Drugs, Sex, and Gender-Based Violence: The Intersection of the HIV/AIDS Epidemic with Vulnerable Women in South Africa – Forging a Multilevel Collaborative Response

Sub-Saharan Africa is the global epicenter of the HIV/AIDS epidemic, accounting for more than one-third of HIV infections worldwide. In South Africa, with a population of 49 million, 5.7 million people are living with HIV; 350,000 died of AIDS in 2007. Among all demographic groups, a greater burden of the disease falls to individuals who are disadvantaged, underserved, and vulnerable. This is especially true for women, where the HIV level among women of childbearing age is currently at 29 % and increasing. Young women aged 15 to 24 are at particularly high risk, accounting for 90 % of all new HIV infections among this age group. The HIV epidemic among women is fueled by endemic poverty, gender inequality and violence, widespread substance abuse, social norms that involve multiple concurrent partnerships, and marked age differentials between young women and their male partners. Within this context, many women resort to transactional sex or sex work for survival. Among sex workers, alcohol and other drug use is particularly widespread, as it helps to ameliorate the shame of conducting sex work and gives women courage to talk with men for “dates. ” Although drug use—including alcohol, crack cocaine, and methamphetamine—may lower inhibitions for sexual transactions, it increases the likelihood of high-risk sex behaviors, such as not using condoms properly, and prevents women from negotiating sexual risk reduction and thereby reducing physical and sexual violence. Overall, these women lack the essential skills for violence prevention to reduce being victimized. Compounding the problem is the highly variable quality of public health services, limited access to mental health services, and very limited formal substance abuse treatment services for women