What Works for Women and Girls

Samoa, Serbia and Montenegro, Thailand, and Tanzania found that of the 19,568 women whohad ever had a partner, 15–71% reported they had experienced physical or sexual violence orboth at some point in their lives by a current or former partner (Ellsberg et al., 2008). A surveyin Vietnam with 465 women found that 37% said they had been beaten by their husbands (Lukeet al., 2007). A study in India with 459 women, 216 of whom were living with HIV, found that40% of HIV-positive women and 30% of HIV-negative women reported being forced to haveunwanted sex with their husbands and one in three of all 459 women reported being hit bytheir in-laws (Gupta et al., 2008b).Both males and females often justify violence as an acceptable gender norm. For example,a study in Ghana found that 56% of boys and 60% of girls argued that it was acceptablefor a boy to beat his girlfriend in some circumstances (Glover et al., 2003 cited in Jejeebhoyand Bott, 2003). Studies in Nigeria and Uganda found that rape was accepted as inevitableamong victims because males were uncontrollable, that rape was accepted as a “way to teacha haughty girl a lesson” and the misperception that women enjoy coercive sex (Ajuwon et al.,2001; Hulton et al., 2000 cited in Jejeebhoy and Bott, 2003). Other studies also report themisperception that men’s sexual needs are beyond their control (Sodhi and Verma, 2003 citedin Jejeebhoy and Bott, 2003).Women threatened by violence and rape, including married women and adolescents,cannot negotiate condom use. A 2006 to 2007 study in Thailand with 205 women living withHIV and 86 women who had experienced violence found that 12% of HIV-positive womenhad forced first sexual intercourse and 34% had partners who refused condom use. Womenwho had suffered violence before testing HIV-positive were beaten more after disclosing theirserostatus (Grisurapong, 2009). A repeat survey from 2002 in Botswana, Lesotho, Malawi,Mozambique, Namibia, Swaziland, Zambia and Zimbabwe found that 40% of women saidthey would have sex if their partner refused to use a condom, and 40% said that they did notthink women have the right to refuse sex with their partner (Andersson et al., 2008). A sampleof 575 sexually experienced young women ages 15–19 interviewed in 2001–2002 in Rakai,Uganda, found that 14% reported that their first sexual intercourse had been coerced. Coercionat first intercourse was negatively correlated with subsequent condom use: 24% of unmarriedwomen who reported coerced first sex had used a condom at last sex, compared with 62%of those who reported no coercion at first sex. Respondents who reported coerced first intercoursewere less likely than those who did not to say they had used a condom at last intercourse(13% as compared to 33%) (Koenig et al., 2004). Linkages between the justice system and thehealth system in many sub-Saharan countries is weak, making women more reluctant to seekjudicial justice for crimes of rape (Kilonzo et al., 2009b).Violence Can Increase Women’s Risk for HIV“There are three mechanisms through which violence is hypothesized to increase women’s riskfor HIV infection: (1) through forced or coercive sexual intercourse with an infected partner, (2)by limiting women’s ability to negotiate safe sexual behaviors, and (3) by establishing a patternof sexual risk taking among individuals assaulted in childhood and adolescence” (Maman etWHAT WORKS FOR WOMEN AND GIRLS299