Co-authored by Karishma Oza, HIVE Program Coordinator.
One in four U.S. women have experienced gender based violence. Among women living with HIV, one in two has experienced intimate partner violence, and more than 60% have been sexually abused – 5 times the rate of the general female population.
For over twenty-five years, Zuckerberg San Francisco General Hospital & Trauma Center-based HIVE clinic, has provided compassionate, expert reproductive and sexual health care to women living with or affected by HIV. The impact and consequences of violence against women, particularly women living with HIV, is magnified through the lens of women’s reproductive health. Reproductive health highlights the intersection of violence and reproductive justice at the individual, community and institutional level.
- Trauma is associated with: increased HIV vulnerability, higher HIV incidence, faster disease progression, more hospitalizations.
- Unaddressed trauma is associated with twice the rate of death among women living with HIV.
- The aftermath of violence and/or trauma ruptures women’s relationships with themselves, their partners, family members and the medical system.
- Women living with HIV have higher rates of tubal regret – meaning more women second guess their decision to have a tubal ligation, for some this decision was made for them.
- Partner contraception sabotage increases rates of unintended pregnancies.
- 33 U.S. states with HIV criminalization laws enforce long histories of systemic oppression, further stigmatizing women.
Pregnancy, contraception, trauma and HIV vulnerability intersect in ways that dramatically impact women’s lives. Even in the face of these overwhelming statistics and devastating outcomes, there is hope. Our collective resilience is cause for a standing ovation. We can seek solidarity in our advocacy efforts and heal through relationships even as we continue efforts to create systems-level change.
Progress at the national level to integrate trauma-informed care into the primary care setting and specific references to trauma-informed care in the updatedNational HIV/AIDS Strategy, shifts institutional approaches. We share strategies for operationalizing these guidelines at the clinic and individual level with a lens toward healing and resiliency-oriented approaches for working with women living with HIV who’ve experienced trauma.
1. Shift our focus from “What is wrong with you?” to “What happened?” Moving away from blame, allowing space for her story, staying curious, seeking to understand her worldview creates opportunity to meet women where they are and understand their lived experiences.
2. Commit to self-care and resiliency oriented approaches to our work. More than just practicing what we preach, this integration of trauma-informed principles become the touchstone for truly becoming a trauma reducing, healing system. This begins with a commitment to heal ourselves.
3. Include women. Ask women for feedback on provider and program approaches, integrate women’s lived experiences when designing new programs or crafting policies, hire women for important roles. Create space for women living with HIV to lead.
4. Use trigger warnings at the beginning of emotionally intense meetings or online content. Those with primary or secondary trauma are among us. Invite self-care. Create awareness and respect with an overview of what to expect. Respect the self-care measures others take.
5. Universal screening for intimate partner violence, with counseling and referrals. Preventative education about the intersection of intimate partner violence and health can be provided to all patients, not just those who have disclosed a history of violence. Ask questions in non-triggering, nonjudgmental language with the goal of patient empowerment and safety.
6. Rape and other forms of violence remove women’s sense of power and control. The medical system is inherently hierarchal. However, medical visits should not create more pain, violence, or humiliation. Turn commands into questions, create space for her response, provide opportunities for women to be in control.
7. “Difficult” patients may have experienced sexual trauma. She isn’t difficult; she’s had a difficult life or experienced traumas that are difficult to integrate. What might be difficult is the system she’s trying to navigate. Reframing allows space for the experience she is living, invites you to meet her where she is today.
8. The body of a survivor remembers traumatic experiences. We are somatic creatures; this is our vulnerability and our strength. Through our interactions with survivors, we can change the way we see her, then change the way she sees herself.
Toward resiliency and healing, we share this poem.
By Silvi Alcivar, The Poetry Store
the gates call you
to move forward,
to pass through thresholds
that make you able to sustain you,
that make you able to sit in service,
to model dignity,
to recognize trauma,
to take care of community,
to live your intellect through your heart
and be wise.
the wise one asks:
what’s the beauty of what we attract?
what’s the beauty asking me to heal?
the wise one remembers the breath.
the wise one drinks the waters of nourishment and release.
the wise one works with the shadow knowing the shadow means
there’s always a source of light.
the wise one asks:
what are you teaching me?
what isn’t being seen, held?
oh, the gates call you, wise ones,
to move forward, to attend
to what needs attending, what wants attention
in ourselves and our inheritance.
call in your support. breathe.
honor the spaces between.
hold intention. clear. release.
put on your golden cape.
heal. and be healed.
Positive Women’s Network-USA
Reach Out! Part 8 of 10 part series. (already?)
(More advice? It’s all here at: http://rwhp.org/sis.html)
Nearly 1 in 5 women in the United States will have experienced rape or attempted rape during their lifetime.
According to the National Sexual Violence Resource Center (NSVRC), sexual violence is defined as any type of unwanted sexual contact. This can include words or actions of a sexual nature against a person’s will and without their consent. Consent is a mutual agreement to take part in sexual activity.
Unfortunately, survivors of sexual abuse often know the person who assaulted them. Studies also show that people who sexually abuse usually target someone they know — a friend, classmate, neighbor, coworker, or relative.
In 2005-10, about 55% of rape or sexual assault victimizations occurred at or near the victim’s home, and another 12% occurred at or near the home of a friend, relative, or acquaintance.
Together, we can change the conditions that contribute to sexual violence.
You can learn the facts about sexual violence and play an active role in changing misconceptions. Prevention starts with believing survivors when they disclose. In your personal life, you can model supportive relationships and behaviors and speak up when you hear sexist, racist, or homophobic comments.
If you are unsure of how to speak up, simply saying a statement like “I feel offended by you saying that” or simply expressing your discomfort with a matter would be a good way to start that conversation.
If you or someone you know is a survivor of sexual violence, please contact the following:
National Sexual Violence Resource Center
Rape, Abuse & Incest National Network (RAINN)
The National Domestic Violence Hotline
Part 4 of our 10 part series!
“Let’s Talk About It’ has a lot to say. Yep, there are options for medical care. (You can check it all out at: http://rwhp.org/sis.html
As February commences, we all have a lot to celebrate: Valentine’s Day, Black History Month and the fact that we have a 29th day this month!
With all this in mind, we must also remember that this month, our community will also be celebrating National Black HIV/AIDS Awareness Day on February 7, 2016! According to the Center for Disease and Control, in 2014, 44% of new HIV diagnoses in the United States were among African Americans showing that this community is disproportionately affected by HIV/AIDS. Now in its 16th year, the national HIV testing and treatment community mobilization initiative focuses on the Black community in the United States.
I am my Brother/ Sister’s Keeper: Fight HIV/AIDS
Awareness Day includes four areas of focus, urging people to get:
1. Educated: Inform Black communities about the basics of HIV and AIDS.
2. Tested: Get tested and know your status. This supports the prevention of HIV, specifically those who are considered high risk.
3. Involved: Host and participate in Black Awareness Day events in the Black community– from organizing testing events to supporting AIDS organizations and providers.
4. Treated: Connect those who have been diagnosed with HIV to treatment and care. This will keep people healthy, living longer and reducing the chances of transmission.
How will you encourage people from ALL communities to get involved and stop the spread of HIV/AIDS?
For more information, please visit: http://nationalblackaidsday.org/
Bringing more people together with different views and ideas including their accomplishments is extremely helpful.
Thank you Sean, Tami, and Jordan. We love you guys. 😉
I can’t wait to meet you all again.
The US Government just released the following infographic which looks at the top 5 changes concerning HIV/AIDS, since 2010.
Also, today was the release of the complete National HIV/AIDS Strategy which looks at the next five years and what they hope is accomplished. The Strategy states that it is designed to “work closer to virtually eliminating new HIV infections, effectively supporting all people living with HIV to lead long and healthy lives and eliminating the disparities that persist among some populations.”
You can download the Strategy at: http://1.usa.gov/1SkAseK
What are your thoughts about the infographic?
Are there other items you would like to see addressed?
When being an advocate, determination is a major factor in what drives our passion and cause. Being determined to fight and voice our opinions is how we have achieved so much progress in our fight against HIV/AIDS and how we will continue to do so.
The “D” in Advocacy is for “Determination”
Determination can take many shapes and forms, but one of the easiest ways to showcase our determination is by attending rallies, demonstrations, or events where we can actively advocate for HIV/AIDS and share our passion and our voice.
An example of this, for those living in Florida, is the 27th annual AIDS WALK MIAMI event, which is a 5k walk-a-thon fundraiser benefiting those who have been affected by HIV/AIDS in our South Florida communities. This event will be held on Sunday April 26th, 2015 in Miami Florida.
Rallies and demonstrations like the one listed above are always being organized throughout the US. If they aren’t happening in your communities, we as advocates can take the first step and organize such rallies and demonstrations and share our determination and passion with those around us.
The following link is a calendar of events being held across the US that we can all get involved in and support.
Share with us a comment below how you showcase your determination when it comes to fighting against HIV/AIDS?
During the upcoming months, LTAI members will be exploring their role in advocacy. Join us each week as we look at different elements of advocacy.
Advocacy requires action and engagement to truly advocate in support of a cause. Taking action such as, writing letters and making calls and being active in our communities, organizations, and within our social groups is the first and probably most important step in becoming an advocate for HIV/AIDS.
The “A” in Advocacy stands for “Action”
One easy way to take action in your community is by volunteering or getting involved in HIV/AIDS service organizations. These could be with small community groups or large national organizations, but either way you can make a difference.
The following are links to directories where you can look for HIV/AIDS service organizations around your area, so that you can take action today!
Three local groups:
and of course us at Let’s Talk About It: http://www.rwhp.org/letstalk.html
What are some ways that you take action in your community? Share your thoughts with us in a comment below and let us know what advocacy means to you!