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For example, more than 80% of married 15 to 19 year-old women in Senegal, Niger, Burkina Faso, Côte d'Ivoire and Cameroon do not have the final say on their own healthcare.7 These inequalities are more severe for marginalised women, including female sex workers, transgender women, women who inject drugs, migrant women and women with disabilities who are also at a heightened risk of discrimination and violence.8 HIV disproportionately affects women and adolescent girls because of their unequal cultural, social and economic status in society.
However, such violence also reinforces and perpetuates gender inequality at both societal and relationship levels.30 Studies have shown that increasing educational achievement among women and girls is linked to better SRH outcomes, including lower rates of HIV infection, delayed childbearing, safer births and safer abortions.3132 In many settings, cultural and social norms mean that girls in families affected by HIV are the ones who drop out of school to care for sick parents or generate income for the family.33 Less than one in three girls in sub-Saharan Africa are enrolled in secondary school.34 The United Nations Children’s Fund estimates that 18.8 million children in West and Central Africa are not in school.
Girls are particularly disadvantaged: just over half (54%) of young women in the region are literate.35 The education and empowerment of women and girls is also fundamental to preventing intimate partner and gender-based violence.36 An analysis of data from 44 countries found that completing secondary education significantly reduces a woman’s risk of intimate partner violence and that a girl’s education is more strongly associated with reduced risk of partner violence in countries where spousal abuse is more common.37 However, in many places schools are not guaranteed safe learning environments for young women.
Many of those interviewed, while showing certain ambivalence, justified their actions on the basis that the women in question had not been `forced'.
Coy argues that broad-based strategies that seek to challenge dangerous male attitudes and actions towards women need to complement standard criminal justice responses.
Studies by Plan International in Senegal, Mali, Ghana, Guinea Bissau, Togo, Liberia and Uganda found violence in primary and secondary schools, while varying across countries, to be prevalent.
The research found that inappropriate sexual relations between male teachers and female students, including transactional sex to cover school fees and the cost of school materials and sex for grades to be common.
Girls who marry as children are more likely to be beaten or threatened by their husbands than girls who marry later, and are more likely to describe their first sexual experience as forced.
As minors, child brides are rarely able to assert their wishes, such as whether to practice safer sex.25 These factors all increase HIV risk.
For example, a study of African couples found that women who had been exposed to intimate partner violence in the previous three months were 50% more likely not to adhere to pre-exposure prophylaxis (medication taken by someone who is HIV negative before exposure to HIV to lessen the likelihood of transmission, otherwise known as Pr EP) than women who had not experienced it.22 An assessment of Demographic and Health Survey results in ten sub-Saharan African countries in 2015 found physical and emotional intimate partner violence to be strongly associated with HIV infection in women.23 Despite 15 of 19 countries in East and Southern Africa having laws against domestic violence and sexual offences, more than 30% of ever married or partnered women (aged 15–24 years) experienced physical or sexual violence from a male intimate partner in the previous 12 months in Uganda, Tanzania, Zambia and Zimbabwe.
This figure was 50% among girls aged 15 to 19 years in Namibia.24 Some of the intimate partner violence experienced by young women occurs within the context of child marriage.