Confronting Cultural Silencing of Women: Untold Stories of Abuse and HIV Risk in Young Women in Africa and the United States

• Author: Andrew M. Muriuki,Tamarah Moss,Denise Kpebo,Sithokozile Maposa
• DOI: http://doi.org/10.1002/wmh3.196
• Date: 01 September 2016
• Published date: 01 September 2016

Confronting Cultural Silencing of Women:

Untold Stories of Abuse and HIV Risk in

Young Women in Africa and the United States

Sithokozile Maposa, Andrew M. Muriuki, Tamarah Moss, and Denise Kpebo

Past research has shown that sexu al abuse increases vulnerabi lity to HIV/AIDS. However, litt le

is known about the context of differen t cultural traditions and how they af fect women’s risk.

This study used data from two stu dies conducted in the United St ates and West Africa, and

purposefully selected semi- structured interviews of those re porting sexual abuse. Data were

collected from 2006 to 2009 (United States) and 2014 to 2015 (West Afric a), and analyzed using

an interpretive team approac h. Findings revealed that mo st study participants lived wi th personal

shame and stigma; they were silent about the abuse they suffered to prote ct themselves and their

families. Those providing me ntal and physical health service s to women with HIV/AIDS must be

cognizant of these cultural is sues and the continuing cycl e of poverty and abuse that put the se

women at risk.

KEY WORDS: abuse and HIV risk, African girl child, risky behaviors

Background

Sexually transmitted HIV infection is a public health concern among African

women living in different parts of the globe. The goal of this study was to gain a

deeper understanding of the experiences of African women who are increasingly

at risk for HIV infection and living with or vulnerable to sexual abuse. While the

expansion of antiretroviral therapy in sub-Saharan Africa has contributed to

reductions in the incidence of HIV/AIDS in Africa (Delva & Abdool Karim,

2014), more work is needed to improve our understanding of factors inf‌luencing

higher HIV rates in younger African women (Roxby et al., 2014). Several studies

have associated HIV risk in African women with stigma, silence, and shame,

especially among those who also experience sexual abuse (Byrskog, Olsson,

Ess

en, & Allvin, 2014; Loutfy et al., 2015; Sprague, Hatcher, Woollett, Sommers, &

Black, 2016).

The co-occurrence of sexual abuse and HIV risk in African women has been

attributed to relationship power disparity, as well as cultural norms about

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discussing sexual issues (Airhihenbuwa & Webster, 2004; Conjoh, Zhou, & Xiong,

2011; Conroy et al., 2015). In the context of an HIV/AIDS epidemic, we need to

gain a better understanding of cultural practices inf‌luencing African girls and

their experience of abuse. We must advance an integrated approach to preventing

sexual abuse to scale back the HIV pandemic and realize meaningful health

outcomes (Roxby et al., 2014).

HIV and Abuse in African Women

African-born women living in the United States are six times more likely to

be infected with HIV than other U.S. women (Blanas et al., 2013). However, there

is a stigma associated with HIV, often based on limited knowledge. Although

little is known about HIV risk and abuse experiences of African women residing

in the United States, previous research in Australia and South Africa suggests

silence, limited disclosure, and an unwillingness or fear to seek therapeutic

modif‌ication is common (Ogunsiji, Wilkes, Jackson, & Peters, 2012; Sprague et al.,

2016). This reluctance to discuss abuse may be attributed in part to cultural

practices that create discomfort (Airhihenbuwa & Webster, 2004) and to unequal

power in relationships (Jewkes & Morrell, 2012).

HIV prevalence among adult s in West Africa is estimated t o be 1–6.7 percent

(UNAIDS, 2013). High HIV rates associ ated with family disruption may further

compromise and increas e the vulnerability of ch ildren (Ankrah, 1993; At winea,

Cantor-Graaea, & Bajunir we, 2005). Little has been pu blished about HIV

risk and abuse experience s of West African women , except for vulnerabil ity

associated with domesti c servitude (Jacquemin, 2004, 2006; Thorsen, 2012).

Survey data from two eas t and three southern Afr ican countries sugge st that

one in four African girls have experienced sexual abuse, but only one in ten

girls obtain appropria te counseling or support services (Sumner et al., 2015).

Cultural norms about disc ussing sexual experie nces may lead to continued

reticence in discussin g HIV risk and sexual abuse (Airhihenbuwa & Webster,

2004).

The literature on HIV risk b ehaviors has also shown t hat African women at

risk of sexually transmi tted HIV infection ten d to have other co-occurring risk

issues, including gende r inequity, experienc es of abuse, and substanc e use

(Wechsberg et al., 2013) . Multiple risks may exp lain stigma, low uptakes o f HIV

testing, and HIV statu s disclosure restrain t (Richter, Makusha, Kom

arek,

Daniels, & Coates, 2016). O ur focus on HIV and abuse risk am ong others is

validated by literature s howing that, other than HIV , lower rates of other

sexually transmitted i nfections such as hepat itis C, chlamydia, and gon orrhea

have been reported among A frican women (Redditt, J anakiram, Graziano, &

Rashid, 2016; Sprague et al ., 2016; Stauffer et al., 20 12). Yet no studies have bee n

done to explore abuse and HI V risk experiences of Afri can women living in

Africa and beyond. Base d on this gap in the liter ature, this study exami nes

stories of abuse and HIV risk of a sample of African wome n living in the United

States and girls in West A frica.

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