Women living with HIV: Disclosure, violence, and social support

Abstract

This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a faceto-face interview. Women in the sample were 33 years old on average; 92% were AfricanAmerican; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HW-positive women.Drs. Gielen, Fogarty, and Faden are from Johns

Intimate partner violence against women in eastern Uganda: implications for HIV prevention

“…In a study in Kenya, women who had ever used condoms had also experienced more partner violence [28]. Intimate partner violence has also been reported following disclosure of HIV results by women to their partners [30,[47][48][49]. Though we did not inquire into reasons for refusal of sex, it is likely that this could have been related to women's perceptions of their male partners' risk of HIV resulting in violence [14].…”

Correlates of sex without serostatus disclosure among a national probability sample of HIV patients

“…Some previous studies have shown that women with HIV are at increased risk for violence and that fear of such violence at the hands of sexual partners may inhibit disclosure (Gielen et al, 1997;Gielen, O'Campo, Faden, & Eke, 2000). It is possible that those in violent partnerships are less likely to disclose out of fear of retaliation, but others who disclose to previously non-violent partners become victims as a result.…”

Women in couples antenatal HIV counseling and testing are not more likely to report adverse social events

“…However, disclosure of HIV status has also been associated with increases in adverse social outcomes, including violence, abandonment and divorce [13,14]. Male partner involvement in VCT may increase the likelihood of VCT uptake, behavior change, as well as improve compliance with pMTCT measures such as nevirapine (NVP) uptake.…”