The impact of GBV, especially sexual violence, for girls was the focus of the second preconference panel. The World Report on Violence and Health (Garcia-Moreno et al., 2005
) describes sexual violence as “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic or otherwise directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim in any form including but not limited to home and work.” A fundamental premise of violence is coercion. Coercion can cover a whole spectrum of degrees of force. It may involve psychological intimidation, blackmail, or other threats such as physical harm or enticement with material goods as well as physical force. It can also occur when the aggressed person cannot give consent. Factors such as poverty, unemployment, power dynamics, and age differentials have been known to promote sexual abuse and violence. The acts of violence inevitably accentuate the spread of HIV and AIDS.
In the ICOWHI preconference, Seloilwe and Tshweneagae (2008)
explored sexual violence and the psychological impact on adolescent girls living with HIV and AIDS in Botswana. Situation Analyses was used to identify that young girls and boys were coerced into sexual relations for material gain (Fidzani, 2000
; Molebatsi & Mogobe, 2000
; Ntseane & Ncube, 2000
; Seloilwe & Ntseane, 2000
). Findings from these studies indicated that youth were enticed with material goods to engage in sexual relations with significantly older partners. This phenomenon was labeled the “sugar daddy and sugar mummy syndrome” because older men and women exchanged sex with younger persons by giving them rides in their expensive cars, buying them cell phones, clothes or actually giving them cash. This is also referred to as the “four C” syndrome of young girls and boys lured with cell phones, clothes, cash and cars for exchange of sexual relations.
Sexual violence has a profound impact on the physical and mental health of girls. In addition to causing physical injury, it is associated with increased risk of sexual and reproductive health problems including HIV/AIDS. Psychological consequences such as guilt, anger, anxiety, depression, post traumatic stress disorder, sexual dysfunction, somatic complaints, sleep disturbances, withdrawal from relationships, stigmatization by family and community, and attempted suicide have been observed as a result.
discussed the physiologic impact of sexual violence on girls the role that skin color plays in accurate identification of injury from sexual violence. Her program of research has begun to identify the pattern and severity of physical injuries that girls develop as compared to women after a sexual assault. Several important issues are being addressed including: 1) the role of skin color in forensic examinations; 2) technology in sexual assault exams, including the costs of technology for resource poor countries; 3) investments needed by developed and developing nations in technology and training of sexual assault examiners and; 4) variations in training needed based on age and developmental status of girls and women and the culture(s) of the population.
described strategies for designing and evaluating effective contextually appropriate, culturally sensitive, and gender specific behavioral interventions to reduce the risk of sexually transmitted HIV infection among female adolescents. She emphasized the importance of collecting indigenous knowledge based on local expertise and experience of members of the community or country that reflects the cultural beliefs and attitudes that may facilitate or inhibit sexual risk behavior and using this information to design effective HIV prevention interventions. Jemmott discussed how these effective interventions have been used in various community settings and disseminated globally, and considered how IPV interfered with the effectiveness of interventions. Questions raised were: Can adolescent girls’ HIV risk—associated behaviors change in the context of partner violence?; What strategies are needed for HIV and IPV prevention?; Who should we target in our interventions, females only, males only, or both?; What about the role of alcohol and drugs?; What about the role of parents?; What resources are needed? She concluded by suggesting we build new global partnerships, listen to girls voices and design culturally competent, collaborative, compassionate strategies to reduce HIV risk behaviors, especially in the context of IPV.
Several of the articles in issue 30(1–2) illustrate the value of understanding indigenous perspectives to illuminate the context of risk and resilience in relation to GBV. Using qualitative interviews, Johnsdotter, Moussa, Carlbom, Aregai & Essén found Ethiopian and Eritrean parents who migrated to Sweden rejected the custom of female genital cutting (FGC) indicating the girl children were at low risk for this type of GBV. Riddell, Ford-Gilboe, & Leipert explored the social and physical strictures imposed upon women living in rural areas of Canada as they carried out strategies to ameliorate their exposure to IPV. They found several forms of social control, more prominent in rural settings, limited women’s access to safety resources. However, rural women preferred more private strategies and were able maintain a resilient spirit that aided them in gaining greater control in their lives. Hawkins and colleagues contend that women’s own appraisal of the severity and dangerousness of IPV are generally concordant with actual outcomes. Their study presents findings on a measurement tool to assess women’s perceptions of severity, dangerousness, and controllability of violence so that interventions can be tailored accordingly.