The social context of gender-based violence, alcohol use and HIV risk among women involved in high-risk sexual behaviour and their intimate partners in Kampala, Uganda

Abstract

This paper explores the interaction between gender-based violence and alcohol use and their links to vulnerability to HIV-infection in a population of women and their regular male partners in Kampala, Uganda. Data derive from 20 life history interviews (10 women and 10 men). Participants were drawn from a cohort of women at high risk of sexually transmitted infection (including HIV). Six of the women were current or former sex workers. Findings reveal that life histories are characterised by recurrent patterns of gender inequity related to violence, limited livelihood options and socioeconomic disadvantage. Overall, findings suggest women are able to negotiate safer sex and protect themselves better against abuse and violence from clients than from their intimate partners, although the status of men as ‘client’ or ‘partner’ is transitory and fluid. Among male respondents, alcohol led to intimate partner violence and high levels of sexual-risk taking, such as engagement with sex workers and reduced condom use. However, male partners are a heterogeneous group, with distinct and contrasting attitudes towards alcohol, condom use and violence. Actions to address gender-based violence need to be multi-pronged in order to respond to different needs and circumstances, of both women and men.

Risky Business: condom failures as experienced by female sex workers in Mombasa, Kenya

“…For example, some aspects of control over condom use may reside with the male partner due to his physical insistence, which is consistent with findings from other research (Schulkind et al 2016). We hypothesise that if women themselves felt responsible in any way for the failure, they may have expressed greater interest in revisiting their condom education or may have abandoned condom use entirely because of presumed future failure.…”

“…These situations represent women’s loss of situational control (Sanders 2004; Pauw and Brener 2003; Heise and Elias 1995; Okal et al 2011; Voeten et al 2002; Okal et al 2008; Schulkind et al 2016). …”

Sociodemographic and Behavioral Factors Associated with HIV Vulnerability according to Sexual Orientation

“…Similarly, unprotected sex can be influenced by alcohol use, as it predisposes users to have multiple sexual partners and dispense with condoms [23,24].…”

Adapting the Risk Environment Framework to Understand Substance Use, Gender-Based Violence, and HIV Risk Behaviors Among Female Sex Workers in Tanzania

“…Evidence also suggests that alcohol use increases FSWs’ risk for GBV (16, 20, 21). Qualitative research describes how clients encourage FSWs to drink to the point where they lose consciousness, which renders them vulnerable to rape (22, 23). Alcohol consumption may also impair FSWs’ ability to detect the risk of violence and escape a risky situation (17, 24).…”