Grace* was married to Thomas* for 10 years, during which time she gave birth to four children, and endured continual physical abuse from her husband.

In 1999, a colleague of Thomas’€™s told Grace that her husband was HIV positive. Thomas had known this for two years, but had failed to tell his wife and continued to have extra-marital affairs.

Although Grace also tested positive, she did not feel she could leave Thomas. However, Thomas left her soon after her HIV test and moved in with a girlfriend. He stopped paying maintenance for a while and secretly divorced Grace ‘€“ something she only found out when she sought medical treatment and was told she was no longer on Thomas’€™s medical aid as they were divorced.

Grace’€™s story is told by Lisa Vetten and Kailash Bhana, researchers from the Centre for the Study of Violence and Reconciliation, as part of their preliminary investigation into the links between violence against women and HIV/AIDS.

Her story, they argue, “illustrates some of the complexities of the lives of HIV positive women living with abusive partners”.

Grace’€™s HIV status seems to have been the reason for her remaining with Thomas, rather than leaving him, they argue. She feared no one else would want her; that an abusive relationship was better than no relationship and ‘€“ critically ‘€“ as an unemployed mother, “staying was an economic necessity to ensure the children would be taken care of and that she would have access to Thomas’€™s medical aid”.

Given that stress weakens the immune system, Vetten and Bhana also ask whether HIV positive women living in abusive relationships like Grace are more susceptible to opportunistic infections than those in supportive relationships.

They also ask whether abusive men more likely to have extra-marital affairs. (An Indian study they refer to suggests they are.)

Vetten and Bhana started their research out of concern that “violence against women and HIV/AIDS may be converging in new and lethal ways”.

Two reports supported this idea of convergence: the murder last year of a woman by her husband, who left a note reading “HIV positive AIDS” on her body before killing himself and research conducted by academic Suzanne Leclerc-Madlala in 1997, which linked rape and HIV status.

“Last week, one guy was telling his friends that he was going to rape all those girls who denied him before when he was clean,” a youngster told Leclerc-Madlala. “Now he was going to give them this AIDS thing and show them something.”

Vetten and Bhana identify four experiences where violence and HIV/AIDS overlap:

• Rape, which by its violent nature makes women and girls more susceptible to HIV.
• Abusive relationships (in which women have no power to negotiate condom use or fidelity).
• Childhood sexual abuse (there is some evidence to suggest that women who were sexually abused as children may engage in risky sexual behaviour when older.)
• Women who disclose their HIV status to their partners may face violence.

The researchers interviewed 52 people involved in organisations dealing with violence against women to see whether they were making a link between such violence and HIV.

They found that, in two cases, a direct link was assumed. The Greater Nelspruit Rape Intervention Project (Grip) and the Department of Forensic Medicine and Toxicology (through Groote Schuur and GF Jooste hospitals in the Western Cape) both offered rape survivors anti-retroviral drugs.

Three Gauteng clinics ‘€“ Sunninghill, Garden City and Milpark ‘€“ also offered a free dose of an anti-retroviral drug to rape survivors presenting within 72 hours of their attack. However, there is no conclusive proof that such drugs are effective in preventing rape survivors from getting HIV.

People involved in counselling reported that they often had to deal with domestic violence, rape and HIV. But many counsellors lack the necessary skills, and few shelters for abused women are equipped to deal with HIV positive women, particularly those with AIDS.

Vetten and Bhana conclude that more research on the connection between gender violence and HIV/AIDS is needed. They also make a long list of recommendations aimed at improving the way in which South Africans deal with these “dual epidemics”, including:

• Defining abandonment of unemployed women and children as economic abuse, in terms of the Domestic Violence Act;
• Establishing whether anti-retroviral drugs do help to prevent HIV transmission after a rape;
• Training for counsellors to enable them to identify and assist women at risk of violence for disclosing HIV status to their partners;
• Making courts and police prioritise sexual offence cases involving HIV positive complainants;
• Developing standard procedures for police officers and prosecutors on how to deal with HIV positive rape survivors (to ensure that the experience does not compound the women’€™s stress.)
• Public education campaigns to challenge coercive sexual practices.
• Closer working relationships between women’€™s organisations and those dealing with HIV/AIDS.

South Africa has the most HIV positive residents in the world. It also has one of the world’€™s highest sexual assault rates. It is thus inevitable that the two trends should impact on one another, and it is imperative that policymakers deal with the overlap.