Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Abstract

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.

Exploring pathways from violence and HIV disclosure without consent to depression, social support, and HIV medication self-efficacy among women living with HIV in Metro Vancouver, Canada

“…Furthermore, given the potential benefits of safe HIV disclosure on women’s health and well-being, future research should investigate how interventions to support safe disclosure can be designed and evaluated to minimize the impact of disclosure on enacted HIV stigma (Kennedy et al, 2015). Research into how Canada’s punitive HIV disclosure laws promote HIV disclosure without consent, stigma and violence and the benefits of repealing such laws, should be continued and supported (Krüsi et al, 2018).…”

“…While voluntary disclosure of HIV status has been shown to be positively correlated with social support (Loutfy et al, 2016), as well as quality of life (Loutfy et al, 2016), and reduced levels of depression or depressive symptoms among WLWH (Vyavaharkar et al, 2011), from a human rights perspective, it is imperative to recognize the potential and realized harms to women from disclosure (Obermeyer et al, 2011), particularly when disclosure is involuntary. These harms can include isolation, abandonment, other stigma, discrimination, and violence (Krüsi et al, 2018; Varga et al, 2006). No quantitative research to our knowledge has been conducted on relationships between HIV status disclosure without consent and important emotional, psychological, and social-cognitive well-being outcomes including depression, social support, or HIV medication self-efficacy; our research aims to fill this research gap.…”

Indigenous Women Voicing Experiences of HIV Stigma and Criminalization Through Art

“…Stigma is used to justify domination and systems of inequity (Parker & Aggleton, 2003). One way that structural stigma manifests is through the criminalization of HIV nondisclosure (Krüsi et al, 2018). Canada's assertive approach to criminalizing HIV nondisclosure, which requires people living with HIV to disclose their status to sexual partners prior to any sexual activity that has a "realistic possibility" of HIV transmission, results in among the highest number of convictions globally (Canadian HIV/AIDS Legal Network, 2019; UNAIDS, 2012).…”

“…Gendered structural factors disproportionately impact IWLWH through criminalization (Patterson et al, 2015). Gendered power dynamics, created by colonial destruction of traditional gender dynamics, complicate condom negotiation for IWLWH (Krüsi et al, 2018;Smith, 2012). Evidence indicates that the current approach to criminalization of HIV nondisclosure exacerbates gender-based violence and puts a disproportionate legal burden on IWLWH (Greene et al, 2019;Krüsi et al, 2016;Patterson et al, 2016).…”

Perspectives of HIV-positive and -negative people who use drugs regarding the criminalization of HIV non-disclosure in Canada: a qualitative study

“…There have been a few important studies regarding the ways in which the criminalization of non-disclosure impacts upon marginalized groups in Canada. These studies have focused on the ways people living with HIV from a range of social locations (e.g., people who use drugs, refugee and immigrant women, cis and trans women) understand non-disclosure legal frameworks and negotiate it within the context of their own lives and sexual relationships [ 27 – 29 ]. In a recent article, Knight et al [ 14 ] explored the impacts of HIV criminalization legal frameworks on the perspectives of and experiences with HIV risk among 85 HIV-negative men and/or men who were unaware of their serostatus.…”