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Indian Journal of Medical Sciences, Vol. 61, No. 5, May, 2007, pp. 251-252 Editorial Human Immunodeficiency Virus and domestic violence: The sleeping giants of Indian health? Stephenson Rob Hubert Department of Global Health, Rollins School of Public Health, Emory University Code Number: ms07039 Over the past two decades, two significant public health concerns have begun to draw increasing attention in India: the increasing prevalence of human immunodeficiency virus (HIV) and the continued presence of high levels of domestic violence. Although HIV prevalence remains relatively low, India now has the largest absolute number of people living with HIV. [1] An estimated adult prevalence of approximately 1% translates into 5.7 million people living with HIV, of which 37% are women under the age of 30. [1] This epidemic is taking place in the context of a cultural environment which is characterized by high levels of violence and social norms that often support violence against women. [2] In such a setting, it is important to understand the intersections between HIV and domestic violence; as successful attempts to reduce HIV prevalence must also entail interventions to reduce domestic violence. Within the field of public health, there has been a growing recognition of the possible linkages between domestic violence and a range of adverse physical, mental and reproductive health outcomes; and recently, studies have suggested associations between the experiencing of domestic violence and the risk of sexually transmitted infections or HIV infection. [3],[4] The possible mechanisms for such relationships lie in the influence that exposure to domestic violence has on a woman's autonomy in sexual activity. Previous studies from India have reported a positive and systematic association between spousal physical and sexual abuse and unplanned pregnancies. [5] A primary explanation for this relationship may lie in the constraining effect of domestic violence upon women's ability to negotiate or effectively use contraception with her partner, specifically with condom negotiation or use of a barrier method requiring the male partner's active cooperation. [6] Results from the Indian National Family Health Survey-2 (1998-99) show that women who reported domestic violence had lower rates of current contraceptive use, despite comparable levels of unmet need for family planning between abused and non-abused women. [7] There is also evidence that contraceptive use may also lead to domestic violence: Rao [8] found a positive association between domestic violence and the wife having been sterilized, which, the authors posited, resulted from increased fears on the part of husbands concerning their wives' fidelity following sterilization. Some of the strongest evidence on the link between domestic violence and contraceptive use comes from in-depth qualitative studies.[9] Evidence suggests that the threat of violence was sufficient to deter women from raising the issue of contraception with their partners and women who attended family planning clinics often faced physical violence from their partners. Similarly, a study from Uttar Pradesh found that women felt that they had little control over their own reproductive decisions, with the threat of physical violence leading to the non-use of contraception and unwanted pregnancies. [9] In their paper, the authors describe some important results from a cross-sectional survey of women attending an HIV voluntary counseling and testing center (CVCT) in Bangalore. [10] The results demonstrate some key points of the domestic violence epidemic that is prevalent in much of India: the role of economics, as either a household stressor triggering violence or in challenging traditional women's roles; and the variations in the risk of violence across age and educational groups. Most importantly, the paper finds that seropositive status of either the husband or wife is a risk factor for the reporting of violence. Although the authors are unable to disentangle the temporal nature of the relationship, the result provides a vivid demonstration of the intersection between HIV and violence in India. The relationship is likely to be the product of a number of factors: women at risk of violence may not possess the autonomy to insist on condom use by their husbands; men who perpetrate violence may also be more likely to undertake risky sexual behavior outside of marriage; or the discovery of HIV-positive status could trigger violence within a couple. There is clearly a need for further research to examine more closely the relationships between violence and HIV in India. The paper sheds new light on an important facet of the HIV epidemic in India: only by tackling the parallel epidemic of violence can women develop the functional autonomy to protect themselves against HIV and social norms that support violence be reduced. As with all successful sexual health initiatives, men must also be included in any behavioral change interventions, not only as vectors of change for women's health, but to adopt healthier social and sexual behaviors of their own. References
Copyright 2007 - Indian Journal of Medical Sciences |
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