GBV and HIV by Meridith Mikulich

The articles on intimate partner violence this week immediately made me think of a news report that I read around the time of the World Cup in South Africa. In response to her work with rape survivors, Dr. Sonnet Ehlers created Rape-Axe, a female condom that has rows of “teeth” that woman can wear anytime (like a tampon), but particularly when she feels unsafe. The condom will attach to a man’s penis during penetration – it is painful, but ultimately harmless – and only a doctor can remove it, ideally in the presence of authorities that can make an arrest.

While this could be a beneficial female-controlled method of protection (against HIV and other health issues), and this threat could deter some men from sexually assaulting a woman, this report also addresses some of the problems with this new technology. For example, this could lead to more violence against the woman in the future (if the man is not arrested) and does not address the psychological issues that women face after an assault. Most of all, this is a not a long-term solution, and the Lancet journal articles speak strongly to this.

A common misunderstanding that I have heard frequently as a nurse is about the sexual transmission risk of HIV. Many women think that the risk of HIV transmission after sexual intercourse with an HIV-positive partner is nearly 100%, whereas estimates are actually around 0.1% per act. As this article states “even in high prevalence settings with injury, a single sexual act has a low risk of HIV transmission; thus, rape results in few HIV cases in women”. This study also confirmed that risk of incident HIV infection was not associated with rape by a non-partner.

At the same time, we also now know that women who experience intimate partner violence and high gender inequity in relationships have an increased risk of contracting an HIV infection. This points to the fact that gender-based violence is not a direct cause of HIV, but works indirectly through another mechanism, like ability to negotiate the use of contraception. I would definitely be interested to see future research that further investigates this phenomenon. Another finding of this study that I found disconcerting was about reported condom use. The study reported that “women who seroconverted were more likely to have used condoms in the year before the baseline survey and to report having done so correctly at last sexual intercourse before their final HIV test than were women who did not seroconvert”. It is very perplexing that the women who are contracting HIV are being infected through consensual sex and are reporting condom use. It seriously makes me question the mediating factors that are bridging this association between gender-based violence and HIV infection. As suggested in the author’s model, it like could be due to other associated factors like numerous sexual partner, substance abuse, more STIs, etc. It also makes me question if there is an association with sex education. It is well known that one large issue with contraceptive use is that people do not always used condoms correctly and/or consistently. While of the details about the relationship between gender-based violence and HIV infection could be further explored and clarified, these results clearly indicate that interventions to empower women and promote gender equality are necessary.

 Report on Rape-Axe:

http://articles.cnn.com/2010-06-20/world/south.africa.female.condom_1_female-condoms-ehlers-south-africa?_s=PM:WORLD

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