The Related Evils of Violence Against Children and HIV Infection

How the intersection of the work of Together for Girls Partnership and The United Nations Joint Programme on HIV/AIDS (UNAIDS) keeps children safe from violence and HIV

Violence against children is a worldwide problem of grave and urgent concern. Violence against children can be physical, sexual, or emotional and can include deprivation and/or neglect. Both boys and girls are at risk.

Violence against children is driven by a host of factors including: globalization, social injustice, inequality, poverty, negative cultural practices, technological advances, and armed conflict.  These things can make children much more vulnerable to various forms of violence such as child marriage, female genital cutting, rape, sexual exploitation, and physical violence. Each of these factors often can lead to a series of related circumstances that can put kids in harm’s way. For example, according to Together for Girls (TFG) violence against children surveys results; many children experience violence in their communities at the hands of their parents or relatives, teachers, neighbors, schoolmates, boyfriends, romantic partners, and spouses. On the other hand, globalization has increased migration within and between countries and increased tourism and trade. In turn, these shifts have increased the volume of child trafficking and the commercial sexual exploitation of children. Technological advances have increased access to the internet and to a variety of “smart” devices which has resulted in more children being exposed to pornography, online bullying and connections that can lead to trafficking and sexual coercion. And armed conflicts often lead to the break down of law and order, which exposes children to all forms of violence. Not to mention that sexual violence is often used as weapon of war and displacement.

Several surveys point out that approximately half of the world’s children or one billion are exposed to violence per year. Of all types of violence committed against children, sexual violence is the most critical for the impact it has on the victim. Adolescent girls are disproportionately affected by sexual violence. Other surveys indicate that one in three women will be subject to physical or sexual abuse in their lifetime. Sexual violence against children is not only a gross violation of children’s rights; it is also a key challenge for global public health in that when children experience or witness violence, they are more inclined to become either victims or perpetrators themselves later in life. The direct and indirect negative consequences violence creates for children, families and communities can result in huge economic cost to countries.

But while the experience of violence is terrible, cyclical, and expensive, the damages aren’t limited to violence itself. It often results in secondary types of trauma such as mental health issues and HIV infection. There is growing evidence that children who have experienced sexual violence struggle with low self-esteem and depression for this reason (as low self-worth can lead people to take greater health risks) and others, are at higher risk of contracting HIV. This is particularly true among high risk groups such as very young adolescent girls, especially those living in areas where many around them have HIV.  Half of all people infected with HIV are under the age of 25 and, in developing countries, up to 60 percent of all new infections are among youth—twice as many of them are girls as boys. This may be attributable to the fact that perpetrators of violence/sexual violence are more likely to be 5-10 years older than their victim and often practice other risky behaviors that predispose them to sexually transmitted infections including HIV. Therefore, perpetrators of sexual violence and those they violate are more likely to be living with HIV.

The risk of HIV sero-conversion after rape is known to be higher than in consensual sex in general, given that forced sexual activity often leads to physical trauma that can make it easier for HIV to pass from one person to another. This is especially true for children because of the increased physical trauma associated with non-consensual sex in people who have not previously had sex and whose bodies are not yet fully developed.

HIV can also affect children indirectly as children rely on their parents or caregivers for upbringing and well-being. Therefore, when parents become sick or die from HIV, kids must fend for themselves, often with more limited resources.   In the midst of a parent’s illness or in the aftermath of their death, children might need to be moved from one household to another. All these factors can make children more vulnerable to violence and HIV infection. The problem doesn’t stop there. Evidence shows that children exposed or subjected to violence are more likely to perpetrate violence and practice risky sexual behavior in the future themselves, thus perpetuating vicious cycle of violence and elevated risk for HIV transmission/contraction. Relationship between Sexual Violence and HIV infection: Conceptual Framework. Dube, 2013

It has recently been proved that treating people living with HIV/AIDS at much earlier stages of infection can reduce of the risk of HIV transmission by 96%. Therefore, the sooner and more broadly people with HIV are treated, the greater the protection to their individual and to public health. More widespread treatment will likely result in a significant drop of new infections. This relationship has been well established in countries like Rwanda, Zambia and Malawi that have recently upped the number of people treated and seen the rate of new infections plummet. In light of the relationship between treatment and the reduction of illness and HIV transmission, the World Health Organization (WHO) issued new HIV treatment guidelines (known as the “WHO 2013 Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV infections”).

Because of the link between HIV and violence against children, reduced violence will result in fewer HIV infections; this is an emerging intersection between HIV interventions and violence against children programs. In addition, as the new HIV treatment guidelines roll-out, we expect that people will be less ill, and as a consequence, more productive, with stronger capacity to care for their children, keep them in school and nurture them – all of which are shown to be protective against violence.

As a Policy and Program officer fellow working with both Together for Girls (TFG) and the joint United Nations program on HIV/AIDS (UNAIDS), this intersection is of paramount importance to the work I do. TFG is a public-private partnership working on ending violence against children across the globe. TFG has conducted surveys to capture data about violence against children in many countries (such as Swaziland, Tanzania, Kenya, Malawi, Zimbabwe, Indonesia, Cambodia and Haiti) and is working closely with governments to support the generation of national action plans based on the evidence collected in the surveys.

UNAIDS works to accelerate HIV prevention, treatment, care and support of all people living with HIV around the world.

It is my proposal not only to these two organizations but also to other organizations and governments committed to fighting HIV/AIDS to consider the effective mainstreaming of prevention of violence against children in all HIV/AIDS interventions. This approach will not only lead to the prevention of millions of new infections and deaths; it is also critical in reducing violence against children and helping children make safe transitions into adulthood further giving them the opportunity to grow into productive, contributing members of society.

 

References

1. World Health Organization. Media Centre 2012: Strategic use’ of HIV medicines could help end transmission of virus. http://www.who.int/mediacentre/news/releases/2012/hiv_medication_20120718/en/

2. Pinheiro PSdMS. Rights of the Child: Report of the Independent Expert for the United Nations Study on Violence Against Children: Office of the United Nations High Commissioner for Human Rights; 2006.

3. UNAIDS report on the global AIDS epidemic 2013. http://www.unaids.org/en/resources/campaigns/globalreport2013/index.html

4. Together for Girls Violence against Children Surveys.

http://www.togetherforgirls.org/#/news/6

5. Jim Mercy. 2013. Center for Disease Control, Atlanta, USA.