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Although the majority of us are aware of the modes of HIV transmission as well as prevention methods, there are many barriers that could potentially prevent one from translating this knowledge into practice. Beyond the biological factors inherent in the transmission of HIV, there are several social and environmental factors that leave persons vulnerable to HIV transmission, one of which is sexual violence. There is now a growing body of evidence that indicates a link between the incidence and acceptance of sexual violence in a population to high risk sexual behavior.
This evidence is particularly relevant to the HIV/AIDS epidemic in Ethiopia because women are increasingly becoming affected by the epidemic. The USAID Ethiopia reports that the “highest infection rates [in Ethiopia] are concentrated in the 15-24 age groups. Within this age group, prevalence among females is three times greater than among males.” Unfortunately, Ethiopian culture perpetuates and accepts violence against women which in and of itself is detrimental to women’s health. In the light of the HIV/AIDS epidemic however, this issue becomes ever more important.
One study conducted by the Department of Community Health at Addis Ababa University along with the Norwegian Institute of Public Health revealed that 15.6 % of female street adolescents in Addis Ababa had experienced rape and 20.4 % had experienced attempted rape within a period of three months prior to the study date. According to another study, conducted by the Department of Psychology at Addis Ababa University, rape was reported by 30 % of the participants as the important factor leading to early sexual debut. However, even without the evidence of reported sexual violence, 61% of the respondents felt that they had ‘very little control’ to stop sex if their partner initiated it, while 73% felt the same way if someone other than their partner initiated sex without their desire These two studies indicate how prevalent sexual violence is in Ethiopia but also indicate that women, in general, do not feel like they are in control to make decisions regarding their sexual health.
In the summer of 2003, in collaboration with the non-governmental organization, People to People, I conducted a small-scale, cross-sectional study using self-administered questionnaires among high school students in Finote Selam, Bahir Dar and Hosanna, Ethiopia. The survey questionnaire included questions from the study “War-Related Sexual Violence in Sierra Leone: A Population Based Assessment” conducted by Physicians for Human Rights as well as questions from the study by Suzanne Maman et al. entitled “HIV Positive Women Report More Lifetime Partner Violence: Findings From a Voluntary Counseling and Testing clinic in Dar es Salaam, Tanzania” Of the women that were sexually active (31/185), 47% of them reported that they had received rape threats, 16% reported that they had “unwanted sexual contact” while 10% reported that they have been raped. Moreover, women who received rape threats were more likely to report having had multiple sexual partners within the previous year as well as having partners who were not monogamous. Even though more studies are needed to corroborate these findings, these results suggest that incidences or the threat of sexual violence predispose young women to practice high risk sexual behaviors that ultimately increase their risk of HIV transmission.
For many cultural, economical and social reasons, women are often times reluctant to voice their opinions in relationships because they are afraid of the implications or possible consequences of their actions. However, it is this specific mind set that leaves women powerless and ultimately puts their health at risk. Nonetheless, the battle against sexual violence and violence against women in general should not be regarded solely as women’s responsibility. If we are to make any meaningful advances in ending violence against women all of us, including men and women need to work together to raise awareness about the issue of violence against women as well as to support and advocate for victims of violence.
In conclusion, unless, the issues of gender inequality and violence against women are understood, current and future efforts to reduce HIV prevalence rates are not going to yield optimum results. By understanding this issue, we will be able to identify important points of intervention that would potentially alleviate many health problems, including HIV/AIDS, and help empower women to make choices which would enhance their sexual health and enable them to become more productive in their communities.
Reference:
1. HIV/AIDS in Ethiopia: A UNAIDS Brief. http://www.usaidethiopia.org
2. Molla M, Ismail S, Kumie A, Kebede F. Sexual violence among female street adolescents in Addis Ababa, Ethiopia. Ethiopian Journal of Health Development 2002; 16(2): 119-128
3. Fekadu Z. Casual sex-debuts among female adolescents in Addis Ababa, Ethiopia. Ethiopian Journal of Health Development 2001; 15(2):109-116
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