Gender based violence and women's vulnerability towards HIV/AIDS in 6 Indian Districts

Background: Violence against women is instrumental in determining a woman’s risk of HIV infection, and has been identified as a key driving factor behind the pandemic. Very little is known about the interplay between violence against women and HIV risks, even though a reduction in violence against women has been identified both nationally and internationally as a key strategy in the fight against HIV/AIDS infection. India is relatively poorly researched in terms of the context of the HIV pandemic. This study analyses couple dynamics and the ways in which violence against women is associated with condom negotiation and perceptions of risk, and highlights differentials by socio-economic and regional groups. The data are drawn from 6 rural districts across 6 states in India Methods: This paper utilises data which has not been exploited fully before. A mixed methods approach is used, combining a quantitative individual-level survey for both women and men (n=9,000) with a series of stratified focus groups (n=30) from the Coordinated HIV/AIDS Response through Capacity Building and Awareness (CHARCA) end of line study conducted in 6 Indian district in 2007. Results: One fifth of female respondents reported that women are more at risk of HIV/AIDS infection than men because they had difficulty in negotiating condom use, avoiding non-consensual sex and violence. Married women in particular reported the most difficulty in condom negotiation. Condom use and perceptions of HIV/AIDS risk are significantly associated with caste, religion and wealth status. The qualitative analysis shows clearly how women perceive themselves as more vulnerable and at risk of HIV/AIDS compared to men. Conclusions: Married women are often overlooked in focused interventions. In order to maximize programme effectiveness, it is important to make strategic objectives about whom to target and what approaches to take. These analyses provide evidence to support the need for interventions that target married women