Sexual violence contributes to the spread of HIV/AIDS and other sexually transmitted infections (STIs) in various ways. Inability to negotiate safe sex in situations of sexual assault, the physical injuries that may accompany a sexual assault, and fear of ostracism all combine to increase women's vulnerability to HIV/AIDS and other STIs and undermine their ability to protect their sexual health. At the core of the problem are gender-based inequalities that set the stage for various factors that directly and indirectly contribute to the spread of the virus. "The different attributes and roles that societies assign to males and females profoundly affect their ability to protect themselves against HIV/AIDS and cope with its impact. Reversing the spread of HIV therefore demands that women's rights are realized and that women are empowered in all spheres of life." From Fact Sheet: Gender and HIV/AIDS, UN Special Session on HIV/AIDS (25-27 June 2001).

In situations of coerced sex, women are not able to negotiate safe sex or contraceptive use and thus are at increased risk of infection. According to UNAIDS, women are biologically more vulnerable to the virus and thus are two to five times more likely than men to be infected with HIV during unprotected vaginal intercourse. From UNAIDS, Women and AIDS (October 1997); World Health Organization, First World Report on Violence and Health (2002). Women in abusive relationships who are unable to negotiate contraceptive use may attempt to use contraceptives covertly, thus putting themselves in further danger if their husbands should discover their contraceptive use.

Physical injuries that may accompany a sexual assault can increase the risk of HIV/AIDS and STI transmission. "In situations of rape, the victim may experience bleeding and tearing of the genital area. This can create passageways for HIV to enter the bloodstream." From UNAIDS, HIV/AIDS and Gender-Based Violence.

A recent study found that a sexual assault victim's "heightened need for intimacy, coupled with the sexualization of affection, may lead her to seek warmth and closeness through repeated sexual encounters." Victims of sexual assault are more likely to have multiple sexual partners in a single year, to have casual sex, and to not use contraception, all of which increase the risk of unintended pregnancies and sexually transmitted infections. From Ending Violence Against Women in Population Reports, vol. 7, no. 4 (December 1999).

Armed conflict, in particular, creates conditions that allow HIV/AIDS to flourish. Rape and sexual abuses such as forced pregnancies and sexual enslavement have become a deliberate weapon of war in various regions throughout the world. UNAIDS notes that "[r]esearch carried out in Bosnia, Croatia, Rwanda revealed the horror that many women faced as a result of policies whereby rape and other forms of sexual abuse were utilized as weapons of war. There were brutal reports of gang rapes and of subsequent establishment of brothel networks for women who had suffered this atrocity. Although seroprevalence data are limited (especially in the former Yugoslavia), it is likely that many women were exposed to HIV as a result of rape and their subsequent exile into what has been called sexual slavery." From UNAIDS, Gender and HIV/AIDS: Taking Stock of research and programmes (UNAIDS/99.16E) (March 1999).

Situations of conflict create impoverishment, forcing women and girls to trade sex to survive. Women may be exploited by military personnel who offer food, money or shelter for sex. Unsafe conditions in refugee camps expose women and girls to risk of sexual violence. Soldiers who are HIV-positive put their partners at risk when they return home. Post-conflict, women can be subjected to violence and discrimination in reconstruction programs, in refugee camps, and when they return to their homes. Wartime can cause social and economic upheavals that negatively affect women, who may enter the sex trade as a means of survival or be subject to trafficking, which has also been linked to the spread of the virus. From Elisabeth Rehn & Ellen Johnson Sirleaf, Women, War and Peace: The Independent Experts' Assessment on the Impact of Armed Conflict on Women and Women's Role in Peace-building 49-50, 52 (2002).

In 2000, the UN Security Council adopted Resolution 1308, recognizing the spread of HIV/AIDS and other STIs as potential threats to international security and recommended that HIV-prevention measures be incorporated into all peacekeeping initiatives. In 2001, the UN General Assembly on HIV/AIDS (UNGASS) unanimously adopted the Declaration of Commitment on HIV/AIDS. Paragraphs 75-78 of the Declaration contain directives to be achieved by 2003 that focus on training and awareness among personnel involved humanitarian and peacekeeping initiatives. From Elisabeth Rehn & Ellen Johnson Sirleaf, Women, War and Peace: The Independent Experts' Assessment on the Impact of Armed Conflict on Women and Women's Role in Peace-building 55 (2002).

Fear of ostracism and further violence associated with having HIV/AIDS or another STI can prevent women from seeking diagnosis and treatment for the virus. For reasons described in detail in the pages discussing criminal law governing sexual assault and the response of police and prosecutors, a woman may be reluctant to disclose that she had been raped for many reasons. She may fear that she would be ostracized by her community, or that the police would not believe her. Inadequate healthcare and lack of network of support systems for victims can preclude women from seeking treatment after rape or sexual assault, and thus new cases of infections may go unreported.

As UNIFEM has explained, HIV-positive women may also be reluctant to disclose their status because of the threat of violence within their community: "The pandemic has introduced further gender-based violence, as women who are HIV positive or are perceived to be positive, such as sex workers, are subject to discriminatory treatment, abandoned and shunned by their families and communities, dismissed from employment, assaulted, and even killed." From UNIFEM, Turning the Tide: CEDAW and the Gender Dimensions of the HIV/AIDS Pandemic (2001). Women, rather than men, bear the brunt of blame for the pandemic, and are stigmatized as promiscuous. As a result, women often fail to seek healthcare or prevention information, and can spread the virus to family members. As Peter Piot, Executive Director of UNAIDS, has explained, combating violence against women and girls thus involves, among other things, breaking the silence surrounding sexual violence and AIDS. From Peter Piot, UNAIDS Executive Director, Commission on the Status of Women, Forty-third Session Panel on Women and Health: HIV/AIDS and Violence Against Women (3 March 1999).

For a collection of research and reports on HIV/AIDS and sexual assault, click here.