Comparative Analysis of Gender Based Violence Knowledge and Attitudes among HIV-Positive and HIV-Negative Youths in Zimbabwe

Literature Review

Globally, statistics on gender-based violence shows that 35% of women worldwide have experienced either physical or sexual intimate partner violence or non-partner sexual violence WHO Worldwide, 13 % of ever-married or partnered women (aged 15 to 49 years) have experienced physical and/or sexual violence by an intimate partner WHO. Studies from Togo, Uganda and Zambia found a higher risk of HIV infection among women reporting various forms of intimate partner violence [1, 2]. Research, however, indicate that many young women and men continue to justify these norms, such as violence against women by intimate partners [3]. Across 36 countries with available data, the percentage of young women (aged 15 to 24 years) who agreed that a husband is justified to strike or beat his wife for at least one specific reason ranged from 3% in Colombia to 80% in Afghanistan [3]. Similar attitudes were held by young men of the same age [3].

Gender-based violence (GBV) is a major challenge despite most countries having legislation in place to respond to it [4]. Research indicates that the prevalence of GBV ranges from 50 per cent to 86 per cent over the course of a woman’s life time, and intimate partner violence from 49 per cent to 69 per cent [5]. The Demographic and Health Survey (DHS) reports intimate partner violence at 35% in Zimbabwe, 34 % in Malawi, and 20% in South Africa. Domestic violence arises from deeply held patriarchal belief systems and norms which perpetuate the idea of women having an inferior social status, driven by toxic constructions of masculinity that engender notions of superiority hence sanctioning violence within relationships and families [5]. Moderate levels of GBV have been reported in Zimbabwe for instance, National Baseline Survey on Life Experiences of Adolescents revealed that about a third of females aged 18-24 years reported experiencing some form of sexual violence before the age of 18 [6].

Ever Heard of Gender Based Violence

Findings demonstrate that knowledge about GBV is moderate among the youth. Approximately 65% of the youths reported ever hearing of gender-based violence (Table 1). It is important to note that YLHIV were more likely to have ever heard of gender-based violence, 71%, compared to HIV negative youths, 53%. As expected, there is a positive relationship between age and ever hearing of gender-based violence. Older youths aged 20-24 years were more likely to report ever hearing of gender-based violence, 74%, compared to those aged 15-19 years, 56%. While 61% and 82% of YLHIV aged 15-19 years and 20- 24 years, respectively, reported that they ever heard of gender-based violence, this compares to 46% and 59% of their HIV negative counterparts. Females were also more likely to report ever hearing of gender-based violence, 65%, compared to males, 64%. This relationship is the same across youths of different sero-status, albeit the YLHIV reported higher levels for instance, while 71% and 70% of YLHIV for females and males, respectively, reported ever hearing of gender-based violence, this compares to 55% and

49% for HIV negative females and males respectively. Ever hearing of gender-based violence increases with the level of education, while, 51% of the youths with secondary school education reported ever hearing of gender-based violence, 71% of youths who completed college reported the same. However, this relationship is more marked among YLHIV. For instance, while 57% of YLHIV who completed secondary education reported ever hearing of gender based violence, 78% of those with college education reported the same. On the other hand, 33% and 59% of HIV negative youths with the same levels of education reported the same. Ever hearing of gender-based violence is related to marital status; for instance, while 80% of the never married youths reported ever hearing of gender-based violence, 61% of the ever- married youths reported the same (p<0.0001). Interesting to note is that never married YLHIV were more likely, 65%, to have ever heard of gender based compared to their HIV negative counterparts, 53%. Ever hearing of gender-based violence is related to religion; for instance, while 70% of Christians reported ever hearing of gender-based violence, 57% of the African traditional religion youths reported the same. It is also interesting to note that a sizeable proportion, 61%, of persons with disabilities reported ever hearing of gender-based violence. This is comparable between the two groups with a bias towards YLHIV, 64% compared to HIV negative youths, 29%. Youths in urban areas were more likely to report ever hearing of gender-based violence, 69%, compared to rural youths, 58%.

Source: N=600. Table 1: Percentage distribution of ever hearing of gender based violence by demographic and socio-economic characteristics.

Sources of Information about Gender Based Violence

The study shows that the majority of youths, 80%, reported radio as the major source of information about gender-based violence (Table 2). This was fairly comparable between YLHIV and HIV negative youths, albeit with a slight bias towards the YLHIV, 82%, compared to 76%. A sizeable proportion of youths, 38%, indicated church as the source of information about gender-based violence; however, HIV negative youths were more likely to report the church as their source of information, 45%, compared to YLHIV, 36%. Adolescents maintained that the radio was a good source of information for because they are not directly facing someone who can actually judge them. Note this remark from an HIV positive girl in one FGD: I prefer the radio as a source of information because I believe that the information is vetted thereby making it reliable source. I especially like it as an HIV positive girl because there is no one to judge me nor accuse me for seeking information which is perceived as undermining my guardians. We HIV positive people live in a mobile court with judges all around us.

While 15% of youths reported newspaper as a source of information about gender-based violence, this was fairly comparable between YLHIV and HIV negative youths although with a bias towards HIV negative youths, 14% compared to 18%. However, it is important to note that NGOs were a popular source of information about gender- based violence among YLHIV, 87% compared to 0% among HIV negative counterparts. As noted elsewhere, NGOs are generally appreciated by YLHIV especially because they are trained to be neutral in their perceptions and conversations with HIV positive people, a quality which is generally lacking in the general public, including guardians. As remarked in a FGD with HIV positive girls: I really like the lady from X NGO who are working in our area. You can ask her any questions and she will not even show a sign of disapproval. Instead, she often commends me for asking questions. And when she cannot answer the question she will always promise a response when next she visits. She is prepared to go and look for information from you.

One director of an NGO maintained that his most important goal is to have his NGO fill the gap between YLHIV and their guardians/parents. He argued that YLHIV are in a double jeopardy. Note his remark in a key informant interview: Youths are generally deprived of information because the community is generally against the idea of rights assuming that educating youths on rights will make them rebellious. And YLHIV are often disadvantaged by their own guardians who do not perceive such youths as having rights. To guardians asking for rights when one is being taken care of is going over the board.

Source: N=388. Table 2: Percentage distribution of sources of information about gender based violence.

Knowledge on the Forms of Gender Based Violence

Generally, youths are more knowledgeable about physical-type violence such as sexual and physical, than soft violence such as emotional and economic. The majority of the youths, 97%, reported knowledge of sexual violence as the main form of gender-based violence (Table 3). This was comparable between YLHIV and HIV negative youths albeit with a slight bias towards the HIV negative youths, 97%, and 98%, respectively. A sizeable proportion of YLHIV, 60%, reported knowledge of physical violence as another form of gender-based violence compared to 0% among HIV negative counterparts. It is also interesting to note that a sizeable proportion, 21%, reported knowledge of emotional violence as a form of gender-based violence with a bias towards YLHIV, 22%, compared to 17%. Economic violence was reported by less than one percent of the youths. Asked about abuse in FGDs, adolescents maintained that they are only aware of what they often experience since they are not taught about violence by anyone. Note this remark by one of the 20-year-old HIV positive girl, with the support of others: Well, these days we hear about sexual abuse at school in science subjects. Physical abuse is something we experience knowing that it is not fair, especially when meted on a grown- up person by another. However, the NGO which works here often talks about sexual abuse and this is emphasized as a means of HIV transmission.

Source: N=388. Table 3: Percentage distribution of knowledge on the forms of gender based violence.

Participant’s Perpetrators of Physical Violence

Asked about who the perpetrators of violence are, a significant proportion, 25%, of youths reported boyfriends as perpetrators of physical violence (Table 4). Worth noting is the fact that HIV negative youths were more likely to report boyfriends as perpetrators of physical violence,

38%, compared to YLHIV, 19%. It is interesting to note that YLHIV were more likely to report guardians and relatives as perpetrators of physical violence. For instance, while 20% and 22% of YLHIV, respectively, reported guardians and relatives as perpetrators of physical violence, this compares to 13% and 0% for HIV negative youths respectively.

Source: N=53. Table 4: Percentage distribution of the participants’ physical violence perpetrators.

Participant’s Perpetrators of Sexual Violence

Asked about whom the perpetrators of the sexual abuse were; the largest proportion, 30%, mentioned boyfriends (Table 5). However, HIV negative youths were more likely to reported boyfriends as their perpetrators, 41%, compared to YLHIV, 20%. The second most reported perpetrators were guardians who were reported by about 16% of the youths. However, note that YLHIV were more likely to report guardians as perpetrators, 24%, compared to their HIV negative counterparts, 8%. Blessers, meaning men who pay for sex, were the third most reported perpetrators as reported by 11% of the youths. Note that while 18% of YLHIV reported blessers as perpetrators, only 5% of the HIV negative youths reported the same. Relatives were reported by about 9% of the youths, 5% of the HIV negatives and 13% of the YLHIV. Young girls living with HIV maintained that most often they are sexually abused by their guardians or other relatives, such experiences, they argued, forced them to continue having sex even for cash or kind. Note this remark from one HIV positive girl during an in-depth interview: After I was raped by my uncle who was my guardian, I strongly felt that trying to avoid sexual relationships was not beneficial. I was already HIV positive anyway, and I was no longer a virgin to the extent that any man who would ever marry me would think that I was infected because I was promiscuous yet I was infected at birth. I started having sex with men who would give me the support I never got from this abusive uncle.

Source: N=53. Table 5: Percentage distribution of the participants’ sexual violence perpetrators.

Reporting of the GBV

Given the low levels of GBV experience, it was interesting to assess the extent to which such GBV was reported. Findings showed that reporting on GBV was generally low, with YLHIV being more likely to report all forms of GBV compared to their HIV negative counterparts. The most reported forms of GBV were physical and sexual abuses which were each reported by 26% of the respondents. However, while 31% of the of HIV negative youths reported having reported physical abuse, 21% of YLHIV reported the same. And while 37% of HIV negative youths reported sexual abuse, only 16% of YLHIV reported the same. Emotional abuse was reported by 17% of the respondents; 23% and 11% of HIV negative and YLHIV, respectively.

Economic abuse was the least reported. Again, YLHIV were less likely to report economic abuse, 8% compared to 18% of HIV negative youths.

It was clear from FGDs that reporting on GBV is not encouraged largely on cultural grounds. Note this remark from a 17-year old HIV positive young man: Culturally it is expected that as a young person you ought to be beaten if you make silly mistakes. Adults are expected to discipline their children and this can be done in a number of ways depending on the gravity and type of the issue. Sometimes you can denied food and beaten at the same time should leave livestock destroying crops in the fields. This is similar to the punishment you might get when you refuse to be sent by adults. Sometimes you can be scolded for certain mistakes.

For instance, I started arguing with my uncle when he asked me to till the land in preparation for the rainy season. I told him that it was still too early to undertake such a thing. His question was: who is the father here? Are you telling me that you know better than I do given my experience? This idea of rights is giving you wrong views about what you can do and say to your parents. He retorted. You are not going to do that to me again, he maintained.

This sentiment was echoed by young HIV negative women in their FGDs. Note this remark from a 24-year-old, young woman with clapping from her group members: I once reported my husband to the police when he beat me. When I got to the police, I was told that that was a family issue which was to be settled at home. And when I got back home my mother-in-law was so furious that she told me to pack my bags and go back to my natal home on the pretext that such behavior does not rule out the possibility of asking people to kill my husband when I am tired of him. And when my husband got to the house, he beat me thoroughly and told me to go back and report to my husbands, meaning the police. I realized that no one was on my side and I decided to leave that man. He used to beat me for nothing, and I mean nothing. And girls, if you allow these men to do anything on you, you will not be shocked to see yourself bathing him after carrying the water from the spring, warming it for him, taking it to the washing place. And you will be told: a woman should be able to endure and get used to such. I for one, refused that.

In addition to cultural expectations, it was also clear that women economic dependence of the abused makes them vulnerable to abuse. Note this remark to another 24-year- old HIV positive woman: Girls, let’s admit, life without a man is difficult especially when you are HIV positive. Yah, even when your husband is also HIV positive at least you have someone to support you financially. Besides, even when you can cultivate your own produce for sale, the land you are cultivating on belongs to the husband and his next of kin. And divorce is not an easy option given that often your parents are dead; it is not hard to go back to guardians who when you get married they feel that they have been relieved. And finding another husband who is also HIV negative is hard. Yet staying alone is a painful option. Life is just hard. Reporting is tantamount to saying that you are no longer interested in remaining in the marriage.

It is also important to note that reporting someone else to the police, or any other authority outside one’s family is largely not acceptable nor supported. Note this remark from an in-depth interview with an HIV positive young lady: I was born HIV positive and I fell in love with my boyfriend who later became my husband. It is unfortunate that I did not tell him that I was HIV positive because I was afraid that I would lose him. But when I registered at the clinic for the delivery of my daughter I tested positive and my husband tested negative. He accused me of being a witch who kills people in broad daylight. Every day I would get extremely painful insults until I decided to leave him. Funny enough, he asked me for his daughter who happened to be negative. I refused but he is taking care of my child. I hope people who are positive would reveal their status early on in their relationships than for it to be discovered later in the relationship.

Emotional abuse was reported as too common to warrant any reporting to anyone. Note this remark from a female key informant interviewee: Well, when two people or indeed any number of people live together you cannot expect to have peace all the time. Some days are good, and some bad. Some words that people exchange are good, and some are bad. How can you report on daily events which are part of life. People just have to learn and know each other’s character and endure or ignore whatever negative things they might say and move on with life. Discussions with groups revealed however that abuses do not go unnoticed, nor ignored. There are systems in place where people can report different kinds of abuse. For instance, it was noted that young man and women, children in general, can report to their grandparents whenever they feel abused. It was maintained that guardians or parents cannot beat a child in front of an elderly, a grandparent usually. Beating a child in front of an elderly is perceived as an indirect way of beating such an elderly. And if one is about to be beaten a runs to an elderly, the beating will stop immediately, for the continuation of such would be interpreted as lack of respect for the elderly and one might be asked to pay a fine. Hence, when a child is emotionally abused, or feels abused in any manner, s/he can report to elderly relatives within the family. Married people are expected to report their problems ranging from emotional abuse to physical and sexual abuse to aunts and uncles. It is also deemed appropriate to report to pastors who are generally perceived to have taken the space of aunts and uncles. Note this remark from a key informant interviewee who was working in an NGO in the area of study: Yah, in as much as we know that children and young people have their own rights. We make sure that we do not give them the impression that they should ignore cultural expectations. Yes, we can assist them with counselling in many areas such as how to deal with stigma, relationships and others, but is doing so we also teach them to respect their guardians and parents. We emphasize that they must be able to report their abuse to relations in their respective families. Reporting to us is the last option that we give them. This is particularly so because these kids must learn to fit in the families and communities they are members of. Reporting to us somewhat removes them from the protection of their families, and this is not the best way since we are not with them 24/7.

It is important to note however, that some youth maintained that both systems of reporting, that is reporting to family members or reporting to the police are not too effective especially if the family does not have elderly people who are also strong in character. The youth argued that a number of the youth either run away from home as a means of dealing with abuse, while others decide to get married as a means of getting into new environments which might be more friendly. Note this remark in an in-depth interview with a 17-year-old HIV negative girl who was married at 16: It was generally maintained that reporting on sexual abuse for both HIV positive and negative youth was extremely hard. It was noted that sexual abuse was often perpetrated by relations within the families, or by next door neighbors. It was argued that sexual abuse by relatives is taboo in Zimbabwean culture, hence reporting on it exposes the family to derision by the community. In addition, it was argued that reporting a relative or neighbor for sexual abuse would lead to such perpetrators being jailed, a situation which ruin the family and community relationships. Thus, at best, the reporting could be done to family members, or not done at all.

Centers where GBV Cases are Reported To

The youth were asked about the places they report. Consistent with the discussions above, the most common places for reporting were elderly relatives who were reported by 60% of the youths (Table 6). Again, YPLHIV tend to report less than their HIV negative counterparts, For instance, while 50% of youths living with HIV reported that they reported to the elderly, about 70% of the HIV negative reported the same. The second most common port of call when abused was religious leaders and health service providers who were each reported by 40% of the respondents. While 45% of the HIV negative youths maintained that they reported to religious leaders, about 35% of the YLHIV reported the same. And while 52% of HIV negative youths maintained that they reported to the health service providers, approximately 25% of YLHIV reported the same. And while 39% of the youths maintained that they would report to a friend, 46% of HIV negative youths and 31% of YLHIV reported friends as a place they would report abuse. Reporting to the police was only mentioned by 37% of the youths; however, the HIV negative youths were more likely to report to the police, 54% than YLHIV, 20%. FGDs revealed that YLHIV generally found it difficult to report abuse. Note this remark from a discussion with a Pastor: I have counselled a number of HIV positive youths. The biggest problem with these problem with these youths is that they feel marginalized in the families most of them are living largely because they are mostly raised by guardians because their parents are departed. Looking at the situation I find both groups, the YLHIV and their guardians. The guardians are having problems on how to raise them especially because they are afraid that they would be blamed for abuse should they raise them with a heavy hand they would with their own children. Sometimes I tell orphans not to use their situations as a way of getting things done or not done for them because at the end they are losers. I try my best to be the go-between these two groups and it appears its producing some results given reports from both groups (Table 7).

Source: N=578. Table 7: Percentage distribution of centres where GBV ases are reported to.

It was noted that sexual abuse is reported is the abuse that is generally reported to health care providers. However, it was noted that the reporting done to health care providers is normally necessitated by the need to get proper treatment. One of the HIV negative girls remarked: I had unprotected sex with my boyfriend and he infected me. But when I got to the clinic, I told them that I was raped. I was looking for a reason I could give for me to get the attention that I needed. The problem is that the providers are like parents to us especially because they know us and our parents. They start accusing you for being promiscuous and sometimes they report you to your parents if you do not lie that you were raped. And once you say its rape, then you tell them not to tell anyone and more than often they keep quite although they often advise you to report to the police. An HIV positive female maintained that it was not easy to know whether or not the sex is rape or consensual. She continues: You know, usually the first sex is never discussed, it just happens. And when you are done, then you feel, oh no, I did not intend to. And the boys also kind of push it a bit knowing fully well that you wouldn’t normally say yes even if they ask for sex. The language is difficult to understand. So generally, we never perceive sex with a boyfriend as rape or abuse unless he really forced himself on you. But again, that is only possible when you are in a compromising situation in which you will be blamed by everyone you try to report to. You know, if you get to a private place with a boyfriend and he forces you to have sex society justifies him. When I told my sister that my boyfriend had forced me to have sex she remarked: What do you expect if you put a lion and a goat in the same kraal? That was the end of the story.

It is interesting to note however that boys maintained that they cannot be raped by a woman. However, they maintained that a boy can only be lured by a woman and when he succumbs that is only manly. Note this remark by a 23-year old YLHIV: Guess what, there is this woman who is crazy about sex and people know her. One day I was passing by the river while she was bathing. I shouted if I could pass by, and she replied in the affirmative yet she was stark naked taking a bath. As I drew nearer she giggled, and remarked: knowing you, you will run away from me. I could not resist and also have my manhood challenged. Besides, what was I to lose; after all I am already HIV positive. I jumped on her and settled the matter. Psychologically she raped me, but who cares, those are the temptations of life. Some succumb, some resist and God is for us all.