By: Erin Taylor, Program Officer
While the Zika virus is today known for its prevalence in Latin America, it was actually identified in and named after a forest in Uganda in 1947. The virus is mostly spread by the bite of an infected Aedes species mosquito although it can be spread from mother to child during pregnancy, through sexual intercourse, blood transfusions, or through exposure in a laboratory or healthcare setting. There is currently no vaccine and as of August 2017, 48 countries in the Americas have confirmed cases of the virus. Of those infected, it appears that the majority have been women. A 2015-2016 CDC study in Puerto Rico showed that “among all cases of Zika virus disease in nonpregnant persons, 61% were in females; in all age groups females accounted for the majority of cases.” This study observed similar findings in Brazil and El Salvador. This begs the question – why are women and girls more susceptible to Zika than men and boys?
This blog, the first in a series about the gendered aspects of the Zika virus response, will focus on the relationship between Zika and gender-based violence (GBV) including a) how the high rates of GBV, including intimate partner violence (IPV), has the potential to increase rates of Zika infection among women; b) how fear of GBV can prevent women from seeking treatment for Zika; and, c) the possibility for Zika infection to instigate further GBV.
A Pan American Health Organization (PAHO) 2014 comparative analysis of nationally representative data on violence against women from 12 countries in the region found that IPV or violence perpetrated by the husband or cohabiting male sexual partner was widespread in all 12 countries with most surveys showing 25-50% of women having ever experienced IPV. Furthermore, the PAHO study found a positive correlation between IPV and numbers of unwanted or unintended pregnancies. According to Johanna Bond, Professor of Law and Associate Dean for Academic Affairs at Washington and Lee University School of Law:
“Power disparities within intimate partnerships often leave women unable to negotiate contraceptive use. In cases of intimate partner violence, sex is often forced or coercive, leaving women with no ability to insist on safe sexual practices or contraceptive use. The official guidance to delay pregnancy is, at best, ineffectual in the context of widespread violence against women.”
The inability of women to negotiate condom use and IPV in the form of coercive sex increases the probability of women contracting Zika through male-to female sexual transmission, especially as Zika can remain in semen longer than in other body fluids (up to 188 days). The Zika infection not only impacts the woman, but also any potential pregnancies as the virus can be contracted during any trimester of pregnancy and can cause microcephaly, a congenital birth defect resulting in smaller than normal head size for age and sex. It is important to note that GBV is not contained to violence from the husband or cohabiting male partner. According to a 2013 WHO report, Latin America has the highest rates of non-intimate partner related sexual violence in the world and the second highest rates of violence by intimate partners or ex-partners. For example, in El Salvador, gangs often use rape as an initiation for new members or as an intimidation tactic. These instances of violence similarly increase women’s probability of Zika exposure as well as unwanted/unintended pregnancy.
Another aspect of the relationship between GBV and the Zika virus is how fear of GBV can prevent women from seeking healthcare services after suspected infection. An April 2017 Oxfam report highlighted how 73% of women who suspected they had Zika in the Dominican Republic did not seek healthcare services. Women reported that a contributing factor was the fear of being assaulted during transport to the hospital or healthcare facility, especially at night or on public transportation. This report echoes the sentiments of Chilean President Michelle Bachelet, who at the 2016 Women and City Summit, stated “The main problem we women suffer in the world is the insecurity in transport and in public spaces that are supposed to be places of safety and coexistence and that end up being discriminatory and violent places.”
Finally, there is a potential for IPV as a result of the disclosure of Zika infection or of the diagnosis of microcephaly. Although there has not been analysis produced on this topic beyond reports of male partners abandoning mothers of children with microcephaly, one can look at the various reports on the relationship between HIV, a virus that can also be contracted through sexual transmission and impact pregnancy, and IPV. According to a WHO report on violence against women and HIV, IPV is a risk factor as well as a result of HIV infection. The WHO highlights a study of HIV infected women in the US of which 20.5% reported physical harm since being diagnosed HIV positive and a study in Kenya, where 19% of 324 HIV positive women experienced IPV. Furthermore, fear of disclosure can provide another deterrent for women against seeking healthcare services if they suspect infection, a problem highlighted above.
Going back to the question posed at the beginning of this blog – why are women more susceptible to Zika than men? GBV has the potential to make women more susceptible to the Zika virus through IPV and GBV in the form of coerced or forced sex or rape whereby the woman is not able to negotiate condom use to prevent male-to-female sexual transmission of the virus. High rates of GBV and the fact that the Zika virus remains longer and can be transmitted via semen suggests a possible positive correlation between GBV and higher infections among women in Latin America although more research needs to be done in this area before any conclusive statements can be made. It is also important to emphasize that the relationship between Zika and GBV goes beyond infection – GBV can also impact the ability of women to seek healthcare and can also be a product of Zika infection or microcephaly disclosure. As a result, programming and interventions focused on Zika must address GBV throughout all stages – from prevention through treatment and care.
WI-HER is currently working to address GBV as part of its overall strategy to integrate gender into Zika prevention and service delivery programs in Honduras, Peru, Ecuador, Guatemala, Dominican Republic, Nicaragua, and El Salvador under the USAID-funded Applying Science to Strengthen and Improve Systems (ASSIST) Project.