In Country of Sustained Conflict, Two Women Work Toward Peace

Few countries in the world have suffered from such a sustained period of war and conflict as the Democratic Republic of the Congo (DRC). This Central African nation, the second largest on the continent, has endured wars resulting in over five million deaths since 1998. The country remains in a state of near-constant conflict, despite the presence of the United Nations’ largest peacekeeping mission in the world, known as MONUSCO. Women have suffered disproportionately, particularly in regards to sexual violence, with the DRC being labeled the “rape capital of the world.”

Spearheading efforts to protect women and offer services to victims are two lifelong Congolese gender justice activists, Chantal Kakozi and Josephine Malimukono, whose successes are noteworthy in an environment rife with gender inequity and militarization. Kakozi is the co-founder of Solidarité des Femmes de Fizi pour le Bien-Etre Familial (SOFIBEF), which addresses sexual and gender-based violence by raising awareness through media, offering psychosocial support to survivors, and pushing for judicial reform to protect women’s rights. Malimukono focuses largely on women’s economic empowerment, working with Ligue pour la Solidarité Congolaise (the League for Congolese Solidarity) to promote civil and socioeconomic women’s rights.

“We have seen women taking the lead in the peace-building effort in the DRC, especially when it comes to sexual violence and gender-based violence, and also in promoting the respect for human rights. We’ve also seen the emergence of many women-led organizations at the community level,” says Kakozi. This is particularly important, she noted, because of the erosion of social cohesion that occurs in communities where violence against women is so prevalent.

Kakozi, who has done significant advocacy work around the U.N. Security Council’s Resolution 1325, says that in the DRC the implementation of particularly important since women and children are the ones paying the biggest price in the conflict. Legally, both women say, the government has said they are taking steps to ensure women are involves in decision-making. But practically speaking, that hasn’t happened, both also report.

“In the parliament, I know that some women are advocating for political parties to have a 50/50 percent representation, but that is not happening at all,” says Malimukono.

“It’s an ongoing struggle for us when it comes to the implementation of SC resolution 1325, and what is written in our Constitution about women [being represented in Parliament]. We are not seeing that happen at the practical level, and we’re still fighting for women to be able to access decision-making spaces and be able to add their voices in all forums of discussion on peace efforts and reconstruction,” adds Kakozi.

Congolese women are pushing for their voices to be heard, even when they are shut out.

“Women have used their own money – they have saved and used their own money to travel and attend negotiations for peace. I want to give you an example – in 2008, there were negotiations in Nairobi, and we women from North Kivu province, we mobilized, organized, we used our own money, and we took the bus, from Goma to Nairobi,” says Malimukono. Once there, the women were denied entry to the negotiations room.

In spite of these setbacks the women push forward, though security poses a constant threat to their success. In 2008, Malimukono’s group built alliances with several militia groups by engaging with spouses of military leaders to get their message to male militia leaders.. As recently as 2011, they were hopeful of the work they were doing. But the uprising of M23 last year [a rebel group that formed in April in 2012; one of M23’s leaders, Bosco Ntaganda, surrendered last Monday] undermined their work.

Given the increasing number of deaths in detention centers and the recently publicized rash of sexual assaults committed by Congolese army battalions – which, as Malimukono points out are often blended with former rebel group members – trustworthy partnerships in peace building seems more important than ever. Kakozi says of the more recent reports of sexual violence, “It looks like it’s happening much more in places where the Congolese army and other armed groups are fighting each other. The unfortunate thing also is that we all know perpetrators of sexual violence are coming from all layers of society.”

The widespread militarization makes it difficult to address the issue of impunity in these cases. They praise the efforts of some MONUSCO units, Kakozi in particular discussing how they intervened in 2011 to help securitize local tribunals that went after high-ranking military commanders who had committed rapes and sexual assaults throughout the Fizi territory. MONUSCO also covered the expenses incurred by Kakzoi’s organization, SOFIBEF, from hosting many of the rape survivors during the trials so they could testify.

That being said, both women stress the need for more help from the mission in curbing incessant uprisings, which prevent the government from doing work that benefits its population. Kakozi says, “We are wondering about the effectiveness of MONUSCO when there seem to be newer armed groups, that seem stronger and are still perpetrating crimes – so we wonder how MONUSCO is doing its work in terms of preventing and responding to violence.”

“Even if they don’t have a clause about militarization in their mandate, they still have to find a way to help our government to do that work,” adds Malimukono.

Despite these struggles with restricted access to the negotiations room and widespread militarization, the women remain dedicated. Last November, when Goma fell under M23, Malimukono says women from the North Kivu province came together and wrote a letter to Susan Rice, asking her to be the spokesperson on behalf on the women of North Kivu. While they have not received a response, the effort is part of their goal to engage the international community more fully in their struggle.

Malimukono and her team are also currently reviewing the most recent peace accord, signed in Addis Ababa in late February, for its incorporation of the role of women. The fact that it was signed by eleven African nations and guaranteed a special envoy – recently announced to be former Irish President Mary Robinson – is significant, both women said, despite that Kakozi noted it tackles issues that were promised to be resolved in a similar 2008 agreement. If it addresses the decentralization of power to the grassroots level, she also wonders how that might be accomplished without the explicit incorporation of women, whose leadership is most evident at the community level. Of significance, Malimukono says that on the same night the peace deal was signed, the there were killings in Rushuru and Kitshanga. Both women await the effectiveness of the accord, which they say will be evident soon enough on the ground.

When asked for her strongest statement to the global community as they ask for support, Malimukono said, “My message remains the same. The militarization – [ending it] is the only way out. We are not free.”

Originally published in MediaGlobal.

Uganda-Ireland Partner Against Domestic Violence

One of the recurring themes at the 57th CSW has been the success of integrating multiple sectors in fighting violence against women in developing countries, and Uganda is no exception.

The March 7 event at United Nations headquarters, “Mobilizing Communities to Prevent and Respond to Violence against Women – Lessons Learned from Uganda,” introduced attendees to two partnerships between the Republic of Ireland and Uganda. The Center for Domestic Violence Prevention and Irish Aid, and the Catholic Church in Uganda and Trócaire, respectively, work together to combat domestic violence in the east African nation.

During the talk, Tina Musuya, the director of CEDOVIP, outlined her organization’s phased-in community mobilization approach against domestic violence: CEDOVIP trains community activists speak with men in local gathering places, like bars, about the traditional roles of men and women and the implications of men’s use of power over women, slowly changing the social norms that have made violence against women acceptable. This is essential in settings that lack infrastructure and services, explained Musuya.

CEDOVIP benefits specifically from a partnership known as GoU-Irish Aid, the Government of Uganda ad the Irish government’s program for overseas development.

Coordinating the discussion was Ireland’s Minister of State for Disability, Equality and Mental Health, Kathleen Lynch.

Lynch told MediaGlobal, “The difficulties we have in terms of culture and tradition are the biggest difficulties.”

In Uganda, where 40 percent of the population identifies as Catholic, engaging the religious community is essential, said Lynch. “It is incredible that when you manage to convince the champions for all sorts of other things within communities, how quickly things then start to move. And how quickly people start to realize and recognize the benefits there are in a change in their attitudes.”

Tackling this is Trócaire, the Catholic Church in Ireland’s overseas development agency. Members of the organization work with high-level church leaders, including bishops, throughout Uganda, in advocating against domestic violence.

In a survey by the agency, 72 percent of Ugandans who responded had seen anti-domestic violence education materials in their church and 88 percent had heard their church leader speak out against it. Because of these efforts, 45 percent of Ugandans surveyed had spoken with their family about harmful effects of domestic violence, 53 percent decided to not engage in violence in their homes, and 37 asked a man they knew was engaging in domestic violence to stop.

Sean Farrell, Trócaire’s country representative in Uganda, told MediaGlobal about the work still to be done. “The biggest challenge we face in the program is, having raised the levels of awareness on the negative effects of domestic violence, we now need to respond to the increasing demands for response at the local level.”

“We have already started planning different interventions with partners looking at response and the testing of potential solutions are already underway, and will inform the program going forward,” he said.

Originally published at MediaGlobal.

Kiribati Tackles Domestic Violence Across More than Twenty Islands

For a country comprised of 33 islands in the central tropical Pacific – 21 of them inhabited – Kiribati’s population is one of the smallest at just over 100,000 people.

Yet this small developing nation has struggled as much as larger countries with the problem of violence against women.

At a UNFPA hosted side event at the 57th CSW, “The Role of Data in Addressing Violence Against Women and Girls,” Anne Kautu, Kiribati’s Women’s Officer in the Ministry of Internal and Social Affairs, spoke of the challenges of data collection and utilization in her country when used to combat violence.

“The problems with the isolation of the islands, of getting to those islands to get the data and also getting the information back to disseminate it – because they need that, they require information [to come] back – that is the main problem at the moment that we are having,” Kautu told MediaGlobal.

Kautu explained that Kiribati was one of the first countries in the Pacific to look at violence against women in a coordinated fashion. Until a 2008 survey conducted with the help of UNFPA, and co-funded by Australian Agency for International Development and the Secretariat of the Pacific Community, no data existed on the prevalence of domestic violence on the island. The study showed that 68 percent of girls and women aged 14-49 years experienced physical or sexual violence at the hands of a partner. The data allowed officials to tailor their responses against abuse.

The Kiribati Family Health and Support Study, a title given to protect the content of the questions, had trained individuals to privately interview the woman or girl randomly selected from the study’s 2,000 households – an essential element of collecting data about domestic violence. Results omitted names of islands or villages to protect the women who shared details about their communities.

As a result of the study, the Kiribati government is currently drafting anti-domestic violence legislation, Kautu said. Government task forces were set up to coordinate and monitor gender-based violence initiatives and police training incorporated curriculum about addressing domestic violence. Standard operating procedures, implemented on even the smaller islands, were established so all sectors – health, education, law enforcement – had increased awareness across the board, Kautu also explained.

Currently, the developing island nation is currently working on a United Nations coordinated initiative addressing capacity building and support for victims, Kautu told the event’s attendees.

“What we’ve done at the moment is tried to train – we have focal points in the outer islands, so we try to get them in and do training with them,” said Kautu to MediaGlobal. “Also, if we need an extra bit of data, we try to get them to be able to do that.”

Speaking to a particular development struggle, she added, “At the moment our country is trying to get Internet installed to all the outer islands, so slowly we have a few islands we can contact. But that’s always a problem, lack of communication and systems. The main way now is getting information through the radio, and using the focal points and existing structures rather than us going out there, because it is very costly.”

Originally published at MediaGlobal.

The Health Implications of Sex-Selective Abortion

Anyone paying attention to the election this past year—or, frankly, even those who tried to avoid it—has at least a superficial understanding of what the abortion rights argument looks like in the United States.

But the long-term population health outcomes of abortion are generally not considered as part of the argument. That’s because when a woman terminates a pregnancy in America, the decision is rarely made based on the sex of the fetus. However, in many developing and growing countries, that is at the crux of a woman’s decision—and the significant shift in gender representation is changing their population health status, and perhaps even the picture of the burden of disease. One of the countries in which this is most evident is China.

Interestingly, and likely unsurprisingly for those invested in a woman’s right to choose, we see that sex selection is itself a manifestation of the gender inequities in economic and social standing in many of these countries—not so different than many of the reasons cited by women in the U.S. seeking abortions. So while the outcomes of sex-selective abortion abroad may pose different problems, it should be acknowledged that the need for abortion is rooted in similar circumstances around the globe.

This issue is addressed by one of the few research studies to explore the ramifications of China’s one-child policy, published in the New England Journal of Medicine (NEJM). China is a prime example of the increase in the male population due to women terminating pregnancies that were discovered to be female, a practice deemed illegal but nonetheless carried out widely.

The ratio of male to female live births in industrialized countries generally ranges from 1.03 – 1.07 (103,000 – 107,000 boys born for every 100,000 girls born). In China, since the inception of the one-child policy, the ratio has risen from 1.06 in 1979, to 1.11 in 1988, to 1.17 in 2001 (117,000 boys born for every 100,000 girls). Some regions show even higher numbers, with the Anhui, Guangdong, and Qinghai provinces reaching ratios as high as 1.3 (meaning that for every 130,000 boys born there are 100,000 girls born).

There are distinctions between urban and rural areas as well, since couples in rural provinces are generally allowed to have more than one child. The sex ratio comes in high at 1.13 for the first birth in urban regions, since one child is usually all a couple will be allowed. It peaks at 1.30 for the second birth (130,000 boys born for every 100,000 girls), which if couples are allowed to have, the preference is clearly male. This contrasts markedly with rural areas, in which the ratio for the first child is normal at 1.05 (105,000 boys for ever 100,000 girls), indicating that sex-selection is not a huge issue since rural couples are allowed a second child. However, the ratio sharply increases at second births, reaching 1.23 (123,000 boys for every 100,000 girls).

(Recently, China has noted that their thinking may be changing in regards to the one-child policy, with the possibility of extending the two-child allowance to everyone.)

This has unsurprising impacts on the health of the population. Some of the more pressing concerns noted by researchers that they articulate as a result of there being fewer women to marry and partner with include mental illness and socially disruptive behavior issues in men. Recently, studies have begun to document these trends, underscoring the significant long-term consequences of this gender imbalance. One recent study showed that even after adjusting for age, education, and income level, unmarried men in China were more likely to have lower self-esteem, higher depression, higher aggression, and more likely to have suicidal thoughts or actions than married men—at statistically significant levels.

The findings of another study, comprised of interviews conducted with people in China born just before and just after the implementation of the one-child policy showed similar results. Researchers found that the policy itself had created a less trusting and less trustworthy population, who are more risk-averse and less competitive, more pessimistic, less conscientious and even more neurotic. The impact of anti-social behaviors in a predominantly male population seems to be shifting the mental health profile of the entire nation.

More concerning as a result of sex-selective abortion and a decrease in the number of women available for marriage is the increased in trafficked women, and the subsequent increase in the number of commercial sex workers. Researchers note that a broad range of high-risk sex behaviors are often demanded by the surplus male clients, increasing the incidence of HIV and other sexually transmitted infections. This alone has been noted as having a likely significant affect on the spread of HIV throughout China, posing a major national public health threat for the country.

The health implications aren’t limited to reproductive health and mental illness. If it is in fact accurate that most of the children living in China’s orphanages are girls, it is unclear how the future healthcare needs of these girls as they age into women will be handled and by whom, with a rapidly growing aging population already relying heavily on the significantly less populous younger generation.

Critics of abortion—sex-selective or not—often cite mental health issues and resulting regret as major reasons why women should not get abortions. So what about the health status—physical and mental—of the women who have these procedures?

Recently, public health researchers have worked to create the first body of scientific literature answering these very concerns. A group of University of California, San Francisco researchers at the group Advancing New Standards in Reproductive Health (ANSIRH) recently presented some of the findings of their longitudinal research known as the Turnaway Study. They found that women who were seeking abortions and who were denied were more likely to have slipped into poverty a year later, more likely to be on public assistance, and less likely to have a job. There was no correlation between abortion and drug use, or abortion and depression.

Abroad, given that sex-selective abortion is usually a procedure performed by private providers due to legal restrictions, tracking this kind of information is extremely difficult. And while this research was limited to the experiences of American women, the results showing decreases in economic status and increases in reliance on some form of public assistance, if available, certainly seem like potential outcomes in countries with worse statistics in terms of gender equality and economic growth.

Is there a solution? The gender imbalance, and therefore the changing prevalence of certain diseases, will not balance out unless sex-selective abortion is essentially made impossible, but it is imperative that the issue of sex-selective abortion not become a rallying cry to end the right to the procedure overall for women. As seen by the work done by researchers in China and the findings by UCSF researchers, the issues surrounding the choice to have an abortion, whether in the United States or abroad, are complex and inextricably linked to the economic and social circumstances of the women.

To tackle the burgeoning disease differences emerging from the sex-selective abortions, the work must begin by tackling the fundamental issues regarding the reasons why women seek these abortions in the first place.

Originally published at The 2×2 Project.

How the Female Condom Can Help the Women of Chile

Huge strides have been made in the understanding of how behavior drives HIV-infection. Notably, much of the coverage of how social constructs (and contexts!) contribute to the epidemic revolves around prevention education in the scope of proper – male – condom use. No doubt, comprehensive interventions in this arena have been instrumental in curbing infections. But it’s worth noting the limitations of this approach given the changing face of the virus.

Chile, a country with a prevalence of 28,963 notified people living with HIV (and an estimation of about twice that actually living with the virus), like many countries, is seeing an increasingly feminized epidemic.

Unfortunately (and perhaps unsurprisingly), most prevention and education frameworks neglect to take into consideration why this is.

In many cases, and specifically in Chile’s, women are contracting the virus via their husbands in relationships presumed to be safe and monogamous, and in which the negotiation of condom use on the part of the woman immediately presumes she is adulterous.

More nuanced approaches to prevention need to be undertaken with the understanding of how relationship dynamics – and the social climate in terms of perceptions of HIV+ individuals – contribute to the spread of the virus.

The International Community of Women Living with HIV/AIDS Chile is doing just that.

ICW Chile primarily works with women who contracted HIV from their husbands, have been subsequently widowed due to the illness, and are now attempting to forge their own way. This is difficult in a place where the stigma of HIV weighs heavily enough for most women to expect job termination if they disclose their status. While treatment is readily accessible – the Ministry of Health provides ARTs for all those in need, an initiative not to be understated – the social ramifications prompt many women to remain silent.

An organization dedicated to education, awareness raising, commemorations, and training in areas of women’s sexual and reproductive health and empowerment (and, importantly, with a board made up entirely of HIV+ women), they are embarking on an undertaking addressing the need for women to be able to protect themselves – by providing them with female condoms.

Female condoms aren’t entirely absent in Chile – but they can hardly be considered accessible when only one organization in Santiago is selling them – at $6 a piece. Of importance to note, they are desired – one organization that represents 2,000 sex workers in Santiago has shared that of the approximately 70 women a week coming to them for contraceptives and protection, female condoms are consistently requested.

The reason? They are often able to negotiate male condoms with clients, but not with their partners or husbands, putting both parties at risk. Female condoms can be inserted before sex by the woman herself, which precludes a negotiation conversation that comes with the use of the male condom (and is often ultimately refused).

This is where ICW Chile comes in.

Female Condom

The ICW Chile has already forged some of the essential partnerships to get this initiative off the ground. Groups like Fundacion Margen (a sex workers’ rights and advocacy group), in addition to their own five sub-regional teams around the country are prepared to help with raising awareness for the campaign as well as actually distributing the female condoms. Two HIV/AIDS organizations and two transgender health groups are also supporting ICW Chile’s efforts, and the Santiago Chapter of the National Women’s Service (SERNAM) has also offered their assistance. Creating a robust community of like-minded organizations, with resources and ties to mobilize is no doubt important here – but without the product, these connections run the risk of withering.

Luckily, one gift that’s helping them get off the ground is from the Female Health Company, one of the two primary female condom manufacturers, which recently pledged to donate 1,000 female condoms to the campaign, an instrumental and desperately needed move.

But it’s not enough.

When you reflect on the numbers above, it’s clear that ICW Chile needs our help in procuring the goods – and we’re going to make it as easy as possible to assist!

The goal is to distribute 30,000-35,000 female condoms in the next six months, and reach out to 60,000 people educationally. Showing a dedicated interest to the Chilean government, by region, and indicating how many people would utilize the female condoms if they were accessible (financially as well as physically!), could help prompt a firmer commitment from the Ministry of Health to provide female condoms on the scale of male condoms.

They’ve set up an Indiegogo page that details what your gift can provide, what you’ll get in return, and some of the important facts we’ve highlighted here. (I’m donating in the name of my mom for Mother’s Day!) They’ve gotten some buzz already, and this is a bandwagon worth jumping on.

I urge you to check out their Twitter and Facebook pages as well, and share widely with your networks. We’ve all seen what social media networks and crowd-funded projects can achieve, and I can think of no better project right now needing our crucial support.

Fostering Social Entrepreneurship in Rwanda

This post also appears on the Spark blog. It serves as a profile of one of Spark’s most recent grantees, an organization I happily support, The Komera Project.

It’s not every day that you get to see the foundations of graduate school flourish into a burgeoning non-profit organization halfway across the globe. So, when one of my close friends from graduate school told me in 2008 that she was starting an organization in Rwanda where she had been living, I was of course eager to support her. And the more I learned about Rwanda and the work her organization was undertaking, I became invested in seeing its success grow.

Named The Komera Project (in Rwanda the word “Komera” means “be strong, have courage”), Margaret Butler developed the idea to start the group over the course of her many runs through the Rwandan countryside. She noticed that sometimes girls from the local villages would jump in and join her on these runs until she realized that her behavior wasn’t going to be considered socially acceptable. Combined with the fact that Margaret was seeing first hand how most girls did not make it to secondary school, she decided to host a girls-only ‘fun run’ one day to promote the education and rights of these girls. As they started off, supporters shouted “Komera!” to the girls, and the group was born.

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Working with the local government, schools, and some on the ground staff from Partners in Health based in Rwanda, Margaret steered the first of Komera’s 10 girls onto their fully funded secondary education path. Komera has since grown to over 60 scholars, and has expanded their reach beyond just funding the girls’ schooling. They now also provide mentorship, a leadership program, and now a social entrepreneurship program.

Some context and understanding of Rwanda is essential to underscore how significant this is. Only 17% of girls in Rwanda go to upper secondary school (high school). 87% of the country lives in rural areas. All Komera scholars are from these rural areas and live on about $1 a day from families working as subsistence farmers or tin miners – so these girls would be farming, mining, and/or working in their households if not in school. Komera focuses on supporting the girls in grades 10-12, since the majority of girls begin dropping from school in grade 10. Komera never takes on a scholar unless they have the cash to fully fund them for those three years – this cost is $500 a year for tuition, uniforms, boarding, all school supplies, and personal supplies like hygiene products.

By 2010, the focus at the Komera Project had shifted from primarily scholarship to figuring out how to keep the girls in school and create a real Komera community, and that’s when the themes of mentorship and leadership came into play.

The transition into boarding at school can be really difficult for the girls, especially since they are spread between 13 different schools. In Rwanda, once you have the funds to pay, the local government decides what school you will go to, so while Komera would prefer all the girls to be in the same 4-5 schools, that isn’t possible. However, they are all in the same district (there are 30 districts in the country total).

To help combat some of the difficulties around these transitions, Komera provides school-based volunteer mentors for all the girls – female staff or teachers who meet one-on-one with the scholars every week. They actually use curriculum to cover topics like health education, financial literacy, what their rights are as women in Rwanda, to any personal concerns they may be having. The girls also meet with the Komera social worker (one of only two paid Komera staff members!) regularly when she visits each school throughout the year. Their next goal is to launch a university mentoring program, and they have started to do some outreach to universities in Kigali (the Rwandan capital) to see if there is interest among Rwandan university women to mentor these girls.

Leadership is another key component of the Komera Project. The Komera scholars attend Leadership Empowerment camp during their month-long summer break, where they take part in the now-annual Girls Fun Run and participate in workshops focused on topics like English-speaking skills, how to use computers, and sex education. These have been essential for the girls, because these month-long breaks can be vulnerable times for the girls who go back home. Most stay with extended family, get pulled back into working with the family and can potentially be convinced that they need to leave school – especially true for the nearly 20% of girls who come from families who don’t fully support their education efforts.

In regards to the new Social Entrepreneurship Program that Spark is helping to support, most recently the idea of sustainability has come up – how does Spark keep the momentum of being a Komera Scholar going once the girls graduate from secondary school? This was particularly pressing since 15 girls will be graduating in 2013.

The girls had been requesting a social entrepreneurship type training for some time – wanting to learn the skills necessary to starting and maintaining a business, a non-profit or grassroots venture. When asked about social entrepreneurship training, all the girls said that they had never even considered how they might be able to give back to their community or considered themselves leaders, and they were really excited about the idea of learning how to create something to benefit and incorporate their community.

The winter break, in November-December hasn’t been able to be filled by Komera because they haven’t been able to fund camps both in May-June when they have the leadership and empowerment camps as well as during the winter months. Finding funding for this new social entrepreneurship training became essential, as well as a way to get a tested and evaluated curriculum in their hands.

A local Rwandan group, Global Grassroots, has been offering entrepreneurship, business training, and skills-based workshops for women in Rwanda since immediately after the genocide – and they’ve been doing so pretty successfully. They have agreed to modify their program for a weeklong intensive program for teen girls, as well as moderate the weekly follow-ups. This will be called the “Girls Academy for Global Conscious Change.”

The girls will work in groups of ten, separated by interests – they’ll select a topic they want to focus on, like health, education, water, and they will learn how to craft a mission statement, develop a program goal and implementation plan, and how to write and follow a budget. They will be given small grants of $50, which will be managed by the social worker and through each phase can retrieve part of the money for supplies, then implementation or advertising. The goal is to have them create these mini-organizations and incubate them throughout the school year, with the hope of maintaining it beyond that year, turning it into a profitable business, and growing it beyond their immediate school community.

When I heard that this was their well thought out plan, I thought Spark would be the perfect place for Komera to seek funding help to cover the costs of the girls supplies, food, transportation, and personal supplies throughout the training. The perfect way to blend two of the organizations that are most dear to me.

The Komera Project embodies the exact kind of values and practices that Spark looks for in grantees, and I look forward to what these budding entrepreneurs are up to in just a few years.

Check out their Facebook and Twitter pages, and visit their site to learn more about Komera and meet some of their scholars.

Retraumatization: The Increased Risk of HIV Transmission among Abuse and Assault Victims

While the transmission of HIV and the causes of HIV-related death are actually more complicated—and even more nuanced—than public discussion would let on, a few presumptions about it remain fairly accurate.

For women who are marginalized in their communities, who are victims of abuse or assault, and who are economically or socially dependent on a spouse, the risk of them contracting HIV or dying from multiple complications from AIDS is simply greater than that of women fortunate enough to not be subjected to these circumstances. Take these scenarios:

  • The power dynamic in an abusive relationship may prohibit women from being able to protect herself from a partner who refuses to wear a condom
  • Women in poverty and those who need to rely on a partner for financial support may have greater risk of comorbid infections than women of economic independence. They are less likely to have the health insurance and relationship with a healthcare provider that would support HIV testing and provide the essential—and expensive—HIV medications to ensure a healthy life and lower the risk of co-morbid infections
  • People without social support, living in fear of what an HIV-positive diagnosis means, or those who have reason to fear stigma around personal behavior when seeking treatment are less likely to know where to access treatment or seek it out because of that fear, stigma and lack of support

Common sense would seem to support these statements. But until recently, the pathways of infection were not always clear, and while the conclusions above seemed certainly reasonable, specific data to support them had been difficult to collect. Two recent studies led by a UCSF-researcher have changed that. One synthesized what is known about PTSD and exposure to trauma among HIV-positive women, and the other explored the root of this relationship.

The results were remarkable. HIV-positive women had between two and six times the rates of childhood and adult physical and sexual abuse, and PTSD. The snapshot of risk behaviors among HIV-positive women was sobering:

  Sample size Number (%) of participants with each characteristic
Sexual activity
Any sexual activity in the past 6 months 113 61 (54.0%)
 With a main partnerMedian number of main partners (if any) 61 43 (70.5%)1 (range 1–2)
 With casual partnersMedian number of casual partners (if any)a 61 23 (37.7%)1 (range 1–25)
Sex with any HIV negative or unknown serostatus partners (if sexually active) in the last 6 months 61 51 (83.6%)
 Disclosure of HIV status less than all of the time with these partners 51 29 (56.9%)
 Using condoms less than all of the time with these partners 51 31 (60.8%)
 Detectable viral load 51 30 (58.8%)
 Disclosure of HIV status less than all of the time, and using condoms less than all of the time, and a detectable viral load 51 16 (31.4%)
Substance use (any, recent)
Cigarettes 110 71 (64.5%)
Alcohol 111 50 (45.0%)
Marijuana 111 39 (35.1%)
Crack/cocaine, heroin, and/or methamphetamines 111 45 (40.5%)
IDUb 112 11 (9.8%)
 IDU who share needles 11 5 (45.5%)
 IDU who have a detectable viral load 11 6 (54.5%)

aOne participant had a very high number of sexual partners (N = 250) and was excluded from the analysis; b IDU injection drug use; ©2012 Machtinger, et al. (retrieved December 16, 2012.)

There were striking findings in terms of both HIV treatment failure and the impact of the above risk behavior in these women, bringing us the first real data hoping to explain this relationship. Those who suffered from recent trauma had more than four times the odds of anti-retroviral (ART) failure while on treatment than HIV-positive non-victims—and this was seemingly not due to self-reported poor adherence to the medication. One potential explanation offered by the study authors is that abuse and trauma interfere with an individual’s ability to stay on a consistent medication schedule, which is essential for control of the virus. Other studies have confirmed that abuse manifest as control, in which a male partner prevents his HIV-positive female partner from accessing services at a clinic out of fear that the stigma of HIV would be attached to him.

HIV-positive victims of recent trauma also all reported experiencing what the study calls “coerced sex,” and have over three times the odds of un-traumatized women of having sex with HIV-negative or status-unknown individuals. They had greater than four times the odds of inconsistent condom use, potentially exposing those casual partners to the virus. While high-risk sex behavior is always a factor in HIV-transmission, HIV-positive individuals who adhere consistently to HIV treatments are significantly less likely to infect HIV-negative partners during sex. So the lack of treatment adherence among traumatized HIV-positive women combined with the risky sex behavior is a great concern.

Interestingly, these figures were only significant among women who experienced recent trauma, indicating that the ongoing—not merely one occurrence—circumstances of abuse are the key to the relationship between HIV-infection and HIV-related illness and death. This can actually be seen as a snapshot of hope—if we are able to offer abuse, assault, and PTSD victims the appropriate support to heal from the experiences, we may be able to weaken the HIV/trauma relationship.

These studies draw a clear line between victims of assault and trauma and both the spread of HIV within their communities and the increased risk of HIV-related illness and death. But interestingly, the risk goes much deeper than these socioeconomic circumstances. The conversation around HIV transmission is generally split into one of two categories: social and behavioral—risky activity, injection drug use, the prejudicial judgment of sex workers; and medical and clinical—how the virus infiltrates the immune system, takes over cells, and how it is and isn’t suppressed with antiretroviral medications. What isn’t usually discussed is the possible combination of these two categories and how together they create a perfect storm for potential infection.

Recent studies have shown that those individuals suffering from PTSD had significantly higher rates of cytomegalovirus (CMV) in their body. A virus that is found in between 50%-80% of adults in the United States, CMV remains largely undetected—latent, suppressed, unproblematic—in healthy individuals. It’s also seen as a marker of immune health and function, and of the body’s ability to control potential infections. Given that 30% of American women with HIV/AIDS have PTSD (five times the national average), the potential relationship between their HIV-status and even further compromised immune function could lead to a myriad of comorbid infections and premature death. Other research has also shown that additional biological mechanisms may prevent ART-treatment from being as effective as possible, including high cortisol (stress hormone) levels. Not only do these victims have to fight against abuse and assault, they have been left without the essential social support to decrease risky behaviors that may expose others to the virus, and their own bodies are in revolt.

Collecting this kind of information is difficult. It requires consistent and positive communication between women and providers, unobstructed access to medical care and uninterrupted ART treatment, and of course, in this example, most importantly—removal from an abusive environment.

The combination of immunosuppression due to PTSD, the detectable rates of HIV in traumatized women whose viral loads are not suppressed by consistent anti-retroviral treatments, and the concurrent risk behaviors of abused HIV-positive women, all contribute to higher rates of HIV-infection in communities, as well as the potential for co-morbid infections and HIV-related death. Until these women are able to find the essential social and community support, free from abuse and trauma, and until their access to care and preventative measures are fully realized, the relationship between trauma and HIV will only deepen.