Gender and HIV
Brown L, Thurman T, Bloem J, Kendall C. Sexual violence in Lesotho. Stud Fam Plann 2006;37:269-80.
Brown and colleagues describe the magnitude and characteristics of sexual violence in two urban areas of Lesotho based on a random household survey of 939 sexually active women aged 18-35. The authors define sexual violence as nonconsensual sex ranging from the use of threats and intimidation to unwanted touching and forced sex. Twenty-five percent of women surveyed reported ever being physically forced to have sex; 13% reported that forced sex was attempted; 31% said that they were touched against their will; and 11% reported being forced to touch a man's genitals. Boyfriends were the most common perpetrators of actual and attempted forced sex (66% and 44%, respectively); known community members were the most common perpetrators of touching the respondent against her will (52%). Currently married women and those with more education were less likely than others to report that sex was forced upon them by an intimate partner or by another type of perpetrator. Women living in areas where a programme raising awareness about sexual violence was ongoing were more likely to report a history of sexual violence. Given the high prevalence of HIV in Lesotho, programmes should address women's right to control their sexuality.
Editors’ note: pilot programmes addressing gender-based violence have included microfinance initiatives (see next article) and male responsibility/empowerment programmes such as Sonke Gender Justice’s One Man Can.
Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, Busza J, Porter JD. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet 2006;368:1973-83.
HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. Pronyk and colleagues conducted the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum. Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. In cohort one, experience of intimate-partner violence was reduced by 55% (RR 0.45, 95%CI 0.23-0.91). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (RR 1.02, 95%CI 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (RR 0.89, 95%CI 0.66-1.19) or HIV incidence (RR 1.06, 95%CI 0.66-1.69) in cohort three. The authors conclude that a combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.
Yang X, Xia G. Gender, migration, risky sex, and HIV infection in China. Stud Fam Plann 2006;37:241-50.
Gender differences in sexual behaviour as a consequence of migration have been ignored in both the migration and the HIV literature in China. Yang and colleagues examined differences among temporary migrants in terms of sexual behaviour and factors that make female migrants more vulnerable to the risk of acquiring HIV infection. Results suggest that the interplay of migration and gender renders female temporary migrants particularly vulnerable to engaging in casual and commercial sex. Although male temporary migrants do not differ from male nonmigrants in prevalence of casual and commercial sex, the prevalence rates of casual and commercial sex for female temporary migrants are found to be 14 and 80 times those for female nonmigrants, respectively. Female temporary migrants' higher unemployment rate and concentration in the service and entertainment sectors are keys to understanding differences in the prevalence of casual and commercial sex among temporary migrants according to sex. The authors conclude that policy measures to promote female temporary migrants' equal access to employment are urgently needed to improve their economic well-being and to reduce their risky sexual behaviour.
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