Rethinking HIV Prevention

A new program connects women's experiences of sexual violence to the risks of contracting HIV.

By Daisy Hernandez Aug 12, 2009

August 12, 2009

HIV prevention has traditionally been focused on addressing what some advocates call the basic risk factors for contracting the virus, like sharing needles and having unprotected sex. But this approach, which worked well in the initial target community (middle-class gay men), has not stemmed the increasing rates of infection among Black and Latina women, who accounted for 82 percent of the estimated AIDS diagnoses among U.S. women in 2005.

Now, advocates and researchers are beginning to consider how the mistreatment of women—including domestic violence, limited access to reproductive care and cultural stigmas about sexuality—puts them at risk for HIV/AIDS. One recent study of nearly 14,000 women found that those who experience physical violence from their partners are more than three times as likely to have HIV as women who do not. The study was published in the journal General Hospital Psychiatry.

Advocates in Worcester, Massachusetts, where 41 percent of those diagnosed with HIV are women, have already begun to shift their approach to fighting the virus. AIDS Project Worcester, an AIDS service organization, launched a new program this year called the W.O.M.E.N.’s (Women of Multiple Ethnicities Network) Health Project to get women to think about sexual violence in a broader way.  

“There are many ways to be forced [into sex]. You have the physical force, the psychological force, the verbal force,” said  Wanda M. Martinez who runs the project. She added that few of the women she meets make the connection between the term “sexual violence” and the unwanted sex they may be having with their partners.

Joe McKee, the organization’s executive director, recounted stories familiar to many women, especially Latinas: being called a whore for visiting a gynecologist, not knowing how to negotiate safer sex and a culture where it’s largely acceptable for men to be unfaithful. “We see this as a form of violence because they’re putting women at risk [for HIV]“, McKee said.

Rosa De Jesus, 46, has been HIV-positive for 18 years. Through the W.O.M.E.N.’s Health Project, De Jesus is now giving presentations to warn women of how they may be at risk. She said it is common for husbands to refuse to practice safe sex, claiming that condoms are for “mujeres de la calle,” or prostitutes. Through her public speaking, De Jesus explains to women that they have a right to refuse sex, even with their husbands.

The W.O.M.E.N.’s Health Project is screening women for both the risk of HIV and sexual violence and training community groups to do the same. One long-term goal is to have information and self-screening tools available in a variety of places, from schools to WIC offices and to bring the connection of sexual violence and HIV to the attention of public health departments.