Cynthia Rothschild is Senior Policy Advisor to the Center for Women's Global Leadership.
Usually when we think of the HIV pandemic, we think of one big health crisis, and a lot of "mini-pandemics" under its umbrella, many of which are based in social "ills" of some sort. Crises in immigration. Under-resourced or even failing health care systems. Millions of kids who have or will lose their parents to AIDS. But we too infrequently think of HIV as part of *another* pandemic – that of the universal and seemingly un-abating crisis of gender-based violence (GBV) And, more to the point here, we (I understand this "we" to be quite broad: activists, policymakers, researchers, academics, health care providers, teachers, etc.) – "we" writ large – have not paid close enough attention to the ways these social and health crises are linked. HIV and gender-based violence, and violence against women in particular, are mutually reinforcing. In too many circumstances, they invent each other, as cause and consequence.
UNAIDS now estimates that there are 17.7 million women living with HIV. The World Health Organization (WHO) and other groups estimate that on a global level, one in three women will be beaten, coerced into sex or otherwise abused in her lifetime. But what we don't necessarily know is what's the link between these statistics and what's the relationship between these crises? And maybe there are a few more direct questions that need to be posed: 1) why don't we know these things? And 2) who's not asking the right questions to uncover the answers?
Twenty-five years into the pandemic, I'd like to know answers to these questions, as would many people. But (is it really 2006?) we still must continue to make the arguments that these are important and legitimate human rights and public health questions to pose.
The HIV and GBV landscape has been marked by failures – failures to develop human rights and gender-equity based policy, especially when it might have been simple to create or implement. One current failure: Throwing PEPFAR (the President's Emergency Plan for AIDS Relief) money into combating gender-based violence without clear criteria for programs and goals for results – and for results that are grounded in empowerment of women and the eradication of gender inequality. When we hear that anti-violence against women funds are going to organizations that are promoting marriage and strengthening family as means of HIV and violence prevention – especially in light of transmission in contexts of domestic violence, we know we are facing a breakdown.
Critical in this list of policy failures has been the promotion of abstinence-only-until-marriage as a means of HIV prevention. Period. For young people, for women, for LGBT people. These polices are coercive, discriminatory and are, at their roots, grounded not in sound public health practice, but moral judgments. And while many of us talk about how women are subjected to sexual assault inside and outside marriage and are not always able to negotiate safer sex, we have also let go of one principle that fundamentally makes abstinence problematic: we don't consistently speak of how it creates terror about sex, how it teaches that sex is a bad thing, dangerous, lethal. Twenty five years ago, we might have spoken of sexual liberation in this discussion. I miss that analysis.
On a global level, activists have been slow to link gender-based violence and violence against women (VAW), as well. HIV organizations have been slow to address experiences of women, and women's organizations have been slow to take on HIV. There's fear and prejudice all around: sexism, fear of feminism, fear of HIV and HIV+ people, fear of being overwhelmed by taking on "additional causes", fear of resources being stretched too thin, fear of fragmentation in coalitions, etc.
The Center for Women's Global Leadership (CWGL) recently released Strengthening Resistance: Confronting Violence Against Women and HIV/AIDS, a report which highlights critical political challenges and innovative strategies used by activists worldwide as they respond to the links between the two pandemics. Activists in both VAW and HIV/AIDS communities are beginning to generate creative and strategic advocacy that is grounded in ideas and practices of resistance: resistance to the virulence of HIV transmission, resistance to pervasive experiences of violence, resistance to governmental complacency and resistance to sexist and discriminatory attitudes and prejudices. We can only hope policymakers follow suit. Quickly.