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July 01, 2002

HIV/AIDS and Violence Against Women

by Alexandra Arriaga

"He used to shout at me . . . he beat me to get a confession, with a cane. He also demanded to have sex with me." Living in Kenya, Annette, age 25, told Amnesty International how she suffered repeated abuse by her husband and was beaten so badly that she required hospitalization, but could not afford it. Her husband abandoned her after she gave birth to their second child. At a conference in South Africa, Prudence Mabele of Positive Women’s Network in Pretoria told about the case of Nomsa, whose husband punched, slapped, and kicked her, and then burned her breasts. Peroshni Govender reported the story in Women’s News:

Nomsa’s eyes were swollen black, her breasts painful to the touch and every muscle in her body ached. Opening her eyes in the light was a mission. It hurt too much. She didn’t know if it was the pain that was unbearable or the reality that her assailant was the man she loved, her husband and the father of her baby. . . . Nomsa’s HIV infection was the catalyst which sparked many of her husband’s rages, a disease he had given to her and thus to their son.

Violence Against Women

Violence against women is a human rights abuse of epidemic proportion that exists in every country. It is a crime no culture can or should attempt to excuse. Although international human rights instruments and many domestic laws prohibit and condemn such violence, it occurs or too often is condoned or excused by local communities and authorities. We all must accept responsibility for bringing this shameful human rights violation and crime to an end.

The United Nations Declaration on the Elimination of Violence Against Women (1993) defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or in private life." This encompasses, inter alia,

. . . physical, sexual, or psychological violence occurring in the family and in the general community, including battering, sexual abuse of children, dowry-related violence, rape, female genital mutilation and other traditional practices harmful to women, nonspousal violence, violence related to exploitation, sexual harassment, and intimidation at work, in educational institutions and elsewhere, trafficking in women, forced prostitution, and violence perpetrated or condoned by the state.

The effect of such violence is devastating. It not only harms the woman, it destroys the family, limits a community’s workforce, and perpetuates an atmosphere of fear, insecurity, and impunity. It also is connected to other devastating human rights abuses.

Increasingly, violence against women is becoming a leading factor in the spread of the Human Immunodeficiency Virus (HIV), which invariably results in the Acquired Immune Deficiency Syndrome (AIDS). Progress against HIV requires that women be able to protect themselves against all forms of violence, including domestic violence, rape, and sexual abuse.

The disease has also placed many women at greater risk of further violence. As Peter Piot, executive director of UNAIDS, explains, "Violence against women is not just a cause of the AIDS epidemic. It also can be a consequence of it. Nearly 14 percent of women today are infected with the virus that causes AIDS. Of those whose infection status became known to others, many suffered direct violence at the hands of their husband[s], famil[ies], or communit[ies]."

Discrimination against women and the lesser value some cultures assign to girls contribute to violence and prevent women from defending themselves. According to the United Nations, more than two-thirds of women worldwide are illiterate and 70 percent live in poverty, making it especially difficult to escape from dependency on their husbands or male providers. If she refuses sex or requests a condom, she may face further violence or abandonment without options for shelter, employment, or healthcare. Abusers rape or sexually assault their victims as part of their pattern of control. Victims often feel powerless and without recourse to bring such abuse to an end.


With three million people dying from AIDS in 2001, and an estimated 13 million children orphaned by the disease, the United Nations recognizes that the HIV/AIDS virus has reached pandemic proportions. Currently, it estimates that 40 million people are living with HIV.

The United Nations estimates that 7,000 people are infected with HIV every day and that 50 percent of them are women who are young, poor, and married, and infected primarily through heterosexual relations, as opposed to needle exchange, for example. Socially and economically disadvantaged women show the fastest growing rates of HIV infection.

Women are biologically more susceptible than men to becoming infected through intercourse, according to recent studies by United Nations Development Fund for Women (UNIFEM) and others. Microlesions can occur during intercourse more easily among women and may serve as entry points for the virus. Very young women and girls, and victims of coerced sex or other forms of violence are even more vulnerable. Pregnant women, who out of fear may fail to get tested or to reveal the results of their tests, risk mother-to-child transmission of the virus.

HIV/AIDS Has No Borders

In the United States, the Center for Disease Control reports that women are developing AIDS faster than men, and that nearly two-thirds of the women (and three-quarters of women under the age of thirty) have contracted AIDS through intercourse. African American and Hispanic women make up three-quarters of the total number of infected women. Most live in poverty and cannot afford healthcare; some are undocumented immigrants fearful of seeking public services.

Discrimination and social gender norms contribute to the increased threat of HIV in women, particularly in Africa, Asia, and Latin America and the Caribbean, which have the highest rates of transmission, although rates in Eastern Europe are rising. Among those affected by violence and rape are thousands of women and girls from Eastern Europe and South Asia who are trafficked as part of prostitution rings and sex tourism. Some are sold into bondage by their families under false pretenses, others are coerced, and others choose to become part of this network as a means of economic survival. Most are unaware of the AIDS risk and many are unable to seek protection.


Africa deserves special attention as the region most affected by HIV, where women comprise 55 percent of the estimated 25.3 million people living with the virus, according to United Nations estimates.

Culture contributes to the difficulties women face. Some African countries continue the practice of female genital mutilation, a form of torture and human rights abuse that increases the chance of tearing of vaginal tissue during intercourse and makes women more susceptible to infection. Generally, African women are expected to play a subservient role, to be obedient and to produce children, making condoms a rare option. Although having multiple sexual partners is accepted practice for many African men, a woman requesting the use of a condom may incite violence by suggesting infidelity. Local culture also encourages women to marry older men who often are more experienced sexually and have a greater chance of being infected.

Women in Africa are in particular danger of acquiring HIV via rape. A woman in Kenya told Amnesty International, "Women have forced sex and are scared of catching something. They say that they are scared because the husband . . . comes to have forced sex with her." Rape statistics have increased dramatically in the past decade, particularly in regions of armed conflict. Ashamed, victims often fail to report these crimes, let alone seek medical attention.

Millions of young girls are brought up with little understanding of their reproductive systems or the mechanics of HIV transmission and prevention. UNICEF reports that girls too often drop out of school at an earlier age than boys and thus are not always privy to the information on human sexuality that is taught at school. In some African countries, more than one out of three women of childbearing age are HIV-infected.

Children Infected with HIV/AIDS

By the end of 2001, an estimated 2.7 million children were infected with HIV/AIDS, largely due to mother-to-child transmission at childbirth or through breastfeeding, according to UNAIDS. Effective and inexpensive drugs that drastically reduce the chance for HIV transmission from mother to child exist, but they require the mother to seek treatment and are not consistently affordable or available.

In South Africa, there has been a horrifying increase in the rape of girl children, infants, and babies. South Africa has one of the highest rates of reported rape in the world. In 2001, South Africa’s police reports indicated that there were nearly 25,000 rape cases of which the vast majority were cases of girls seventeen years and younger, with reported victims as young as nine months.

A prevalent myth in South African society is that sex with a virgin will rid a man of HIV or AIDS. Already, rape has reached epidemic proportions in South Africa. "In South Africa you have a culture where men believe that they are sexually entitled to women," says Dr. Rachel Jewkes of the South African Medical Research Council. "You don’t get rape in a situation where you don’t have massive gender inequalities. One of the key problems in this country is that people who commit rape don’t think they are doing anything wrong."

International Human Rights, Violence Against Women, and HIV/AIDS

International human rights law prohibits violence against women and recognizes gender discrimination as its root cause. It also addresses the abuses related to HIV/AIDS infection. Relevant international instruments include: the International Covenant on Civil and Political Rights (ICCPR), ratified by the United States in 1992; the International Covenant on Economic, Social, and Cultural Rights (ICESCR); the Convention Against Torture and Other Cruel and Inhuman or Degrading Treatment or Punishment (CAT), ratified by the United States in 1994; the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW); the Convention on the Rights of the Child (CRC); and the Universal Declaration of Human Rights (UDHR). International standards continue to evolve in recognition of the pervasive nature of violence against women under circumstances ranging, for example, from domestic violence, to coercive sex work, to rape as a weapon of war.

The most significant international treaty for the rights of women, CEDAW, recognizes that discrimination is a root cause of violence against women and that the denial of equal rights to women reinforces and perpetuates violence against them. The committee charged with overseeing implementation of CEDAW has affirmed that violence against women constitutes a violation of internationally recognized human rights. In 1992, the committee adopted General Recommendation 19, which deals entirely with violence against women. It states: "The definition of discrimination includes gender-based violence, that is violence that is directed at a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, mental, or sexual harm or suffering, threats of such acts, coercion and other deprivation of liberty." The committee also called on state parties to consider this when reviewing their laws and policies and to take both penal and preventive measures. In 1996, the United Nations Special Rapporteur on Violence Against Women reported that domestic violence might constitute torture as it "involves some form of physical and/or psychological suffering, including death in some cases."

The devastating reports of mass rapes committed as acts of war in the former Yugoslavia and in Rwanda and Burundi, and the horrifying physical and psychological harm to women and their families, caused the international community to reexamine rape, not only as a violation of human rights, but also as a war crime.

In a landmark ruling, the International Criminal Tribunal for the Former Yugoslavia on February 22, 2001, for the first time in history brought charges solely for the crimes of sexual violence against women and defined in its findings that rape and enslavement constitute crimes against humanity. Most importantly, the newly established International Criminal Court in Article 7 of its statute states that in the context of war, "rape, sexual slavery, enforced prostitution, forced pregnancy, and enforced sterilization or any other form of sexual violence of comparable gravity" constitute crimes against humanity and war crimes.

The abuses related to HIV/AIDS often involve access to information and affordable treatment and the right to privacy, in addition to violence and discrimination against the infected individual. The ICESCR recognizes "The right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The steps to be taken . . . to achieve the full realization of this right shall include those necessary for . . . (c) the prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) the creation of conditions which would assure to all medical service and medical attention in the event of sickness." See Article 12. This right is also found in the UDHR, CEDAW, and CRC. In addition, the UDHR, ICCPR, and CRC, include the right to information and education, which can facilitate sexual health and HIV prevention, and also the right to privacy, which can help women seek HIV/AIDS treatment without fear, especially women victims of violence. The ICESCR recognizes "the right of everyone . . . to enjoy the benefits of scientific progress and its applications." See Article 15. This would require governments to protect the right of all persons to access adequate treatment at affordable prices.

What Should the United States Do?

As a world leader, the United States should insist on the defense of the rights of women and invest generously to combat the spread of HIV/AIDS. The United States should be an outspoken leader in this effort as follows:

Rights of Women: Hold foreign governments accountable for defending the human rights of women internationally and eliminating the factors contributing to inequality. Expand foreign assistance programs to prevent discrimination and diminish the likelihood of human rights violations by providing girls access to education and women access to economic opportunities (including microenterprise), property rights, and adequate healthcare to all in need. Facilitate rule of law initiatives to ensure domestic laws and policies prohibit discrimination against women and all HIV-infected individuals and the prosecution of offenders, extend to women and all HIV-infected individuals access to legal recourse, and prevent all forms of violence and discrimination against women.

U.S. Assistance: Increase U.S. foreign and international assistance to provide education, facilitate legal reforms, ensure women’s access to economic and political opportunity, family planning information, and HIV treatment and prevention.

HIV Prevention: Provide education on HIV prevention, access to affordable medicine and healthcare, and privacy. Promote a culture in which women are able to participate in decisions, including those related to sexual relations. Contribute generously to the United Nations managed Global Fund to Fight AIDS.

Treaty on the Rights of Women: Ratify CEDAW and insist on its implementation worldwide. Already, 170 countries have ratified this treaty that provides an international standard against gender-based discrimination.

Other International Human Rights Agreements: Implement the ICCPR and Torture Convention, both of which the U.S. has ratified, and other international agreements, including the commitments made at the World Conference on Women (Cairo and Beijing) and World Conference on Human Rights (Vienna).

Legislation on Violence Against Women: Adopt legislation and appropriate adequate funding to address violence against women in the United States and abroad. For example, the Violence Against Women’s Act includes many essential provisions to combat domestic violence in the United States and to offer model approaches to other countries. Ideal legislation also should include healthcare concerns related to HIV infection.

Private Sector Pharmaceutical Partnerships: Encourage pharmaceutical companies to make available affordable testing to determine HIV infection, antiretroviral therapy, and breast milk substitutes to reduce mother to child transmission of HIV; provide medical assistance to victims of rape and other forms of violence and human rights abuse; and continue to work toward a safe and readily available microbicide vaccine.

Reporting and Advocacy on Rights of Women and HIV/AIDS-infected Individuals: Increase reporting in the Department of State’s annual "Country Reports on Human Rights Practices" to accurately reflect violations against women and HIV/AIDS-infected individuals. Ensure that U.S. embassies monitor and defend the rights of women and HIV/AIDS-infected individuals.

The consequences of inadequate action by the United States will be devastating, not only for victims around the world but also for regional stability and U.S. national security. Human rights abuses are central to the deteriorating conditions that can lead to instability and further human tragedy. Violence against women already has claimed too many lives and created far too many orphans. The shear number of HIV-infected individuals points to an impending catastrophe that promises to create a generation debilitated by disease that will require intensive medical attention, and foster the elements for political and economic instability that inevitably spill across national borders. It is crucial that the United States take action. At the heart of the solution is a domestic and foreign policy that respects the human rights of all, prohibits violation of rights, holds abusers accountable, and promotes assistance to all without discrimination.

Alexandra Arriaga

Alexandra Arriaga is director of government relations for Amnesty International USA. Amnesty International is a worldwide grassroots organization that promotes and defends human rights (