International Women's Health Coalition - IWHC


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Triple Jeopardy Realities Box

Pervasive gender inequalities mean that girls especially face numerous violations to their sexual and reproductive health and rights, including sexual initiation before they are physically or emotionally ready.1,2 Girls who live in extreme poverty, among marginalized populations, without family support, or in situations of conflict and displacement are particularly vulnerable to coerced sexual encounters and abuse.3-7

Half of new HIV infections worldwide are in women,8 and in 2007, young people, ages 15–24, accounted for about 40 percent of new HIV infections among people age 15 and older. 9 Globally, there are 5.4 million young men and women who are living with HIV, and nearly 60 percent of them are female.10


Girls are highly vulnerable as children and adolescents to sexual abuse and violence in their homes, neighborhoods, schools, and communities.1-7 Early sexual initiation is strongly associated with sexual coercion in many places.

Triple Jeopardy Chart

The use of physical force or emotional coercion during a sexual act greatly increases the risk of HIV transmission to the female if the male is infected. The female genital tract is highly susceptible to sexually transmitted infections (STIs), including HIV.19 Violence and rape can further increase HIV risk by causing abrasions, bleeding, and tearing, especially among young girls whose genital tracts are not yet fully mature.20

Many girls and young women, especially the very young, cannot refuse unwanted sex or negotiate protection from pregnancy and STIs, including HIV, particularly when they fear retaliation. They can suffer multiple adverse physical, social, and emotional outcomes.1,2,21  In situations of force or coercion, whether by strangers, acquaintances, family members, boyfriends, “sugar daddies,” or husbands, negotiating condom use is virtually impossible.

Effective strategies, policies, and programs are urgently needed at national, provincial, and local levels to protect young people, especially girls and young women, from sexual abuse or coerced sex and its consequences, including HIV infection.1,2,30-33   Continuous advocacy, strategic investment, and committed leadership are essential to addressing the triple jeopardy of sexual violence, HIV/AIDS, and adolescence.

We are grateful to reviewer Lucy Stackpool-Moore.

For more information on adolescents, including additional policy and program recommendations, please visit www.iwhc.org/resources/youngadolescents/index.cfm.

1 Shireen J. Jejeebhoy, Iqbal Shah and Shyam Thapa. 2005. Sex Without Consent: Young People in Developing Countries. New York and London: Zed Books.
2   Shireen J. Jejeebhoy and Sarah Bott. 2003. Non-consensual sexual experiences of young people: A review of evidence from developing countries. New Delhi: Population Council. http://www.popcouncil/pdfs/wp/seasia/seawp16.pdf.
3 UNICEF, UNAIDS and WHO. 2002. Young People and HIV/AIDS: Opportunity in Crisis. New York: UNICEF.
4 Judith Bruce and Amy Joyce (eds.). 2006. The Girls Left Behind: The Failed Reach of Current Schooling, Child Health, Youth-serving and Livelihoods Programs for Girls Living in the Path of HIV. New York: The Population Council.
5 Global Coalition on Women and AIDS, WHO. November 2004. “Sexual violence in conflict settings and the risk of HIV,”  Violence Against Women and HIV/AIDS: Critical Intersections. Information Bulletin Series, no. 2.   Geneva: World Health Organization. http://www.who.int/gender/en/infobulletinconflict.pdf
6 Global Coalition on Women and AIDS. 2005. “Violence against sex workers and HIV prevention.”  Violence Against Women and HIV/AIDS: Critical Intersections. Information Bulletin Series, no. 3. Geneva: World Health Organization. http://www.who.int/gender/documents/sexworkers.pdf
7 Global Health Council. 2007. Girls and HIV: A New Epidemic in the Women of Tomorrow?  Thematic issue of Global AIDS Link, No. 101. Washington DC: Global Health Council.
8UNAIDS. 2007. AIDS epidemic update December 2007. Geneva: UNAIDS/WHO, . http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2007/default.asp
9 UNICEF. January 2007. Children and AIDS: A Stocktaking Report. New York: UNICEF. http://www.unicef.org/publications/index_38048.html
10 WHO, Children and AIDS: Second stocktaking report Fast Facts. http://www.who.int/hiv/mediacentre/Stocktaking_FastFacts.pdf
11 “In Ethiopia, Malawi, United Republic of Tanzania, Zambia and Zimbabwe, for every 15- to 19-year-old boy who is infected, there are five to six girls infected in the same age group… In major urban areas of eastern and southern Africa, epidemiological studies have shown that 17 to 22 per cent of girls aged 15 to 19 are already HIV infected compared with 3 to 7 per cent of boys of similar age.” Taken from: UNICEF. July 2002. Young people and HIV/AIDS opportunity in crisis. http://www.unicef.org/newsline/HIV_10REV67.pdf
12 The Kaiser Family Foundation. November 2007. The global HIV/AIDS epidemic. Washington DC: The Kaiser Family Foundation. http://www.kff.org/hivaids/upload/3030-103.pdf.
13UNICEF. The State of the World’s Children, 2008. Table 4, HIV/AIDS. New York: UNICEF. http://www.unicef.org/sowc08/statistics/tables.php
14 UNAIDS. 2006.   Report on the Global AIDS Epidemic, 2006. Geneva: UNAIDS/WHO, cited by Kaiser Family Foundation, “The HIV/AIDS Epidemic in South Africa,” January 2008.  http://kff.org/hivaids/upload/7365_04.pdf
15 UNAIDS. 2006.   Report on the Global AIDS Epidemic, 2006. Geneva: UNAIDS/WHO. http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/Default.asp
16 World Health Organization. WHO Multi-country Study on Women’s Health and Domestic Violence Against Women. Summary Report. Geneva: WHO http://www.who.int/gender/violence/who_multicountry_study/en/index.html
17 Julia C. Kim, Lorna J. Martin and Lynette Denny. “Rape and HIV post-exposure prophylaxis: addressing the dual epidemics in South Africa.” Reproductive Health Matters, no. 11(22) 2003:101-112.
18 Patrick Burton. 2005. Suffering at School: Results of the Malawi Gender-based Violence in Schools Survey. Malawi: National Statistical Office.
19 World Health Organization. 2005. Sexually Transmitted and Other Reproductive Tract Infections: A Guide to Essential Practice. Geneva: WHO.
20 Global Coalition on Women and AIDS, WHO. 2004.“Intimate partner violence and HIV/AIDS.” Violence Against Women and HIV/AIDS: Critical Intersections. Information Bulletin Series, no. 1. Geneva: WHO. http://www.who.int/gender/violence/en/vawinformationbrief.pdf
21 Population Council. “The adverse health and social outcomes of sexual coercion: Experiences of young women in developing countries.”  Research Brief. New York: Population Council.http://www.popcouncil.org/pdfs/popsyn/PopulationSynthesis3.pdf.
22 Kristin L. Dunkle, Rachel K. Jewkes, Heather C. Brown et al. 2004. "Gender-based violence, relationship power and risk of HIV infection in women attending antenatal clinics in South Africa." Lancet 363(9419):1415-1421.
23 Shelley Clark, Judith Bruce, and Annie Dude. 2006. “Protecting young women from HIV/AIDS: the case against child and adolescent marriage.”  International Family Planning Perspectives 32(2):79-88.
24 Shelley Clark. 2004. “Early marriage and HIV risks in Sub-Saharan Africa.” Studies in Family Planning 35(3):149-160.
25 International Center for Research on Women. 2003. Cross Generational Sex Fueling the HIV/AIDS Epidemic in sub-Saharan Africa. Washington, DC: ICRW.
26 Nicole Haberland, Erica L. Chong and Hillary J. Bracken. 2004. “A world apart: the disadvantage and social isolation of married adolescent girls.”  Brief based on background paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents. New York: Population Council.
27 Claudia Garcia-Moreno and Charlotte Watts. 2000. “Violence against women: its importance for HIV/AIDS.”  AIDS 14 (Suppl. 3):S 253-265.
28 UNAIDS, Global Coalition on Women and AIDS, Stop Violence Against Women, Fight AIDS, Issue 2 (2005). http://womenandaids.unaids.org/themes/docs/UNAIDS%20VAW%20Brief.pdf.
29 World Health Organization. 2004. Gender Dimensions of HIV Status Disclosure to Sexual Partners: Rates, Barriers and Outcomes. A Review Paper. Geneva: WHO.
30 WHO. 2003. Integrating Gender into HIV/AIDS Programmes. A Review Paper. Geneva: WHO.
31 Sarah Bott, Andrew Morrison and Mary Ellsberg. 2005. Preventing and Responding to Gender-based Violence in Middle- and Low-income Countries: A Global Review and Analysis. World Bank Policy Research Working Paper 3618. Washington, DC: World Bank.
32 David A. Ross, Bruce Dick and Jane Ferguson (eds.). 2006. Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing Countries. UNAIDS Inter-agency Task Team on Young People. Geneva: World Health Organization.
33 Judith Mirsky. 2003. Beyond Victims and Villains: Addressing Sexual Violence in the Education Sector. London: The Panos Institute.
34 Deborah Rogow and Nicole Haberland. 2005. “Sexuality and relationships education: toward a social studies approach.”  Sex Education 5(4):333-344.
35 Fiona Leach. 2006. “Gender Violence in Schools: What’s New?” Brighton, United Kingdom: Centre for International Education, University of Sussex.
36 Karl L. Dehne and Gabriele Riedner. 2005. Sexually Transmitted Infections Among Adolescents: The Need for Adequate Health Services. Geneva: World Health Organization.
37 World Health Organization. 2005. Sexual and Reproductive Health and HIV/AIDS: A Framework for Priority Linkages. Geneva: WHO, UNAIDS; London: IPPF; New York: UNFPA.
38 Rachel Goldberg. 2006. Living Up to their Name: Profamilia Takes on Gender-based Violence. Quality/Calidad/Qualité No. 18. New York: The Population Council.
39 World Health Organization. 2004. Clinical Management of Rape Survivors: Developing Protocols for Use with Refugees and Internally Displaced Persons (revised ed.). Geneva: WHO.