A team of American and South African researchers has an unconventional prescription for reducing the risk of HIV among women – female empowerment.
If young women in rural South Africa enjoyed true gender equality with their male partners, nearly 14% of the new HIV infections recorded between 2002 and 2006 could have been avoided, the researchers said. In addition, if – by some miracle – all instances of physical or sexual violence by men could have been prevented, so would 12% of the new HIV cases diagnosed during that four-year period.
Those calculations come from a study published online Wednesday in the journal Lancet. The researchers crunched data from a trial designed to test the effectiveness of an HIV-prevention program called Stepping Stones.
Of the 1,099 women included in the Lancet study, 128 acquired HIV during the course of the trial. That worked out to an overall incidence rate of 6.2 new infections per 100 person-years. But the rates weren’t uniform across all groups of women.
Among those with “low relationship power equity,” there were 8.5 new cases per 100 person-years; for women in more equal relationships, there were only 5.5 new infections per 100 person-years. The researchers also found that among women who were victims of intimate partner violence more than once during the study, the infection rate was 9.6 new cases per 100 person-years; for all other women, there were 5.2 new cases per 100 person-years.
Cultures that “celebrate male strength and toughness” tend to tolerate a higher degree of male control over women, and that makes women more vulnerable to the adverse consequences of “risky sexual behavior, predatory sexual practices, and other acts of violence against women,” the researchers wrote. Therefore, health officials should be concerned not only with the availability of HIV medications but with social programs “that address violence and gender inequity in relationships.”
It may sound pie-in-the-sky, but the Office of the U.S. Global AIDS Coordinator has already earmarked $30 million for pilot programs aimed at preventing gender-based violence in Tanzania, Mozambique and the Democratic Republic of Congo, according to Jay Silverman, director of violence-prevention programs at the Harvard School of Public Health. In an editorial that accompanies the study, Silverman wrote: “We must hope that this initial allocation will be followed by far greater investment.”
-- Karen Kaplan
Photo: New research indicates that women like Claudia Pena (above) would be less vulnerable to HIV infection if they were on more equal footing with their partners. She got HIV from her live-in boyfriend, who was sleeping with other men. Credit: Genaro Molina / Los Angeles Times
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