Greentree White Paper: Sexual Violence, Genitoanal Injury, and HIV: Priorities for Research, Policy, and Practice

Abstract

The links between sexual violence, genitoanal injury, and HIV are understudied but potentially significant for understanding the epidemic's disproportionate impacts on young women and girls, particularly in sub-Saharan Africa, other hyperendemic areas, and conflict-affected regions. A Scientific Research Planning Meeting was convened by the Social Science Research Council at the Greentree Foundation in New York, March 19-20, 2012, bringing together an interdisciplinary group of researchers, clinicians, and policy makers to identify knowledge needs and gaps in three key areas: (1) the role of genitoanal injury on HIV transmission, acquisition, and pathogenesis; (2) the influence of sex and age-related anatomic characteristics on HIV transmission, acquisition, and pathogenesis; and (3) the role of heterosexual anal intercourse in HIV transmission. This article reflects the consensus that emerged from the Greentree Meeting regarding priority scientific research questions in these three areas, associated data collection and measurement challenges and opportunities, and implications for policy and practice.

Preventing HIV Infection in Women

“…[39] The intersection between sexual violence, anogenital injury, and HIV infection may be a critical factor in HIV's disproportionate impact on women and girls in some regions of the world with generalized epidemics. [40] Researchers have therefore recently called for a multidisciplinary focus on three key areas: sexual violence perpetrated against adolescent women, sexual violence in conflict-affected areas, and effects of such violence on the HIV epidemic. [40]…”

“…[40] Researchers have therefore recently called for a multidisciplinary focus on three key areas: sexual violence perpetrated against adolescent women, sexual violence in conflict-affected areas, and effects of such violence on the HIV epidemic. [40]…”

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa

“…Moreover, women who experience sexual abuse in childhood are at increased risk for exposure to intimate partner violence in adulthood (5), a known risk factor for HIV infection (13). Sexual trauma further contributes to HIV infection biologically, through genito-anal injuries that facilitate transmission of the virus (14), as well as socio-contextually, as violence makes it challenging to negotiate HIV risk reduction practices such as abstinence or condom use (15). Beyond the traumatic event itself, a history of trauma can over time lead to diminished sense of control over one's body, reduced self-esteem, self-destructiveness, and maladaptive coping behaviors, including substance use, all of which can compromise a woman's ability to protect herself from HIV (16-18).…”

Challenges in conducting research on sexual violence and HIV and approaches to overcome them

“…Multiple studies have implicated sexual violence as a strong correlate of HIV acquisition in women 1–6 . Given the 35% global prevalence of violence against women 7 , characterizing the mechanisms whereby such violence affects the acquisition of HIV is important to the development of global HIV prevention strategies.…”