Care and support for people living with HIV/AIDS

What makes people vulnerable?because rape can result in torn tissue and hence create an easy entry-point for HIV,but because their rapist has a higher risk of being infected. In most countries, forexample, sexually transmitted infection rates among the military are generally two tofive times greater than those in comparable civilian populations, even in peacetime.In times of conflict, the figures increase dramatically.Sexual abuse of women and childrenThe relationship between violence and HIV is often indirect: the fear of violence makesit more difficult for women to refuse unsafe sex. In the case of sexual violence, however,the relationship can be very direct.Like domestic violence, sexual violence directed against women is depressingly commonall over the world, although accurate statistics are few and far between. A study ina low-income area of Nairobi, Kenya, illustrates women’s reluctance to report sexual violenceeven when it is extremely common in the community. Some 30% of women agedover 18 said they had been sexually abused, as had one-fifth of teenage girls, but thevast majority took no action. Many said they were too shy – some had been raped by arelative or friend of the family; others considered it would be a waste of time to report.Those that do report abuse are sometimes made to suffer themselves and are seldomrewarded by the arrest of the person in question. Of 16 cases of rape reported to policeand/or the local chief in a six-month period (including two cases of incest and two rapesof minors), action was taken in only five cases. Unfortunately, police records in Kenyatend to record most violent offences as “assault”, and trends are difficult to track.In Botswana, where record-keeping is more thorough, a review of police and courtrecords shows a steady rise in reported rape cases (see Figure 19). Many of the rapevictims are very young: over two-fifths of all rape cases that reach the courts involvegirls under the age of 16. In 1997, just a fifth of reported rape cases ended in a conviction,and three-quarters of the convicted rapists were given a prison sentence of fouryears or less. Most cases were closed even before resulting in a criminal prosecution.After lobbying by women’s groups and human rights groups, Botswana changed itsrape laws in 1998. The minimum prison sentence for those convicted of rape is now 10years and rises to 15 years if the rape is committed by someone found to be HIV-positive.If it can be shown that the rapist was likely to have known he was HIV-infected,the minimum sentence is 20 years.Botswana is not the only country to take decisive action in the face of unacceptablyhigh rates of sexual abuse, especially of young girls. Zimbabwe, for example, hasaltered its judicial system to increase the likelihood that perpetrators will be successfullyprosecuted (see Box 10) while also providing abused children with services suchas the Family Support Trust. Based at a major hospital in Harare, the Family SupportTrust gives free medical and psychological care to girls (and more rarely boys) under theage of 16 who have been sexually abused. In 1998, an average of 77 children a monthcame to the clinic. By 1999, as the clinic became better known, the number rose to 9451