Sexual assault can increase the risk of transmitting HIV. During the assault, abrasions and cuts commonly can occur which allow the entry of the virus. Adolescent girls are particularly susceptible to HIV infection through forced sex, and even through unforced sex, because their vaginal mucous membrane has not yet acquired the cellular density providing an effective barrier that develops in the later teenage years. Those who suffer anal rape --- boys and men, as well as girls and women --- are also considerably more susceptible to HIV than would be the case if the sex were not forced, since anal tissues can be easily damaged, again allowing the virus an easier entry into the body.
Being a victim of sexual violence and being susceptible to HIV share a number of risk behaviours.
- Forced sex in childhood or adolescence, for instance, increases the likelihood of engaging in unprotected sex, having multiple partners, participating in sex work, and substance abuse.
- People who experience forced sex in intimate relationships often find it difficult to negotiate condom use --- either because using a condom could be interpreted as mistrust of their partner or as an admission of other partners, or else because they fear experiencing violence from their partner.
- Sexual coercion among adolescents and adults is also associated with low self-esteem and depression --- factors that are associated with many of the risk behaviours for HIV infection.
- Being infected with HIV or having an HIV-positive family member can also increase the risk of suffering sexual violence, particularly for women. Because of the stigma attached to HIV and AIDS, an infected woman may be evicted from her home.
- Children with no one to care for them, may be forced to live on the streets, at considerable risk of sexual abuse.
STDs are infections that are passed from one person to another during vaginal, anal, and oral sex. They’re really common, and lots of people who have them don’t have any symptoms. STDs can be dangerous, but the good news is that getting tested is no big deal, and most STDs are easy to treat.
Among the various ways of reducing the incidence of both sexual violence and HIV infection, education is important. For young people in care, they need supportive adults who can talk with them openly about sex, sexual health and healthy relationships. All young people need to learn life skills, including how to avoid risky or threatening situations --- related to such things as violence, sex or drugs --- and how to negotiate safe sexual behaviour.
Adults need accessible information on sexual health and the consequences of specific sexual practices, as well as interventions to change harmful patterns of behaviour and social norms that hinder communication on sexual matters. It is important that health care workers and other service providers receive integrated training on gender and reproductive health, including gender-based violence and sexually transmitted diseases such as HIV infection.
For rape victims, there should be screening and referral for HIV infection. Also, the use of post exposure prophylaxis for HIV --- given soon after the assault, together with counselling --- may be considered. Similarly, women with HIV should be screened for a possible history of sexual violence. Voluntary counselling programmes for HIV should consider incorporating violence prevention strategies.