خشونت خانگی، مالکیت جنسی، و خطر اچ آی وی در زنان در عمق جنوب آمریکا

Domestic violence and sexual abuse are important correlates of HIV risk in women. This paper examines the links between HIV risk and domestic violence in women in a region with the highest HIV/AIDS rates in the United States. The theoretical framework incorporates Butler's (1993) and (1990) concept of performative gender and Collins’ (2000) “controlling images” of African American women as a context for domestic violence in the Deep South. Two focus groups were convened to develop a definition of domestic violence as HIV risk; 50 in-depth individual interviews of HIV-positive women were subsequently conducted for specific information on the topic. A final focus group was conducted for verification and feedback. The interview data revealed that controlling images of women as sexualized bodies were enacted through rape, sexual coercion, and name-calling in intimate relationships. The main finding was that the women lacked the ability to control sexual activities (including condom use) in abusive relationships with HIV-positive men. The women used various strategies to escape abusive partners and to obtain treatment for HIV/AIDS. The study concludes that the links between gender inequity, domestic violence, and HIV transmission should appear in prevention materials to encourage domestic violence screening in health settings, and to provide abused women with information on the not-so-obvious risks of being infected in abusive relationships.

Violence towards women is an indicator of HIV risk. This violence can take the form of rape, especially during wartime (Acquaro & Landesman, 2003), childhood abuse (Cohen et al., 2000) and intimate partner violence (IPV), including domestic violence (Wyatt et al., 2002). Most studies of violence in relation to HIV risk in US women focus on a “continuum of risk” that begins with childhood abuse, followed by risk-taking through sexual promiscuity and illicit drug use, and vulnerability to rape and other violent acts. These studies often refer to co-factors such as own or partner's drug use, trading sex for money, drugs or shelter, having multiple partners, and having sexually transmitted infections (STIs) (e.g., Eby, Campbell, Sullivan, & Davidson 1995; Coker, Smith, McKeown, & King 2000). The focus on violence as an HIV risk factor for women throughout the lifespan is a sharp reminder of how child abuse has long-term health implications (Dunne & Legosz, 2000).

The women in this study gave voice to their experiences of domestic violence as performative gender in the American Deep South. This voice arose from a cultural context in which gender relations have been defined in terms of micro-economies of power and status, and in which domestic violence is embedded within a particular discourse of gender polarity in a matrix of white domination. While it is important to acknowledge that domestic violence does not place all women at risk of HIV/AIDS, it is equally important to identify how local factors create HIV risk in abused women: in this case, in a region where women are being infected at a disproportionate rate. The task for HIV prevention campaigns for local contexts is to include both domestic violence factors (e.g., the inability to negotiate sexual activities because of abuse) and contextual perspectives on HIV risk so that prevention messages can be tailored to the specific situation. The links between gender inequity, domestic violence, and HIV transmission should appear in these prevention materials to encourage domestic violence screening in health settings, and to provide abused women with information on the not-so-obvious risk of being infected in abusive relationships.