16 July 2014

Cote d'Ivoire: Sexual Violence Fuels HIV Epidemic

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Three years after the Ivory Coast post-election crisis of 2010 ended, rape is still a major problem and the security situation for Ivorian women remains bleak.

During the crisis sexual violence increased, but according to a 2014 Human Rights Watch Report, the UN reported at least 100 cases of sexual violence in the first half of 2013, including many against children.

Amina,* 19, was raped in April by a taxi driver. "I took the taxi and while on our way the driver proposed a shortcut. We arrived at a place where there were no houses. He stopped the car and pointed a knife towards me and ordered me to take my clothes off. I cried and begged him not to rape me. He slapped me and threatened to kill me. He raped me without even using a condom," Amina said.

In March 2014, Centre PAVIOS - a government facility that provides care to sexual violence victims - recorded 90 cases of sexual violence in the area of Attecoubé, the western part of Abidjan. The victims were all aged between four and sixteen. Baba Koné, who works as a social assistant in the Centre, believes this number is just the tip of the iceberg, as many victims refuse to speak out.

Sexual violence and HIV

Sexual violence leads to higher incidences of unsafe sex as women and girls are unable to negotiate condom use. Men who perpetrate sexual violence are likely to have had more sexual partners and more unsafe sex leading to higher prevalence of HIV and other sexually transmitted infections. Research indicates that vulnerability to HIV among women who have experienced sexual violence may be up to three times higher than among those who have not.

Dr. Muriel Assoi, a gynecologist in a clinic in Abidjan, said: "Rape or sexual assault can cause cuts that allow easy entry of HIV. Breaking of vaginal tissues during sexual assault lead to bleeding that increases risk of HIV."

Annie*, a rape survivor, said: "After the accident [the rape], they [the doctors] told me to take an HIV test, which I did. The first results were negative. Three months later, I took another test and the results were positive."

According to Armel Koffi, coordinator at the Sexual and Reproductive Health Program, although there is no specific data, a higher HIV prevalence among women in the country is mainly explained by sexual violence. "The lack of legal protection and impunity makes women more vulnerable to sexual violence. And this makes them vulnerable to HIV infection. All these factors are linked."

Attitudes to women

Axel Ado, a sociologist from Université Alassane Ouattara, believes sexual violence is embedded in Ivorian society. "The low status of women and girls in law and custom contributes to the extent to which they are vulnerable to sexual violence," he said. "The fact that sexual violence predominantly involves men raping women reveals that rape reflects a dynamic of gender inequality and subordination. This power dynamic is deeply imbedded in social attitudes."

Anita*, a twenty year old woman who was raped by her cousin, said: "I asked him [the rapist] why he was doing this to me. He said: 'You are a woman and I have every right to you.' I realized that women are nothing more than men's property."

Christine Houssou, president of Ivorian Coalition of organizations of women living with HIV, said: "In Ivory Coast, sexual violence is a neglected issue. And it is often downgraded by authorities to indecent assault which can be prosecuted but carries significantly lower penalties. Men do not consider rape as an offense to women's rights but as a 'sex thing'."

Need for medical care

It is vital to provide comprehensive health services and psychological support to women who have experienced sexual violence. These include sexual and reproductive health services, such as emergency contraception and HIV testing and prophylaxis, which need to be provided within a specific time frame.

PAVIOS provides emergency contraception as well as prophylaxis to victims. But according to Koné, a lack of information and social stigma can prevent victims from attending the centre straight after the assault, which is when any treatment must take place if it is to be effective in preventing pregnancy or HIV.

Aziza*, a young lady who was raped six months ago, has another reason. "The cost of drugs are among the main obstacles victims face," she says. "I could not afford the medical ordinance. And I caught an infection."

In fact, very few referral centres are able to provide all drugs free of charge and only free antiretroviral treatment is guaranteed.

Lack of legal protection

For victims who are seeking legal redress, the cost of a medical certificate 50,000 Francs CFA (approximately $100) partly explains why a low number of victims take legal action. According to an OCHA report only 34 per cent of recorded cases choose to go to court.

Abia*, a fifty eight years old mother of two, remembers how policemen made fun of her when she went to file a complaint after being raped. She said: "They told me I should be happy because considering my age; they [the rapists] gave me what I could no longer get. I understand that in this country, when you are in your forties and older, it is a blessing to be raped as sexual partners are scarce."

The Global Summit to End Sexual Violence in Conflict in June shone a spotlight on this widespread crime and abuse of human rights and a movement is underway to ensure such crimes cannot be committed with impunity in times of war. But as Ivory Coast demonstrates, the post-conflict context is also in need of urgent attention.

A Somali proverbs says: "The last camel in line goes as quickly as the first. Whatever happens to the least of us has an effect on all of us." As long as gender inequality and sexual violence is allowed to prevail, achieving zero new HIV infections in Ivory Coast will remain a pipe dream.

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