Partner Reduction and Violence Against Women and Girls 

Increasingly, from a public health perspective, partner reduction is touted as the most obvious strategy to reduce HIV prevalence.[1]  This particular approach is premised on a strong belief is that once people accept the reality of AIDS and know how to protect themselves, they would simply adopt the appropriate behaviours.  Thus putting a heavy emphasis on the ABC strategy – A for abstinence, B for being faithful (or reducing the number of sexual partners) and C for condom use.   

However, women’s rights actors have argued from the beginning that issues of profound vulnerability and inequality that drive HIV transmission are much more complex than most people initially thought.  In reality, enduring gender inequalities, including economic inequality and gender violence, which continue to contribute to women's vulnerability to HIV is still alarming.  In fact, in the context of women and girls vulnerability to violence, without the ability to control their sexual lives, women and girls are in no position to abstain form sex.   From a scientific and epidemiological perspective, partner reduction sounds like the logical or rational approach.  Yet, as a strategy it is ineffective for many married women, including women in abusive relationships who are not able to abstain because their husbands force sex on them, women who choose to be monogamous but have no control over their husband’s monogamy, or women who risk physical violence if they request condom use by their partner.

This is confirmed by research conducted in diverse countries which found that violence and the fear of violence acts as a significant barrier to women negotiating condom use or fidelity with their partners or choosing to leave risky relationships.[2]   In addition, women’s economic dependence on men often makes it difficult for them to refuse sex, and indeed makes it more likely that many will participate in sex for favours[3]While the “ABC” prevention approach is important, it is NOT sufficient.  Strategies addressing gender inequalities are urgently needed.  The problem with the ABC approach, is that without shifting deeply gendered dynamics within intimate and familial relationships between women and men, and without addressing the root causes of male entitlement and female subservience, as an AIDS strategy, it is doomed to fail. 

An approach that places too much emphasis on partner reduction, further increases the HIV vulnerability of socially marginalised groups such as sex workers.  The danger is that at the social level, sex workers could face increased stigmatization and also risk of violence.  In addition, this could result in states justifying inadequate health care, information, education and other basic rights to the most marginalised of their citizens.   

Moving forward, 

•  Strategies that simply seek to change behaviour based on arguments about ‘safety,’ does not challenge power relations between men and women, especially in the context of sexual relations.  Strategies to prevent further infections need to take cognisance of the cultural context and needs to strategically address the social climate that sustains violence against women and girls.  
  
• There is a need for more careful analysis and research of factors contributing to behaviour change (especially those that effectively shift power relations).  
  
•  Contexts as disparate as California, Uganda, and Thailand show that HIV prevention responses that are endogenous, inexpensive, and simple based on the premise that communities, however disparate, have within themselves the resources and capital to reverse this epidemic. These lessons have shown that responses that are locally led, promote changes in community norms, creating enabling and protective environments can achieve declines in HIV infection.  There is a need for much wider adoption of these approaches and the resources to support this work.    

July 2008      

Women Won’t Wait seeks to accelerate effective responses to the linkages of violence against all women and girls and the spread of HIV by tracking and, where necessary, calling for changes in the policies, programming and funding streams of national governments and international multilateral and bilateral donor and technical agencies. For more information about the Women Won’t Wait campaign, please contact: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it  

International Members of the “Women Won’t Wait – End HIV and Violence Against Women. Now.” campaign:Action Aid; African Women’s Development and Communications Network (FEMNET); Association for Women’s Rights in Development (AWID); Center for Women’s Global Leadership (CWGL); Center for Health and Gender Equity (CHANGE); Fundación para Estudio e Investigación de la Mujer (FEIM); GESTOS-Soropositividade, Comunicação & Gênero; International Community of Women Living with HIV&AIDS Southern Africa (ICW-Southern Africa); International Women’s AIDS Caucus; International Women’s Health Coalition (IWHC); Latin American and Caribbean Women’s Health Network; Open Society Initiative for Southern Africa (OSISA); Program on International Health and Human Rights, Harvard School of Public Health; SANGRAM; VAMP; and Women and Law in Southern Africa (WLSA).