Domestic Violence and HIV Infection in Uganda
Human Rights Dialogue 2.10 (Fall 2003): "Violence Against Women"
November 5, 2003
Jacqueline is a thirty-two-year-old Ugandan woman who tested HIV-positive after her husband died of AIDS. Before he died, he routinely raped and beat her, and refused to use a condom during sex. Her four children are infected with HIV, as is her co-wife. The similar experiences of many Ugandan women illustrate the ways in which domestic violence can play a critical role in rendering women vulnerable to HIV infection. As a result of violence or a fear of violence, Ugandan women are unable to protect themselves from infection and to access HIV/AIDS services. Although Uganda has ratified international and regional human rights treaties providing for women’s rights to protection against violence and women’s rights to health, the unchecked domestic violence and the lack of access for women to HIV/AIDS services are clear indications that the government is failing to meet its responsibilities.
In addition to women’s greater physiological susceptibility, social, cultural, and legal forms of discrimination compound their vulnerability to HIV. Domestic violence, already a leading cause of female injury, deprives women of bodily integrity by eliminating their ability to consent to sex, negotiate safer sex, and determine the number and spacing of their children. In many cases, the threat of abandonment or eviction constrains economically dependent women to remain in abusive relationships, thereby exacerbating their vulnerability to HIV infection. One HIV-positive woman said, “He used to force me to have sex with him. He would beat and slap me when I refused. . . . The very first time I asked my husband to use a condom because I didn’t want to give birth he said no. He raped me and I got pregnant. I’m still with him because I don’t have a cent. He at least pays the rent.”
Ugandan women confront a male-dominated power structure that upholds and entrenches male authority in the home. In 2002-03, as a researcher for a Human Rights Watch report on the correlation between domestic violence and women’s vulnerability to HIV infection, I talked with many women who viewed domestic violence as a natural by-product of marriage. Customs such as the payment of “bride price,” whereby men essentially purchase their wives’ sexual favors and reproductive capacity, underscore men’s entitlement to dictate the terms of sex. Practices such as widow inheritance by a man of his brother’s widow can expose women to unprotected and unwanted sex with HIV-positive partners. When women in polygynous marriages are coerced into unprotected sex, they are exposed to a higher risk of HIV transmission as a result of the man having unprotected sex with multiple partners.
The Ugandan government has failed to enact laws for the effective prosecution and punishment of acts of violence against women. Inequitable divorce laws make it difficult for women to terminate their marriages legally. The government has yet to criminalize marital rape. Draft legislation to regulate domestic relations and sexual offenses has been pending since at least the early 1990s, despite vigorous lobbying by many of our local NGO partners. Moreover, none of the pending legislation adequately addresses domestic violence––nor will it as long as the government upholds the notion of the inviolability of marital privacy and fails to address discriminatory marriage and property laws that impede women’s escape from abusive marriages. State prosecutors told us that few domestic violence cases are actually prosecuted. In addition, women we spoke with said government officials often address domestic violence charges by attempting to reconcile the parties and pressuring the women to return to their abusive husbands.
Human Rights Watch is working with several local women’s and human rights groups in Uganda to hold the government accountable for its failure to prevent and remedy domestic violence, establish relevant medical protocols, and modify and transform harmful traditional practices. International human rights law has been a useful advocacy tool. By systematically failing to enact and enforce criminal laws and address violence against women in the home, the government in effect condones and endorses it. When government agents such as the police pay inadequate attention to domestic violence compared to other forms of violence, we argue that this violates provisions upholding the right to equal protection under the law and provides proof of tacit state complicity.
Despite oversight by UN committees of Ugandan state implementation of international treaties such as the International Covenant on Civil and Political Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Ugandan NGOs assert that government efforts to improve the socioeconomic status of women have been minimal. They argue that despite the government’s gender-progressive reputation and a rhetorical commitment to women’s rights, many changes are cosmetic and do not impact women on the ground. The abdication of state responsibility has left many of the NGOs working with Human Rights Watch in Uganda as the only providers of any recourse to battered women in the form of legal education and representation, shelters for abused women, and care and support for women living with HIV/AIDS.
Uganda is blessed with a developed and vibrant network of NGOs working on women’s rights and a coherent and well-established HIV/AIDS movement. NGOs such as Raising Voices are addressing domestic violence at the community level with programs that specifically aim at male participation and include strategies such as the enhancement of the police response to domestic violence. In addition to providing us with our initial access to domestic violence survivors and women living with HIV/AIDS, Ugandan NGOs collaborate with us on advocacy through press releases and radio broadcasting. A particularly notable outcome expressed by our NGO partners has been their increased awareness of the intersection between the work of rights-based and HIV/AIDS NGOs.
Domestic violence leading to a heightened risk of HIV transmission is a widespread phenomenon, and research similar to that reported here could have been conducted in any one of a number of countries. Yet this is a critical time for Uganda: while a wide range of bilateral and multilateral donors is contributing extensively to HIV/AIDS initiatives, our interviews with Ugandan health officials revealed that the impressive decline in overall HIV/AIDS prevalence rates in Uganda is leveling off. These health officials also acknowledged the dangers of complacency. The failure to address the very serious underlying and contributing issue of domestic violence may compromise Uganda’s continued success in the fight against HIV/AIDS.
Uganda also provides an important case study for the region. The fact that domestic violence is not addressed in a country widely considered a success story in the fight against HIV/AIDS holds grim implications for African women. If women are unable to protect themselves in a country where national adult prevalence rates declined from 18.5 percent in 1995 to 8.3 percent at the end of 1999, what are the chances in countries such as Kenya, which, until recently, had no coherent government strategy to tackle HIV/AIDS, and where AIDS has reduced the average life expectancy from sixty-five to forty-six years? With Uganda included among fourteen countries slated to receive five years of AIDS program support from the United States and a grant from the Global Fund worth over U.S. $36 million to support the ongoing fight against HIV/AIDS, this is a pivotal time for addressing the links between domestic violence and women’s vulnerability to HIV––a topic unfortunately not mentioned during President Bush’s recent trip to the country.
The correlation between domestic violence and women’s vulnerability to HIV infection adds considerable impetus to the need for all governments to address seriously and meaningfully domestic violence against women. Otherwise, in a continent devastated by HIV/AIDS, any strategy to combat the pandemic will be compromised. Programs that attempt to prevent the spread of HIV/AIDS by encouraging abstinence from sex, fidelity, and consistent condom use are a start, but they do not address women’s unequal decision-making power and status within their intimate relationships. Human rights law, which clearly establishes state responsibility to protect women from battery, is a useful tool for holding governments accountable. The words of one victim describe it best: “After testing he would force me to have sex without a condom. I don’t know why he was opposed to condoms after testing and yet he had used them for birth control [before testing]. He said, ‘Why bother, we’re already victims.’. . . There should be a law to stop husbands forcing wives to have sex. I would use the law.”