December 2004

Youth actors rehearsing a drama skit on HIV/AIDS in Dar es Salaam, Tanzania. Photo credit: Jessie Mbwambo

In 2001, researchers from the Horizons Program and Muhimbili University in Tanzania published a disturbing finding. Among women attending an HIV voluntary counseling and testing (VCT) center in Dar es Salaam, young HIV-positive women (under 30 years old) were 10 times more likely to report physical violence with a current partner than HIV-negative women in the same age group. Their research also revealed that HIV-infected women overall reported significantly more sexual violence in their relationships, a greater number of physically violent partners in their lifetime, and a greater number of physically violent events with their current partner.¹

Unfortunately, such findings are not confined to Tanzania. Researchers working in Rwanda, South Africa, India, and the United States have found similar relationships between women’s HIV serostatus and experiences of partner violence.²

These findings raise important questions for programmers and policymakers concerned about controlling the AIDS epidemic among women, particularly young women who are disproportionately affected by the disease compared to young men in countries like Tanzania. What is the pathway by which partner violence and HIV infection operate among couples? What can be done to break the cycle of violence to safeguard both women’s and men’s health and wellbeing?

These questions are being investigated by the Horizons Program and its partners through another round of research in Tanzania. Researchers from Muhimbili University College of Health Sciences, Johns Hopkins University, and the Horizons Program are conducting a three-year follow-on study in Dar es Salaam, Tanzania to evaluate a community-based intervention for young men that aims to change attitudes and behaviors related to violence and HIV/AIDS.

Study Context

In Tanzania, an estimated 17 percent of females ages 15 to 19 years are infected with HIV, compared to only 8 percent of males. This glaring discrepancy is due to a combination of factors, including social and economic circumstances that limit women’s ability to determine when and how sex takes place.

Increasingly, researchers and program implementers are identifying gender as a key determinant of sexual power dynamics, which in turn influences HIV risk. Gender refers to widely shared expectations and norms within a society about appropriate male and female roles and behavior. While specific gender roles differ by culture, males and females across cultures consistently form their belief systems, pattern their behaviors, and initiate intimate relationships during young adulthood. This therefore may be an ideal time to work with youth, particularly males, to challenge unhealthy gender norms about violence and control in sexual relationships, and to mobilize support for HIV-preventive behaviors, such as abstinence, partner reduction, and condom use.

Infidelity, a Trigger for Violence

The new study began in July 2003 with six months of formative research to learn more about violence in sexual relationships among youth. Researchers conducted in-depth interviews with 40 men and 20 women ages 16 to 24, and 14 focus group discussions with similarly aged youth. Informants were recruited from sports grounds, market places, bus depots, and bars.

The vast majority of respondents were single, but almost all of these were currently in an intimate relationship for longer than three months with at least one partner. The majority of men had completed a minimum of seven years of education, while most women had not finished primary school.

Both male and female informants associated violence with infidelity, which is an important risk factor for HIV infection. Most of the young men interviewed had multiple concurrent or serial sexual relationships. Some women also described multiple sexual partnerships, though these reports were far less common than those of the men in the sample.

Men and women described deep mistrust of partners because infidelity is so widespread. “I don’t trust my fellow and he doesn’t trust me…. It’s not easy to trust each other because youth don’t settle down; one may lie to you while he has another woman apart from you,” said an unmarried female respondent.

Men and women described infidelity, real or suspected, as the most frequent trigger for violence in their relationships. “When a woman isn’t faithful there’s a need to use force,” said a married man.

There were also reports of violence by men in response to being accused of infidelity by a female partner. “I was passing on a road. He was with his friend [other partner] and told me not to pass. I insisted and when I passed, I said he was the father of this [pointing to her stomach and referring to her pregnancy]. He attacked and started beating me,” recounted one unmarried woman.

The most common types of violence were hitting, slapping, punching, and kicking. All of the male participants who condoned violence or who reported personal experiences with violence in their relationships also reported that infidelity justifies the use of violence against women. Several young women noted that infidelity is a justification for men’s use of violence against their female partners. Furthermore, men who used physical violence in their relationships were more likely to have forced a partner to have sex against her will.

At the same time, quite a few young men felt that use of violence against women or forced sex under any circumstance could not be justified. “It’s not allowed to make love to a woman by force. This is against the rights of women. To make love needs the consent of the two people and so it’s not allowed anywhere that a man is allowed to force a woman to make love,” said an unmarried man.

Moreover, several male informants described personal convictions toward faithfulness in their relationships, with concern about HIV/AIDS being a primary motivator for maintaining a monogamous relationship.

¹Maman, S. et al. 2001. “HIV and partner violence: Implications for HIV voluntary counseling and testing programs in Dar es Salaam, Tanzania,” Horizons Final Report. Washington, DC: Population Council.

²Maman, S. et al. 2000. “The intersections of HIV and violence: Directions for future research and interventions.” Social Science and Medicine. 50(4):459-78.

© 2004 The Population Council, Inc.

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19 October 2007