Sexual and gender-based violence is a pervasive global health problem, rooted primarily in the context of women's and girls' subordinate status in society. Sexual violence in particular poses significant risks to women's health, including physical injuries, psychological trauma, unwanted pregnancy, and sexually transmitted infections (STIs), including HIV. The human rights framework holds that all people, including women and people living with HIV, have the right to live without stigma, discrimination, and violence, and with self-determination. In recent years, global health advocates have used this framework to bolster support for issues of sexual and gender-based violence and associated health consequences. At the U.N. Summit on Peacekeeping on September 23, 2010, the United States Secretary of State, Hilary Clinton, announced an increase in support by the US Government for the prevention of sexual violence, particularly in conflict settings such as the Democratic Republic of Congo. Reducing sexual and gender-based violence (SGBV) is one of the five gender strategies promoted through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and it is crucial to meeting the global UN Millennium Development Goals, which call for lowering maternal mortality, improving child survival, combating HIV/AIDS and other STIs, A nine-year-old girl called Chisinsi* woke up early in the morning to go to school in Lusaka, Zambia. She wondered, "Do I tell mummy or not?" Finally she decided to go to school without telling her mother. Throughout the day, Chisinsi felt pain as she walked and tried to urinate. After school, Chisinsi asked to accompany her mother to the market where she was going to buy relish. On the way to the market, she told her mother: "Last night after I went to bed, dad came to my bed and did stupid things to me." The mother melted with fear and anger. In Zambia, many children, as well as adults, refer to sex as a "stupid thing." Chisinsi's mother rushed to report the incident to the local police and hospital. At the hospital, both mother and child were counseled and the child was given HIV PEP among other medications and services. Friends of the family told her mother that PEP would damage Chisinsi's health and that, because she was young and innocent, she could not catch HIV from this act of sexual violence. Chisinsi's mother asked the nurse if this was true, and the nurse explained how the medicine works, what the side effects were, and how to cope with them. With this information, Chisinsi continued to take the medication. Police investigations, combined with accounts from health care providers and Chisinsi herself, revealed that the father had also defiled Chisinsi at age five as well. He was sentenced to 25 years of imprisonment. Currently the family is under the capable supervision of a community based organization-Young Women's Christian Association (YWCA) for continued emotional and social support until they are ready to move on.
