, it will be important that campaigns to prevent gender-based violence are multi-sectoral in nature. Health personnel, including doctors, nurses, and community health workers, must be sensitized to the issue of gender-based violence and count on the knowledge and skills to investigate the phenomenon in conversation with victims. Community-based prevention and education programs will also be critical and should involve both men and women in exploring and discussing their views and expectations about gender norms. At the same time, making sure victims of gender-based violence can access quality social services is important. Policymakers and law enforcement officials have an important role to play in enforcing laws against gender-based violence and offering protection to victims.
What is the link between gender based violence and HIV?
In Latin America and the Caribbean, HIV infection rates among women are rising, leading to what experts consider the feminization of the epidemic in the region. In some Caribbean and Central American countries, women make up nearly 50% of all infections; in North and South America the percentage of HIV infected people who are women, which tends to be closer to 25% or 30%, is rising in some communities, as well. There are several ways in which ideas about gender and power interact to increase women’s vulnerability to HIV/AIDS, but the low status of women in societies across the region is a significant factor. The fact that women tend to have less education, combined with expectations on the part of husbands or in-laws in some communities that female family members should confine their activities to the home, means that some women cannot access information about HIV/AIDS and how to protect themselves from infection.
As I discussed last week, up to 30% of women in Latin America and the Caribbean report having experienced some form of physical, psychological or sexual abuse from spouses or intimate partners over the course of their lifetimes. Women who face physical, psychological and sexual abuse within the home are at a disadvantage when it comes to negotiating the use of condoms or other safer sex practices, and studies in multiple countries have demonstrated that women in abusive or violent relationships face greater risks of HIV infection than other women. Rape exposes women and girls to situations in which they cannot protect themselves, and one UNFPA study estimated that 18% of girls in the Caribbean had been sexually abused before the age of 16. The region is also seeing increasing rates of human trafficking, including sex trafficking, with would-be migrants particularly vulnerable. Women who are made to engage in sexual activity by criminal organizations may face violence at the hands of procurers or clients and an inability to protect themselves against infection with HIV.
Across the Latin America and Caribbean region, health officials are working with women’s groups and community members to develop outreach programs to improve women’s access to information about the links between gender-based violence and HIV/AIDS. In El Salvador the Asociación Comité Contra El Sida Cabañas (CoCoSI) focuses on raising awareness of HIV prevention and reducing stigma and discrimination against people living with HIV/AIDS. Sex workers’ unions have been particularly proactive in educating women who engage in sexual commerce about HIV and how to protect themselves from violence and infection. For example, the Asociación de Mujeres Meretrices de la Argentina promotes legal reforms to protect the rights of sex workers and to ensure their protections under the law. In Nicaragua, community groups have worked with television stations to feature HIV positive characters in popular programs such as “Somos Diferentes, Somos Iguales” and to dramatize situations involving gender-based violence and HIV in order to raise awareness of the issues.
In the long term, efforts to improve women’s social status across the region will both empower them in the context of abusive or violent relationships and help ensure they have the information they need to protect themselves from HIV infection. Organizations dedicated to reducing gender-based violence and those focused on HIV/AIDS should collaborate to enhance their advocacy and outreach efforts. Improved economic opportunities for women will also reduce their dependence on abusive spouses or partners and enable women to support themselves safely removed from violent environments. At the same time, enhancing outreach and education programs – to the community, to law enforcement officials, and to policy makers – regarding the links between gender-based violence and HIV remains essential.