New research from South Africa shows that women who have physically violent or controlling male partners are at increased risk of HIV infection. The risk has long been suspected, but the study supports the notion with numbers.
The study assesses statistically how violence against women boosts their chances for getting HIV , the virus that causes AIDS. Researchers from South Africa's Medical Research Council, University of the Witswatersrand, and the University of Michigan in the United States interviewed nearly 1,400 women being tested for HIV in clinics in Soweto.
Of those who reported sexual or other physical assaults by their partners or who had little power in their relationship, about 40 percent were infected with HIV . University of Michigan researcher Kristin Dunkle says this compares to about a 29 percent infection rate for women not in violent or controlling relationships.
"What we found without a whole lot of surprise is that the experience of violence from an intimate partner or being involved with a partner who is very controlling was associated with a strongly increased probability that a woman would test HIV positive," she said.
The researchers found something else that previous U.S. studies had discovered, that being in a violent or controlling relationship also increases a woman's chance for engaging in risky sex with other partners. This led to the question whether it is the relationship itself or the risky sexual behavior related to it that boosts a woman's likelihood of becoming infected.
So Ms. Dunkle and her colleagues adjusted the data to subtract the effect of risky sexual activity.
"If you statistically account for women's risk behavior, there remains an independent effect from being involved with a violent or controlling partner," said Kristin Dunkle. "So that says to us then it's the violent encounter itself that is the source of risk for women."
As the researchers report in the medical journal The Lancet, a violent or controlling partner increases a woman's risk for HIV by 50 percent over women who live in non-violent households.
"That suggests the hypothesis, then, of course, that violent and controlling men are more likely to be HIV positive than are other men," she said.
The South African study reinforces findings from other parts of the world. According to the United Nations AIDS program, UNAIDS, a recent study in India shows that 90 percent of women being treated for sexually transmitted diseases at several clinics had only one sex partner their entire lives. The deputy executive director of UNAIDS, Kathleen Cravero, said at a Washington panel discussion that 14 percent of these monogamous women were infected with HIV .
"In many countries of Asia, marriage is the major risk factor for HIV infection among young women," said Kathleen Cravero. "The fact is that most women do not become HIV-infected through high risk behavior and certainly not through high risk behaviors over which they have any control."
An editorial in The Lancet journal says no single strategy can alleviate violence against women and enhance female equality. It says the challenge is to encourage policy makers, health organizations, women's advocates and others to work together to reduce such violence and increase the effectiveness of HIV programs. Earlier this year, UNAIDS and equal rights campaigners launched a coalition to improve prevention and treatment for women and girls with HIV .
The U.S. State Department says President Bush's $15-billion, five-year plan to combat AIDS in designated countries will work closely with communities, donors, and others to promote gender equality, protect women from sexual violence related to the virus, and build family skills in conflict resolution.
One of the anti-AIDS strategies the Bush plan supports is the so-called ABC approach - A for abstinence from sex, B for being faithful to a partner, and C for condom use. But the University of Michigan's Kristin Dunkle says her South African study shows that the strategy is useless for women if they are forced to have sex with infected partners.
"I think when you start getting data like this that really shows the impact of being involved with a violent or controlling man, you start to have very concrete evidence that that's just not going to work in a situation where individuals don't have individual control over their behavior," she said.
Ms. Dunkle says the problem requires broader cultural interventions, including educating men.