Women who experience gender-based violence have a higher risk of contracting HIV: this should be considered in South Africa's prevention strategy.
"Between one in four and one in five [20% to 25%] of HIV infections in young South African women can be attributed to gender-based violence, according to South African and Ugandan research," said Rachel Jewkes from the Medical Research Council at the sixth National Aids Conference in Durban this week.
According to Jewkes, the main pathway to HIV infection because of gender-based violence is not rape as many people might think. "What's responsible for much more of the new infections are the indirect pathways, such as the profound psychological impact this violence has on abuse victims including anxiety, depression, post-traumatic stress disorder and substance abuse."
Jewkes said two things occured as a result of this psychological distress to increase these women's risk of contracting HIV.
"Firstly they are more likely to have risky sex, more partners, transactional sex, and are also more likely to end up in sex work," she said.
Psychological distress, according to Jewkes, also makes it much harder for women to protect themselves. "It makes them more likely to accept the man's dominance in the relationship."
She said that once a woman accepts she is likely to have more sex and more frequent sex, she is also less likely to use a condom.
"Gender based violence is responsible for the psychological distress, which results in acceptance, which results in more violence and consequently more psychological distress: a cycle of risk and consequence," said Jewkes.
Another factor that significantly increases these women's chances of becoming HIV infected is that men who perpetrate gender-based violence are more likely to have HIV themselves. "Violent and controlling men take more sexual risks and have a higher prevalence of sexually transmitted infections," she said.
Jewkes said that women who experience intimate partner violence have a 50% increased risk for HIV than women who don't.
"Clearly if we want zero new HIV infections we have to address gender-based violence," she said.