A South African Perspective on Gender Inequality, Violence, Sexual Health and HIV

"[R]esearch with adolescents in South Africa...shows that those who have experienced intimate partner violence or who are in relationships with low equality are at greater risk of incident HIV infections, compared to those who do not."

In this commentary accompanying the discussion: "Will There ever Be an AIDS-Free Generation?" (available in video format), the author, Rachel Jewkes, discusses the critical impact of women's subordination to men and exposure to violence on their risk of HIV. "Nearly one in seven new HIV infections could be prevented if young women were not subjected to physical or sexual abuse and a similar proportion if they did not experience the greatest relationship power inequalities...South African research suggests that severe violence exposure (more than one episode of physical or sexual intimate partner violence) is critical here...."

"The two most important intersections between violence, gender inequity and heightened HIV risk find expression in ideas about appropriate behaviour of men and women. In particular, these relate to the notion that men should be dominant over and in control of women....Parallel expectations from women are that they will submit and treat their man ‘like a father' and not challenge his behaviour and control....Research shows that teenagers tend to be more socially conservative with respect to gender roles than older men and women. This undoubtedly influences the high HIV incidence among teenage girls. Addressing their vulnerability requires working through the issues surrounding gender, and will not be achieved through attempts to change behaviour in isolation from the broader social and relational context."

The author acknowledges that programmes must address both male and female perceptions of gender norms. "Evidence from the Stepping Stones programme evaluation shows that men can change in response to interventions that address gender issues, even among impoverished, relatively disempowered rural men, and that the incremental changes that made men a little less violent and more caring translated into a lower risk of genital herpes infections." She examines the engagement of women in sex work: "There is a particularly well established trajectory between early sexual abuse and engagement in sex work, which makes the practice inherently deeply interwoven with gender equity issues."

Scientific evidence supports the need for programming on gender equity and prevention of violence and its role in reducing HIV risk. "Core elements [of programming] involve a recognition that efforts need to be directed at both men and women, and that for adolescents, HIV prevention and reproductive health promotion need to be co-programmed with gender equity as they have common roots. Recent reviews of what works in the prevention of sexual and intimate partner violence, published by the WHO [World Health Organization - See summary of Preventing Intimate Partner and Sexual Violence against Women: Taking Action and Generating Evidence in related summaries listed below], show that some of the interventions that have been evaluated have proven to be effective in violence prevention and can form key parts of HIV prevention programming." Jewkes concludes with a recommendation to "develop mechanisms for programming what is now known to work whilst further developing the evidence base."