A study from Canada found that nearly half of women living with HIV in the study had ever had their HIV status shared without their consent i.e. “being outed”. Over a third of participants had ever experienced physical or verbal violence related to their status. The study found those who had ever been outed or ever been homeless were more likely to have experienced status-related violence compared to those who weren’t.
Women living with HIV are more vulnerable to experiencing intimate partner or gender-based violence. Qualitative research suggests the risk of violence is especially heightened after sharing of status. Canada has the dubious recognition as being one of the most punitive countries for HIV criminalisation in the world, going so far as to prosecute victims of sexual assault because they are living with HIV.
Led by Daniella Barreto of the Centre for Gender and Sexual Health Equity in Vancouver, researchers set out to better understand the relationships between non-consensual status disclosure and violence among women living with HIV in this highly criminalised environment using quantitative methods.
The researchers looked at a cross sectional sample of baseline data collected when women enrolled in an ongoing community-based participatory research study called Sexual Health and HIV/AIDS: Women’s longitudinal needs assessment (SHAWNA).
Started in 2010, SHAWNA partners with HIV and community service providers through several community advisory boards and twice-yearly participant interviews to ensure that that community-identified needs are driving the research agenda.
Participants are referred to the study by a team of peer research associates, other peer workers, women living with HIV, self-referral, or by HIV care and service providers. Eligible participants in SHAWNA are cisgender and transgender girls and women aged 14 and older who live or receive services in the Vancouver area.
Three hundred sixteen women were included in the study. The median age was 43. Over half (58%) were Indigenous, including the 13% who selected Two-Spirit Indigenous, meaning they have both a male and female spirit, 34% were White, 9% were considered ‘otherwise racialised’, which includes Black, African, and/or Caribbean. A third had a sexual minority identity and 10% had a gender minority identity, defined as anything except heterosexual and anything except cisgender, respectively.
The majority had ever experienced homelessness (78%), sex work (74%), and/or incarceration (73%). Nearly all (90%) reported non-injection stimulant use, 62% reported non-injection opioid use, 71% reported injection stimulant use, and 70% injection opioid use. Sixty three per cent had a diagnosed mental health condition. Nearly half (47%) responded yes to the question, “has anyone ever ‘outed’ you for knowing or suspecting you were HIV positive?”.
Researchers separated out the sample by their primary outcome, which was whether participants said yes to the question “have you ever been verbally or physically abused by someone because they knew or suspected you were HIV positive?”. Thirty four per cent said yes to that.
With bivariate analysis, people who had ever experienced homelessness (p=0.024), those with a diagnosed mental health condition (p = 0.003), and those who had their HIV status shared without consent (p = <0.001) were more likely to have experienced violence because of their HIV status.
In the adjusted multivariable analysis women who had experienced homelessness were over twice as likely (AOR: 2.18, 95% CI: 1.03-4.49) to also report experiencing violence related to their HIV status. Those who had ever been outed were over seven times likelier to report experiences of violence (AOR 7.46, 95% CI: 4.21-13.21).
While the cross-sectional study cannot tell us whether violence occurred before or after being outed, whether the events occurred around the same time, or attribute cause and effect, the strong relationship found between these factors among this highly vulnerable population calls for urgent action.
Combining these findings with previous research – where Black and Indigenous women living with HIV in Canada stated that the HIV criminal laws led to increased violence in their lives – the picture is bleak indeed. The authors call for women living with HIV to be protected through HIV criminalisation reform and increased access to trauma-informed, culturally safe programmes and services. However, it is not clear what, if anything, the Canadian government is doing to these matters.
Barreto D et al. HIV disclosure without consent linked to increased violence against women living with HIV in a Canadian setting. AIDS Care, online ahead of print, 22 May 2023.