科研之友
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摘要
AIDS prevention in southern Africa serves those who can choose their HIV risks. Promoting abstinence [1], male or female condom use [2,3], microbicides [4] or reduced concurrency [5,6] all presume that beneficiaries will be choice-enabled. Male circumcision [7], quintessentially for choice-enabled males, does not address prevention for those who are coerced to have sex, female or male.Victims of sexual abuse make up a big part of the southern Africa population. One in every ten 每 males and females 每 is sexually abused every year and one in every three has suffered sexual abuse by the age of 18 years [8]. With the exception of post-exposure prophylaxis for reported rape, no preventive strategy addresses these, the choice disabled, who might like to benefit from prevention but who are unable to do so because they do not have the power to make and to act on prevention decisions.If the shortage of prevention approaches for the choice disabled is an equity oversight, it is a singularly dangerous one. The physical risk of HIV infection to victims is increased by lack of lubrication and trauma [9,10]. Champion reported an STI rate of 47% among sexual violence victims compared with 30% in the rest of the population from which they were drawn [11]. HIV prevalence rates are much higher among young women than men: 16% compared with 5% in one South African study [12]. In another, intimate partner violence and high levels of male control in a woman%26apos;s current relationship were significantly associated with HIV infection [13]. In fact dozens of studies have found HIV risk factors associated with sexual coercion and that HIV-infected people experience more sexual coercion than those who are HIV-negative [14]. But these are nearly all cross sectional studies, making it impossible to conclude that sexual violence causes HIV infection.Even so, however one looks at it, victims of sexual violence are a reservoir for infection that is not reached by existing prevention initiatives.The wo
