Understanding The Crisis Rape-HIV Nexus – Analysis

The social and political instability that contributes to broad instances of sexual assault also increases the rate of HIV transmission and hinders service accessibility. Experts agree that to effectively address HIV, programs must focus on sexual violence – a task easier said than done amidst the fog of war.

By Allyn Gaestel

Rape in the Democratic Republic of the Congo (DRC) made headlines again this spring when a study by the American Journal of Public Health confirmed the worst fears of those tracking the long-standing epidemic of sexual violence in the war-ravaged country: every hour, 48 women are raped.

Rape as a weapon of war is not unique to the DRC and is not a modern phenomenon; the symbolism of raping Troy’s women to assert dominance over a culture is present even in the Aenied. Sudan, Liberia, Sierra Leone, Uganda and Cote d’Ivoire are all recent hosts to epidemics of aggressive sexual violence.

Instability begets sexual violence

Instability can lead to increased instances of sexual violence, as there are elevated social tensions, power struggles and often impunity for these crimes. When a society is in crisis mode, it is less likely for its institutions to function. In the DRC, for example, women’s rights advocates blame the failed court and prison systems for permitting the spread of the ‘culture of rape’ beyond the military and rebel groups into broader society. After years of raising awareness about the wartime rape perpetrated by soldiers, rebel groups and UN peacekeepers, activists began receiving increased reports of teachers raping school girls, police commanders raping teenagers, and incest; phenomena they related to the normalization of sexual violence, and impunity for the perpetrators in the midst of instability.

Women’s groups in Haiti also reported an upswing in sexual assault after last year’s devastating earthquake. Without proper lighting or adequate and functional security forces in displaced persons camps, women have been, and continue to be, subjected to assault. And one HIV activist spoke of increased “promiscuity”, both in consensual and non-consensual sex, when people, unemployed and without opportunity, have nothing to occupy them.

The HIV link

But even beyond the immediate injury and trauma that stems from sexual assault, a less-discussed outcome can be an increased chance of exposure to HIV – an even higher probability than occurs during consensual sex. Forceful entry can damage the vaginal or anal tissue, creating more openings for the virus to enter the bloodstream. Research from the London School of Hygiene and Tropical Medicine has modeled that “genital trauma increases ‘per-sex-act’ risk [of contracting HIV] by a multiplicative factor of 1.5 for single sites of trauma, 3 for multiple sites of trauma and 6 for anal rape.” The World Health Organization has also reported that studies showed “women living with HIV are more likely to have experienced violence and that women who have experienced violence are more likely to have HIV.”

The HIV rate among soldiers is generally higher than in the rest of the population. UNAIDS estimates militaries can have a two-to-five times higher rate than the general population during peacetime, and the numbers climb even higher during periods of conflict. This is linked in part to the expanded mobility of combatants and the disruption of their normal sexual and familial relationships. Soldiers, separated from their partners for lengthy periods of time, are more likely to have multiple partners, including sex workers, who also generally have a higher prevalence rate than the population. Sexual violence perpetrated by soldiers is an unfortunately widespread phenomenon in conflict and can increase transmission of the virus.

Compounding the issue is the fact that in crisis periods medical and social structures are often severely weakened. In Haiti, women’s advocates reported that police ignored women’s reports of assaults or told them to come back when they identified the attacker. Attempts to provide medical and social services have been piecemeal and poorly publicized, and at least one clinic that dealt with rape cases did not offer HIV testing. In the critical months following the earthquake, some emergency clinics withdrew, leaving a hole in access to care.

Stigma hinders access to post-rape medical attention even in peacetime; in many communities survivors of rape are made to feel responsible, and their reputations are sullied. But during wartime the psychological blockages to care access are compounded by infrastructure difficulties. Public health awareness about the accessibility of services is difficult when social workers have to minimize their movements to stay safe. Many rape survivors do not know that they need to access medical services within 72 hours to take advantage of post-exposure prophylaxis (PEP). In many war zones, access to any medical care can be difficult, especially with a time limit, and not all clinics offer PEP.

Testing and treatment services are also weakened during wartime. Governments struggle to motivate state employees to work in dangerous zones, and hospitals can be damaged in the crossfire. When daily life is regularly disrupted by crises, it can be difficult for people living with HIV to take medicine at the correct time and difficult to receive regular anti-retroviral medicine when supply chains are disrupted by conflict.

While data-collection is difficult during periods of conflict, at the end of Liberia’s 14 year conflict – which was host to significant numbers of child soldiers, sex slaves and sexual assault – the Liberian government estimated an 8.2 percent HIV prevalence rate in 2002, while UNAIDS estimated 5.9 percent in 2003. This compares with the most recent 2008 estimate of 1.7 percent.

The appalling stories of crisis-rape that make it into the media are only one aspect of the long-term injustice and social instability that sexual assault causes for individuals and communities. The instability that contributes to broad instances of sexual assault also increases transmission of HIV and hinders service accessibility, creating a web of human rights violations. Experts agree that to effectively address HIV, programs must address sexual violence – a task easier said than done amidst the fog of war.

Allyn Gaestel is a journalist and analyst based in Port-au-Prince, Haiti. Her work has appeared in The Atlantic Online and Reuters, in addition to many other publications. She is a former United Nations correspondent and National Press Foundation Fellow.

Published by International Relations and Security Network (ISN)