……Today it’s just words that are demeaning and hurtful and the next it’s a fist across your face with the words “you made me do it”
My student intern from Limkokwing University of Creative Technology LUCT, Welile Ayew wrote a blog article this week and quipped, ‘‘have we failed as men’’. Welile says every day he wakes up, checks himself in the mirror and asks, “Do I want to raise a daughter in this world?” He says he is ashamed of calling himself a man and has considered a vasectomy a number of times, because of all the abuse that men have put women through. Welile asserts that he doesn’t want his daughter to live in a world where she doesn’t feel safe.
Gender Based Violence (GBV) continues to be on the rise in the country and honestly, this is quite disturbing. Today it’s just words that are demeaning and hurtful and the next it’s a fist across your face with the words “you made me do it” following. A man or a woman who loves you will never abuse you and will never have to run for cover every time you raise your hand.
Which is why this week we delve deep into the issues of GBV and how this ‘enemy’ is an opportunistic factor to HIV, and can set us back from the gains we have made in the fight against AIDS. Gender-based violence has been shown to increase women’s risk of HIV acquisition. Research has also shown how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP). What are the barriers you ask. Well, we will get to that later on but first let us define what GBV is.
Gender-based violence (GBV) is defined as violence perpetrated against an individual based on their gender/gender identity and it is an important global health and human rights concern. GBV includes physical, sexual and psychological/emotional violence and can be perpetrated by a variety of actors, including intimate partners or lover, family members, community members, and representatives of the state (e.g. law enforcement officials). GBV is a common experience for women globally, with estimates suggesting that 1 in 3 women experience some form of GBV in their lifetime, primarily from an intimate partner. Marginalized populations including female sex workers (FSW), transgender women, and women who use drugs experience even higher rates of GBV, often perpetrated by their lovers and other factors.
GBV is associated with several acute and long-lasting health consequences, including HIV. Globally, women are at even greater risk for HIV acquisition and HIV-related illness and death, due to their marginalized status in society, and the associated barriers they face in accessing HIV services.
GBV as a barrier to access HIV Services, Treatment and Care
A large body of evidence has demonstrated an inseparable link between GBV and HIV among women. Women who experience GBV are more likely to engage in HIV risk behaviours such as condomless sex and are more likely to be living with HIV. Similarly, evidence suggests that women living with HIV are at increased risk for experiencing violence. Violence and the threat of violence hinders the ability of individuals to protect themselves from infection. When sex is violent or forced, women are put at high risk of HIV infection. Harmful ancient and barbaric traditions such as men marrying virgins in the hope of being ‘cured’ of HIV and practices such as female genital mutilation could lead to an increased risk of HIV infection for those women and girls.
In a study in Central America, 28 per cent of people living with HIV in the region say they have experienced some form of violence in the last 12 months. It is critical to clarify how GBV may act as a barrier to accessing HIV testing, linking to and staying engaged in HIV care and treatment, as well as PrEP, not only to address violence against individual women and meet their HIV care needs, but to also achieve public health-oriented HIV epidemic control goals.
Although the rollout of Anti-retroviral treatment (ART) in Eswatini happened in the early 2000s, in 2003 to be precise, the World Health Organization (WHO) published guidelines which promoted the use of anti-retroviral treatment (ART) by anyone diagnosed with HIV, given the protective effects of early treatment initiation. Further, in 2017, UNAIDS adopted the ‘epidemic control’ paradigm whereby the global HIV response is now working towards 95% awareness of HIV status, 95% of those with HIV on treatment, and 95% of those on treatment virally suppressed. Also in 2017, WHO finalized guidelines promoting pre-exposure prophylaxis (PrEP) - a formulation of antiretrovirals (ARVs) that prevents HIV acquisition even if exposed to HIV- for all those at substantial risk of HIV, including members of key populations.
In response, a massive global effort to encourage HIV testing and treatment has been rolled out, as testing is the entry-point to HIV care and ART for those living with HIV, as well as PrEP for those at substantial risk of HIV. Key to the success of both HIV treatment and PrEP use is the regular adherence to medication.
So how can we address some of these issues? By giving communities accurate information about HIV, encouraging relationships that empower women and men to make healthy decisions and by addressing some of the social norms that discriminate against women and girls.