Indigenous Women Voicing Experiences of HIV Stigma and Criminalization Through Art

Abstract


 
 
 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.
 
 

Impact of Canadian human immunodeficiency virus non-disclosure case law on experiences of violence from sexual partners among women living with human immunodeficiency virus in Canada: Implications for sexual rights

“…The interplay between gender-based inequities and laws criminalizing HIV non-disclosure constrains the sexual rights of women living with HIV. 32 Consistent with previous work, 44,49 our analysis showed that HIV non-disclosure case law may undermine the sexual agency of women living with HIV, representing a barrier to the formation of new sexual partnerships, and precluding women from realizing sexual agency and empowerment in the era of U = U. 2 Similarly, focus groups and in-depth interviews among women living with HIV in Ontario identified the law as a barrier to fully engaging in sexual relationships, regardless of whether a woman had an undetectable viral load or intended to use condoms.…”

“…35 Photo-voice workshops among 17 Indigenous women living with HIV in BC highlighted the intersection between HIV criminalization and colonial violence in shaping experiences of disclosure, violence and stigma. 49 These findings illuminate a need for culturally sensitive, traumaaware services tailored to marginalized and racialized groups. They also speak to the importance of an intersectional approach to structural stigma to understand how HIV non-disclosure case law is enacted and experienced differentially in ways that exacerbate pre-existing social inequities among women living with HIV.…”

“…Previous work has shown that ethnic minority groups are disproportionately affected by intimate partner violence. 80 In Canada, Indigenous and ACB communities face complex experiences of racism, poverty and stigma, which diversely shape their experiences of health, violence and the criminal justice system, 49,81 and create adverse consequences of HIV disclosure in the current legal system. 35 Photo-voice workshops among 17 Indigenous women living with HIV in BC highlighted the intersection between HIV criminalization and colonial violence in shaping experiences of disclosure, violence and stigma.…”

“…48 Qualitative scholarship has begun to explore women’s experiences of sexual relationships, violence and disclosure in a climate of HIV criminalization. 32,35,49,50 However, quantitative work to quantify the impact of HIV criminalization as a structural driver of violence within sexual partnerships and to measure differential impacts across the diversity of women living with HIV in Canada is lacking. At this juncture, this analysis sought to estimate the reported impact of HIV non-disclosure case law on experiences of violence from sexual partners among women with HIV, and to consider the implications for sexual rights for women living and loving in the era of U = U.…”

Beyond criminalization: reconsidering HIV criminalization in an era of reform

“…Such critiques of molecular surveillance are grounded in longstanding critiques against the racist practices of medicine and public health, which view the bodies of people living with HIV solely as objects of risk and study, not subjects deserving of rights and decision-making [32 ▪ ]. In Canada, qualitative research with Indigenous women living with HIV has proposed the experience of over-surveillance by health professionals, police, and the law, as a form of ‘colonial surveillance and racism’ [39 ▪ ]. Critical public health scholars in the area have called for research into the implications of increased surveillance, and for all approaches to be grounded in human rights and racial justice [20 ▪ ].…”