By Choya Adkison-Stevens, OCADSV Equity & Inclusion Coordinator
Note: this piece is the first in a series supporting advocates to work with survivors around sex, sexuality and sexual health. Future columns may discuss such topics as sexual trauma, sex work, reproductive coercion, kink, non-monogamy, and others. If you have question, ideas, or experiences you want to share, please contact Choya Adkison-Stevens; thank you!
“At double the national rate, 55% of HIV-positive women have been found to experience DV.”
The links between intimate partner violence, sexual violence, and HIV/AIDS were news to me. Not exactly surprising, but beyond the scope of training I received when I began doing sexual and domestic violence work, and even outside the bounds of much of the innovative health partnership efforts generated by programs, Coalitions and funders over the last few years. I was excited when Bradley Angle asked me to sit on their advisory committee for a collaboration with Cascade AIDS Project that seeks to improve advocacy responses for survivors of domestic violence who have HIV/AIDS. And in the year since that project began, I’ve learned a lot. This piece aims to provide a collection of resources describing the overlaps between intimate partner violence (IPV), sexual violence and HIV, and addressing what we as a movement and as service providers can do to improve our support for survivors who are positive.
It occurs to me that HIV is closely connected to sexuality and sexual health -- and this may be part of why we as a field seldom address these intersections. In 2017, there still exists immense stigma around all things related to people’s sexual experiences, particularly those of survivors. Sexuality is treated as a private matter, yet it is influenced by community norms and systems of oppression, as well as public health dynamics related to violence, poverty, access to care, and so much more. It is clear that, in order to form meaningful and effective relationships of support with survivors in our programs, we must develop our capacity to engage with areas of their experiences that have been stigmatized and therefore present even more insidious risks to their health and safety.
Research shows that IPV in relation to HIV can preclude or follow a person’s HIV-positive status; that is, someone might get infected through intentional or unintentional exposure as part of a pattern of abuse, or an abusive person could escalate violence by targeting their partner’s health issues. Links include:
People who are in abusive relationships are more likely to contract HIV, due to intentional exposure, unsafety of negotiating condom use, sexual coercion, and cheating as abuse tactics
“Women in relationships with violence have four times the risk for contracting STIs, including HIV, than women in relationships without violence.”
People with HIV are more likely to experience violence from a partner after disclosure of their status
Abusive partners may use HIV positive status in gaslighting and threats, such as “you’re sick -- who else is going to want you?”, and to justify humiliation and violence
Pervasive cumulative health impacts
“Relationship violence and trauma history can compromise the health and prevention practices of women living with HIV. Recently abused women have more than 4 times the rate of antiretroviral therapy failure, and of not practicing safe sex, as women who have not experienced abuse recently.”
Please learn more about links and impacts by reading/viewing:
Conversation Guide: Starting the Discussion about HIV/AIDS - by National Network to End Domestic Violence (NNEDV)
Violence Against Women and HIV/AIDS: Critical Intersections - by World Health Organization (WHO - provides a more global view, with specific description of links and suggested interventions)
DV and HIV/AIDS Toolkit (and specifically the HIV power and control wheel) - by NNEDV
Video on women, HIV and intimate partner violence - by Greater Than Aids (an incredible online resource for those with HIV/AIDS and people who support them - research, fact sheets, etc)
Intersections of IPV and HIV - recorded webinar by Family Planning National Training Centers
The impact of intimate partner violence against women and HIV/AIDS: a review - from US National Library of Medicine, National Institutes of Health
Given the intersections of IPV and HIV, it is imperative that survivors are given information and assistance regarding HIV/AIDS by those working in domestic violence service programs.
What can we do? Helpful recommendations for ways to improve our services to survivors with HIV/AIDS:
- Talk to every victim/survivor about HIV risk, but don’t ask about their status; if they choose to disclose, keep the information confidential
- Learn about testing and treatment for HIV/AIDS, including options through public health and other clinics for free or reduced-cost testing
- Plan for medication storage and access in residential programs
- Advocate for telemedicine appointments (meeting with a doctor via videochat) for people who are HIV positive or are taking PrEP, but live in rural communities and/or for whom transportation and isolation are barriers to care
- Partner with local HIV community-based organizations
- Make social media posts for World AIDS Day, December 1st, or partner with HIV orgs for events or awareness-raising
- Address your own beliefs and biases about HIV/AIDS and develop a level of comfort in discussing sex and sexual health
- Get to know Oregon laws related to HIV/AIDS
- Challenge myths about HIV/AIDS
The Oregon Coalition looks forward to additional opportunities to strengthen statewide awareness of and programming around these intersections. If you would like to embrace this work, seek further training on these issues, or seek support to implement changes in your programming related to survivors with HIV/AIDS, please contact me at [email protected] or (503) 230-1951 x311.
More opportunities to improve our work, and further resources, are available at:
Creating a culture of acceptance: abuse, HIV and women in shelter - recorded webinar by National Resource Center on Domestic Violence
Sexual Violence and HIV: a Technical Assistance Guide for Victim Service Providers - by National Sexual Violence Resource Center
HIV Care and Treatment - by Oregon Health Authority
End HIV Oregon - by Oregon Health Authority
The Center for HIV Law and Policy - has a page listing Oregon specific laws (specifically, “Although Oregon does not have an HIV-specific criminal law, STIs, including HIV, can be treated as an aggravating factor in sentencing determinations following a sexual assault conviction.”)