Kampala — LINDA (not real name) a 35-year-old mother, was frequently beaten by her husband. "He would beat me to the point that he was too ashamed to take me to the doctor. He forced me to have sex with him and beat me if I refused. Even when he was HIV-positive, he still wanted unprotected sex.

He refused to use a condom. He said he cannot eat sweets with the wrapper on," Linda says .

Hope Turyasingura, the technical advisor, Center for Domestic Violence and Prevention (CEDOVIP), says gender-based violence is a key driver to HIV. She says all forms of violence fuel women's vulnerability to HIV infection. She adds that domestic violence is an important, but often neglected factor contributing to the spread of HIV/AIDS among women.

Cases of both domestic violence and HIV infection are disproportionately high. Research demonstrates that there is a relationship between domestic violence and HIV/AIDS. In fact, some people view domestic violence as a cause for the contraction of HIV, while others see the contraction of HIV as a cause of domestic violence.

"Despite national laws against rape and other forms of assault, the failure of governments to enact marital rape laws combined with cultural norms and practices subordinating women's roles within the family and society inevitably contribute to the spread of HIV/AIDS among women," Turyasingura says. The high incidence of HIV infection among married women infected by their husbands is often the result of the wives' inability/reluctance to require the use of condoms, and to refuse sexual relations with their husbands for fear of violent retaliation.

Grace Namwanjje, a couple's counsellor at The AIDS Information Centre, says abuse against women is still common and only feeds into the tradition of male dominance. These issues regarding women's rights and equality have an important and substantial impact on the continuing spread of HIV/AIDS.

She says a combination of factors heighten women's vulnerability to HIV. "Cultural perceptions of women's sexual and reproductive obligations in marriage rob women of bodily autonomy, while unequal property rights, the payment of bride price and women's inability to take their children from the fathers' homes render women unable to leave abusive relationships," she says.

Namwanjje says the emotional consequences of domestic violence, such as depression and low self-esteem, leave the survivor prone to high risk HIV behaviour, including drug use, the inability to negotiate condom use and prostitution.

Turyasingura says research findings show an increased risk of HIV/AIDS among women and that being HIV-positive is a risk factor for violence against women.

"Women need to be given power and control over themselves and their bodies in order to stop the spread of this pandemic. If women are given the authority that they deserve, men, including their husbands, will not be able to make decisions for women regarding sexual practices, hence controlling the spread of the epidemic to some extent," Turyasingura says.

According to the Uganda Police Crime report 2008, there were 137 cases of domestic violence reported, in which 156 persons lost lives.

Namwanjje says when a is HIV-positive and the woman negative, the couples tend to stay together. However, when the woman is HIV-positive and the man negative, the woman was often abandoned by her partner, families and friends, as well as suffered violence due to her status. HIV-positive men go ahead and force women into having unprotected sex or sometimes rape them. When a woman refuses to give in, she ends up being beaten.

"Where a man is HIV-positive there is always a lot of violence. Men say the woman cannot deny them sex when they are in his house," Namwanjje says.

She says in addition to coping with violence and disease, many women also face a challenge of the uncertain future their children if both parents have HIV/AIDS. As a result, many economically dependent women stay in high-risk, violent marriages.

Turyasingura says women with violent or controlling male partners are at increased risk of HIV infection. "We assume that abusive men are more likely to have HIV and impose risky sexual practices on their partners." She adds that cultural expectations have encouraged men to have multiple partners, while women are expected to abstain or be faithful, yet faithfulness offers little protection to wives whose husbands have several partners.

Turyasingura says poverty intensifies the factors that determine women's vulnerability to HIV infection. "Abuse of women by poor, frustrated, angry men has been a factor in making HIV as widespread as it is. Once HIV begins to spread in the general, heterosexual population, all sexual relationships become much riskier. In other words, violence against women might have been the spark that set off the blaze."

She says as more people learn about how to protect themselves from HIV, those who remain most vulnerable to infection will likely be those who suffer most from injustice, anger and abuse.