While it may not be the first thing that comes to mind when we think about epidemics like Zika and HIV/AIDS, there is a strong relationship between infectious disease and violence against women. This relationship goes in two directions: epidemics tend to cause an increase in violence against women, and gender based violence tends to facilitate the spread of infectious disease.
The current Zika epidemic is strongly linked to violence against women. Much is still unknown about how to prevent and treat Zika and the congenital birth defects it causes. (See Short Answers to Hard Questions About Zika Virus for more information about this virus.) In the face of this uncertainty a number of Latin American governments have advised women to avoid becoming pregnant. This epidemic disproportionately affects poor and minority communities in Latin America where women are faced with rampant gender based violence. Recommendations by their governments to avoid pregnancy indicate a fundamental misunderstanding of how violence against women undermines women’s ability to control their own reproductive lives.
To those of us who live in a world where contraceptives are available and where most women have the right and the ability to choose when and with whom they conceive, the recommendation to postpone conception may seem like common sense. However, as UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein has said; “Clearly, managing the spread of Zika is a major challenge to the governments in Latin America, however, the advice of some governments to women to delay getting pregnant, ignores the reality that many women and girls simply cannot exercise control over whether or when or under what circumstances they become pregnant, especially in an environment where sexual violence is so common.”
In El Salvador where public officials have called on women to avoid pregnancy, conditions are similar to those in many other countries affected by Zika. These public officials ignore the fact that 31 percent of all pregnancies in El Salvador occur among girls between the ages of 10 and 19. Many of these young girls are in relationships with substantially older men, making it difficult if not impossible for these young women to control their sexual activity and use of contraception. The reality of their lives removes any possibility of avoiding pregnancy and the risk of carrying an infant with serious birth defects caused by Zika.
Ongoing gang violence makes El Salvador one of the most dangerous countries in the world. Rape and sexual assault are commonly perpetrated by both the gangs and security forces. Between January and August 2015, 1,123 cases of sexual violence were reported to the National Civilian Police of El Salvador. This number represents a vast underreporting as many women fear and mistrust the authorities, who are often implicated in the violence. The rights of these women are not only violated by the men who assault them. They are violated again by the government which places the burden of curbing the effects of Zika on the shoulders of women who are least able to control its spread. The government asks women who are often the victims of sexual violence to assume reasonability for a huge public health threat. Instead of making unreasonable demands on women and girls to avoid pregnancy, governments can effectively fight Zika only by addressing sexual violence and ensuring that women and girls have access to safe and reliable reproductive health services.
Making the problem even worse, El Salvador has such a severe ban on abortion that some women who have suffered miscarriages have been jailed upon being accused of aborting their pregnancies. In November 2015 Amnesty International released a report detailing the harm being caused by these laws. Strict abortion bans result in illegal abortions with high rates of severe injury and even death, as well as unjust detention of women who suffer miscarriages, and economic and psychological trauma experienced by women and their families. This severe abortion ban just serves to increase the risks that women face and the burden they are being asked to shoulder during this epidemic.
Like Zika, HIV takes a disproportionate toll on women. Over 60 percent of all newly infected young people are women. Women who experience intimate partner violence are 50 percent more likely to be infected with HIV. Women subjected to violence are not able to negotiate condom use with their intimate partners, are not able to abstain, or to compel their partners to be faithful. All of these practices increase the risk of contracting HIV. Women are also more likely to contract HIV if the sexual act is violent because abrasions make it easier for the virus to enter the body.
Similar to the situation faced by young girls in El Salvador, relationships between young girls and older men in sub-Saharan Africa are much more common than they are in the United States. Sanya Mojola’s book Love, Money and HIV provides a compelling account of young Kenyan women who are engaging in sexual relationships with older men who can provide financial resources that are not otherwise available to them. Unequal power dynamics between young women and older male partners increases rates of sexual violence. These relationships are a leading cause of the substantial gap in HIV infections between young men and women in this region.
Women who experience violence or the fear of violence are also less likely to get tested for HIV or seek treatment. They fear being abused or abandoned if they disclose their HIV status to their partners. When women do not have access to treatment the disease continues to spread.
As public health officials work to combat these two epidemics they will not be successful unless they also incorporate an understanding of sexual violence. Protecting the human rights of women is a necessary element in protecting the public health of these populations.
Amelia Shindelar is working towards her Master of Public Policy at the Humphrey School of Public Affairs. Amelia studies the intersections of health, human rights and development. She is a summer 2016 intern for Global Rights for Women.