Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000tion to question their husbands about their extramarital encounters, negotiate condomuse or refuse to have sex. A study in Zambia confirmed how much subserviencein marriage, often reinforced by violence, can compromise women’s abilityto protect themselves. Fewer than a quarter of women in the study believed thata married woman could refuse to have sex with her husband even if he had beendemonstrably unfaithful and was infected. And only 11% of the women thought awoman could ask her husband to use a condom in these circumstances.According to a large number of studies in many countries and on all continents,between a third and a half of married women say they have been beaten or otherwisephysically assaulted by their partners. From Cambodia to the Gaza Strip, fromChile to Switzerland, studies in country after country show that violence within marriageand regular partnerships is frighteningly common. In Uganda, 41% of men intwo districts said they beat their partners.There is often a thin line between physical violence and sexual coercion. In a largestudy in the Indian state of Uttar Pradesh, 17% of men said they beat, slapped,kicked or bit their wives, and 7% said they used physical force to make their wiveshave sex with them. Aggravating the risk to wives, men who used force to get sexat home were far more likely than other men to report extramarital sex and sexuallytransmitted infection.Box 9. Rape in warThe military can have a powerful impact on the general population’s exposure to HIV,whether through commercial sex with civilians or through rape in times of conflict.Rape, a weapon of war since time immemorial, is most often used to humiliate andcontrol the behaviour of civilian populations or to weaken an enemy by destroyingthe bonds of family and society. It may take place in front of other family members.During the last century, hundreds of thousands of women were raped in war.According to the International Planned Parenthood Federation, during Bangladesh’snine-month fight for independence in 1971, at least 250 000 women were raped, ofwhom 10% became pregnant as a result. In South-East Asia, the United NationsHigh Commissioner for Refugees has reported that 39% of Vietnamese boat womenaged 11–40 were abducted and/or raped at sea in 1985. In a random sample of 20Ethiopian refugees in a camp in Somalia in 1986, 17 knew someone in their villageand 13 knew someone in their family who had been raped by the Ethiopian militia. Ina letter dated 13 March 2000, the United Nations special rapporteur on violenceagainst women called for investigations into allegations of gang rape and murder ofwomen and girls by soldiers in Sri Lanka. And the list goes on.Women raped by military personnel suffer not just immediate physical injury and therisk of pregnancy but are also exposed to a far higher risk of HIV and other sexuallytransmitted infections than they would be through other unprotected sex, not just–––>50