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BMJ 2010; 340 doi: (Published 23 June 2010) Cite this as: BMJ 2010;340:c3296

Power, violence, and HIV in women

Agencies charged with controlling HIV should develop strategies to redistribute power within sexual relationships and prevent violence against women, say researchers. Lack of power in relationships and violence were both independently associated with incidence of HIV in a cohort of young poor South African women (incidence rate ratio for women with “low power equity” 1.51, 95% CI 1.05 to 2.17; IRR for women reporting violence 1.51, 1.04 to 2.21). Lack of power accounted for an estimated 13.9% (2.0 to 22.2) of new infections in this study. Violence by intimate partners accounted for 11.9% (1.4 to 19.3).

All 1099 women were HIV negative at the start of the study, and 128 women acquired HIV during follow-up. Analyses were adjusted for age, sexual behaviour, and infection with herpes simplex virus type 2 (HSV2). The researchers are confident that their findings are real, not statistical artefact. The link between power, violence, and HIV in young women may be causal, and trials should be done to test decisively whether empowering young women and tackling abusive male behaviour prevents HIV. These women had a mean age of 18.

Women in violent relationships are in double jeopardy, says a linked comment (doi:10.1016/S0140-6736(10)60971-3). Their partners are more likely than other men to acquire HIV and more likely to transmit the infection. The US has already pledged $30m (£20m; €24m) to design and test programmes to prevent abuse, says the comment. Hopefully more money will follow. Changing entrenched cultural norms that place men firmly in control of sex may be harder.

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