Co-authored by members of Plan International Canada's Global Fund team: Magalie Nelson, Health Advisor and Kate Waller, Gender Advisor under the leadership ofBernabe Yameogo, Director of the Unit. The Global Fund Team at Plan International Canada works to accelerate the end of the malaria, AIDS and tuberculosis epidemics
A 25-year old Beninese woman confides: "They (men) do not know what they make us live. Some of us here have become HIV-infected women because of the weight of society, we cannot tell our husbands: condoms or nothing. They allow themselves to go to town to do what they want with loose women and we stay at home in silence. They bring us the virus without us being able to refuse. Can you imagine how a woman feels when she knows that the relationship she is having may be the cause of her death and she has no power to say no ..."
Her story is all too common of women and girls around the world. Evidence clearly shows the links between gender-based violence (GBV) and HIV – both as cause and consequences of women and girls' vulnerability to HIV. In some areas, women who were physically or sexually abused by an intimate partner are up to twice more likely to get HIV. Young women and adolescent girls represent 60% of newly infected worldwide and 22 % in West Africa have increased vulnerability. Key populations, i.e. sex workers, men who have sex with men (MSM), transgender people, prisoners, people who inject drugs and their sexual partners are also very affected populations of the epidemic, representing 25% of new infections. Benin is no exception. The female/male ratio of HIV infection is 14 to 10 and the prevalence in key populations 5 to 17 times higher than the general population.
As the civil society Principal Recipient of The Global Fund to fight Aids, Tuberculosis and Malaria HIV Grant in Benin, Plan International is committed to using a gender transformative approach to address the root causes of GBV to fight HIV. In 2017, a key first step was to commission a national gender study of GBV with the government, UNAIDS and other partners. The gender study will serve to identify and understand key gender and social-based forms of discrimination, stigmatization and GBV factors influencing vulnerable and key affected women, men, girls and boys in all their diversity and their vulnerability to HIV in the context of Benin.
Preliminary study results indicate that in the context of Benin, rigid and unequal gender norms define and privilege male decision making power in intimate sexual relationships. These unequal power relations leave women and girls from the general population and key populations, particularly sex workers and people who inject drugs, with little negotiating power to protect themselves in sexual relationships or to make autonomous positive health choices. Unequal gender norms justify and perpetuate high levels of gender based discrimination and violence among women, girls and key populations, including sex workers and MSM.
Despite varying responses, a key finding was that the women and girls and key populations most likely to experience GBV were those who challenge dominant gender norms and expectations such as women seeking health care without their husband's permission or contesting their partner's decision, such as refusing sexual intercourse. Women who are less educated, older and divorced or separated experience higher levels of violence. Due to such prevailing and deep-rooted gender norms at household, family/community and institutional levels, women, girls and other vulnerable groups have little choice but to remain silent about these traumatic experiences even if there are some levels of health, psychosocial and legal services available to them.
Of the girls and women interviewed, almost all (98.5%) girls and women (81%) reported being victims-survivors of at least one type of GBV (physical, sexual or psychological) in the last 12 months, of which 15% was sexual violence. Two-thirds (63%) of 127 women and men living with a disability experienced at least one type of physical, sexual or psychological violence combined with experiencing high levels of reported ostracization due to their disability. Key populations interviewed are mostly affected by psychological abuse and violence, namely sex workers (155/197), MSM (33/75), people who inject drugs (29/44), lesbian women and girls (17/27) and transgender women and men. Most male and female survivors, whether from the general population or key populations, tend to keep the experience to themselves or resolve the issue through in-laws or their immediate family ties. Few choose legal recourse or available government and NGO run social protection centers. Lack of autonomous decision making power, fear of retaliation and stigma and guilt and general lack of knowledge of the law are all factors that hinder reparation and access to services.
Progressive gender equality and justice laws and legislation exist in the country. Benin has signed international human rights agreements and ratified most of them. Its own constitution states that "men and women are equal in law... that any form of sexual harassment is an offense regardless of the quality of the author or the victim and the place of commission of the act .. " and has a supportive legal framework. These laws, however, have not been completely followed with needed and appropriate human rights based and gender responsive HIV services. The barriers raised in the gender study clearly show that unless these gender and social based forms of discrimination and violence limiting the choices of women and girls and certain key populations are addressed, their rights to health will continue to be denied.
Based on study findings, key recommendations are to: focus on changing men's attitudes and practices towards adopting more gender equitable values and practices; increase women and girls' economic bargaining power; develop targeted social group and whole community/family interventions to address self and collective stigmatization and design a more coordinated response to GBV focused on the needs of victims-survivors such as through emergency GBV kits.
This is an unavoidable road toward ending the epidemic.
This blog is part of the blog series: Barometer Rising: No time to backtrack the fast track to ending HIV as a global health threat by 2030 by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (1 December). The series features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on the right to health within Canada and globally to critically reflect on the response to HIV knowing we are now just 2 years from the 2020 Fast-Track targets (90-90-90) and just over a decade away from the 2030 Global Goals for Sustainable Development (SDGs).
Are we on the right track or are we on the back-track?
Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.