Social and cultural norms that sanction male violence against intimate partners can preclude a woman from being able to negotiate safe sex with her partner. Women's lack of bargaining power in intimate relationships, for example, "is one of the many factors preventing many women from negotiating the use of male and female condoms, which can effectively prevent the transmission of HIV/AIDS." From UNIFEM, Empower Women, Halt HIV/AIDS. As Peter Piot, Executive Director of UNAIDS, explains further:

[Women] often cannot insist on fidelity, demand condom use, or refuse sex to their partner, even when they suspect or know he is already infected himself. And they often lack the economic power to remove themselves from relationships that carry major risks of HIV infection. . . . Women, fearful of getting beaten or thrown out, are unlikely to ask their boyfriends to wear a condom, or question them about fidelity.

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). 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.

A woman who depends on her partner economically cannot afford to jeopardize the relationship even when she suspects he may be HIV positive or has an STI, or that he has multiple partners. "If she refuses him sex or asks him to use condoms, she is breaking the conspiracy of silence that surrounds his extramarital activity—or, even worse, intimating that she was unfaithful. And while some men agree to use condoms, many react with anger, violence, or abandonment." From UNAIDS, Women and AIDS (October 1997).

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. Women who test positive for HIV may be at increased risk of violence at the hands of their spouse or partner if they disclose the results of the test. From World Health Organization, Violence Against Women and HIV/AIDS: Setting the Research Agenda—Meeting Report (23-25 October 2000). In a survey of providers of HIV-related healthcare in the US, "24% reported having at least one female patient who experienced physical violence after disclosing her HIV status to her partner, and 45% had patients who feared such a reaction" In Nairobi, of a group of 66 women who disclosed their status to their partners, 11 were chased away from their homes, 7 were beaten up and one committed suicide. From Ending Violence Against Women, in Population Reports, vol. 7, no. 4 (December 1999).

As UNIFEM has explained, HIV-positive women may also become the targets 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 Sisonke Msimang explains:

We are beginning to see dangerous patriarchal responses to the epidemic—from virginity tests to decrees about female chastity from leaders. In part this is simply an extension of deeply rooted myths about female sexuality. However, with HIV/AIDS, it can also be attributed to the fact that in many cases women are the first to receive news of their sero-positive status. This is often during pre-natal screening, or when babies are born sick. Bringing home the 'news' that there is HIV in the family often means being identified as the person who caused the infection in the first place. We know that, in the vast majority of cases, this is simply not true.

From Sisonke Msimang, HIV/AIDS, globalisation and the international women's movement, in Gender and Development: Women Reinventing Gobalisation, vol. 11, no. 1 (May 2003).

As a result of the threat of violence and stigmatization, 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).

Measures combating HIV/AIDS and STIs must also address the power imbalances that can exist within intimate relationships and the cultural and social norms that sanction male violence against intimate partners. Approaches that focus on "fidelity, abstinence, and condom use do not address the ways in which domestic violence inhibits women's control over sexual matters in marriage, minimize the complex causal factors of violence, and incorrectly assume that women have equal decision-making power and status within their intimate relationships." From Human Rights Watch, Just Die Quietly: Domestic Violence and Women's Vulnerability to HIV in Uganda, vol. 15, no. 15(A) (August 2003).

For a list of research and reports on domestic violence and HIV/AIDS and other STIs, click here.