While a growing body of research points to the shortcomings of the criminal law in governing HIV transmission, there is limited understanding of how cis and trans women living with HIV (WLWH) negotiate their sexuality and HIV disclosure in a criminalized environment. Given the ongoing criminalization of HIV non-disclosure and prevalence of gender-based violence, there is a critical need to better understand the dynamics of negotiating sexual relationships and HIV disclosure among WLWH. We conducted 64 qualitative interviews with cis and trans WLWH in Vancouver, Canada between 2015 and 2017. The interviews were conducted by three experienced researchers, including a cis and a trans WLWH using a semi-structured interview guide. Drawing on a feminist analytical framework and concepts of structural violence, the analysis sought to characterize the negotiation of sexual relationships and HIV disclosure among WLWH in a criminalized setting. For many participants their HIV diagnosis initially symbolized the end of their sexuality due to fear of rejection and potential legal consequences. WLWH recounted that disclosing their HIV status shifted the power dynamics in sexual relationships and many feared rejection, violence, and being outed as living with HIV. Participants’ narratives also highlighted that male condom refusal was common and WLWH were not only subjected to the gendered interpersonal violence of male condom refusal but also to the structural violence of legislation that requires condom use but fails to account for the gendered power imbalance that shapes condom negotiation. Despite frequently being represented as a law that ‘protects’ women, our findings indicate that the criminalization of HIV non-disclosure constitutes a form of gendered structural violence that exacerbates risk for interpersonal violence among WLWH. In line with recommendations by, the WHO and UNAIDS these findings demonstrate the negative impacts of regulating HIV prevention through the use of criminal law for WLWH.

Indigenous women living with HIV are disproportionately affected by the criminalization of HIV nondisclosure. The purpose of this paper is to better understand how the criminalization of HIV nondisclosure shapes the lived experiences of HIV-related stigma, disclosure, and health service among cis and transgender Indigenous women living with HIV (IWLWH). This study was developed based on a community roundtable on HIV criminalization with engagement of legal experts, HIV service organizations, and IWLWH on the unceded traditional territory of the Coast Salish Peoples, including the ter̓ritories of the xwməθkwəy̓ əm (Musqueam), Sḵwx̱ wú7mesh (Squamish), and Səlílwətaɬ (Tsleil-Waututh) Nations (Vancouver, British Columbia, Canada) in 2016 to 2018. Drawing on community-based participatory photovoice methodology, Indigenous Peer Researchers played a central role throughout this project, including planning, facilitation of photo-voice workshops, and analysis. This analysis includes 17 IWLWH. Through a peer-engaged analysis process, the photovoice images and narratives illustrated how the criminalization of HIV nondisclosure is intertwined with colonial violence to shape experiences of social isolation and exclusion, disclosure, access to safe health care, responsibility, fear, and resilience. The legal requirements of HIV nondisclosure are unattainable for many IWLWH who are not able to safely disclose their HIV status, negotiate condom use, and maintain a low viral load. In line with the Truth and Reconciliation Commission of Canada and National Inquiry into Missing and Murdered Indigenous Women and Girls, the justice system must be reoriented from punishment and oppression to healing and wellbeing for all Indigenous women living with HIV. Simultaneously, we call for culturally safe services that protect privacy and recognize strengths of IWLWH.

This study examines correlates of being unable to access primary care in the past 6 months among cisgender (cis) and trans women living with HIV (WLWH). Data were drawn from a longitudinal community-based cohort study of WLWH (ages 141) in Metro Vancouver, Canada (2014Canada ( -2017. Of 291 participants contributing 914 observations, 15.5% reported being unable to access primary care at baseline. In multivariable analysis, increased odds of being unable to access primary care was associated with (a) having im/migrated to Canada, and, in the past 6 months, (b) identifying as gender minority, (c) experiencing physical or sexual violence, (d) having suicidal ideation or attempts. Decreased odds were associated with recently accessing HIV-specific resources. Our findings suggest that primary health care for WLWH should address high levels of violence and mental health conditions as well as barriers to services for gender minority and im/migrant WLWH.