Female Empowerment to Fight HIV?

Equalizing the balance of power between men and women in personal relationships could help reduce HIV transmission in South Africa, according to a new study.

Beginning in 2002, American and South African researchers tracked the incidence of HIV among 1,099 South African women ages 15-26 who were HIV-negative at the start of the four-year trial. Study data were drawn from an analysis designed to test the effectiveness of an HIV prevention program called Stepping Stones.

Overall, the incidence of HIV at the conclusion of the study was 6.2 per 100 person-years, but the rates of HIV varied with the level of "power equity" the women reported in their relationships with their male partners.

Women with "low relationship power equity" had an HIV incidence of 8.5 per 100 person-years, while women with medium or high power equity had a rate of 5.5 new infections per 100 person-years.

Some 13.9% of HIV infections could be avoided if gender equity in heterosexual relationships were enhanced so that no women were in relationships with low power, the researchers concluded. In that same vein, 11.9% of new HIV infections could be prevented if women did not experience more than one episode of physical or sexual partner violence, they wrote.

The researchers discussed their findings in the context of other research exploring the links among HIV, gender inequity, and gender-based violence. Such links, they wrote, "lie in the patriarchal nature of society, and ideals of masculinity that are based on control of women and that celebrate male strength and toughness."

Pilot programs aimed at preventing gender-based violence in Tanzania, Mozambique, and the Democratic Republic of Congo have been targeted to receive $30 million from the Office of the U.S. Global AIDS Coordinator, according to Jay Silverman, director of violence-prevention programs at the Harvard School of Public Health.

"We must hope that this initial allocation will be followed by far greater investment," Silverman wrote in an accompanying editorial.

The full report, "Intimate Partner Violence, Relationship Power Inequity, and Incidence of HIV Infection in Young Women in South Africa: A Cohort Study," and the editorial, "Key to Prevent HIV in Women: Reduce Gender-Based Violence," were published in The Lancet.