Sexual violence and genital injury: the physiology of HIV transmission risk.

The American Journal of Reproductive Immunology (AJRI) has kindly agreed to publish the proceedings of a recent Scientific Research Planning meeting entitled ‘Sexual Violence and HIV Transmission’. This conference was the first of its kind to focus on the physiology of sexual violence as a factor in HIV transmission. All review articles from this meeting will be available Online as a special issue of AJRI early in 2013. We are delighted to present a unique collection of perspectives representing the basic sciences, public health, the behavioral and social sciences, clinical research, and epidemic modeling. The review articles in this issue were developed as a contribution to the consultations and Scientific Research Planning Meeting on Sexual Violence and HIV transmission convened by the Social Science Research Council on March 19–20, 2012 at the Greentree Foundation in New York (hereafter referred to as the Greentree Meeting). In addition to the individual articles, this Special Issue also includes a Summary of the Greentree Meeting Proceedings. Financial support for the Meeting was provided by the National Institutes for Health, Office of AIDS Research; the Joint United Nations Programme on HIV/AIDS (UNAIDS) and UN Action Against Sexual Violence in Armed Conflict (UN Action). The principal motivation for convening the Greentree Meeting was to generate new insights about the physiology of sexual trauma and its role in HIV transmission, acquisition, and pathogenesis. Although many scholars, practitioners, and policy-makers have begun to associate sexual violence with heightened HIV risk, genital trauma has yet to be identified as a cofactor in epidemiological models of HIV transmission or as a plausible explanation for the vastly disproportionate rates of infection among young girls as compared to young boys in some settings. This is more than just an anomaly in sub-Saharan Africa, where 76% of all HIV-positive women reside and young women between 15 and 24 years are between two and eight times more likely than their male peers to be HIV positive. For the survivors of sexual violence in conflict-affected and HIV endemic areas, the relationship between the behavioral, structural, and physiological drivers of HIV transmission is far more complex than being simply a function of ‘heterosexual transmission.’ We believe that the Greentree Meeting broke through a crucial impasse in HIV research that has resulted from a tradition of siloed and disciplinary-specific approaches to an inherently bio-social problem. The Greentree Meeting, a potentially replicable model of collaboration, offered a two way process of discovery: with greater understanding about the physiology of HIV transmission risk, behavioral, public health, and social science researchers are better able to assess the relevance of biomedical factors across different geographic and social settings. Similarly, greater understanding on the part of bio-medical researchers about the social dynamics that influence transmission can help generate new insights about the physiology of risk among specific populations. To this end, the Greentree Meeting participants also produced a consensus Research Agenda and White Paper.1 The White Paper concludes that: ‘The contribution of sexual violence and genital injury to HIV transmission and acquisition has not yet been fully understood or integrated into the global AIDS response, even as it plays a potentially significant role in the development of HIV epidemics, particularly among young women. Causal pathways between sexual violence and genital injury and HIV infection are complex and involve a range of biological, behavioral, and social factors that must be explored simultaneously. Participants at the Greentree Scientific Research Planning Meeting identified a robust agenda for inter-disciplinary research, cognizant of its applications to program and policy that should be pursued imminently.’ We hope that all the outputs of the Greentree meeting will, collectively, catalyze additional interdisciplinary research, policy, and practice that further establishes the links between sexual violence and HIV and, ultimately, helps reduce infections among those most at risk.