Domestic Violence and Risk for HIV

Lailaa Yasmeen Bartley SisterLove, Inc. MPH Intern

I am a 23 year old native of Savannah, GA, currently living in Atlanta. This year has been full of great events for me. I traveled abroad for the first time to Costa Rica in March, I graduated from Columbus State University in May, and I got engaged to the love of my life in July.

Currently, I am a first year Master of Public Health student at Morehouse School of Medicine (MSM). My degree concentration is health education/health promotion, and my specific research interests are women’s and teenage sexual health, childhood obesity, infectious diseases, the health of the homeless. It has always been my goal to serve others in whatever career I chose, especially those whose voices are rarely heard. This motivated me to apply to Morehouse School of Medicine. I love the fact that their primary goal is to aid the underserved and minority populations.

Outside of public health, my hobbies are reading, trying new things, shopping (especially at thrift stores), and constantly trying to maintain a close relationship with God. Following the attainment of my Master of Public Health (M.P.H) degree, I plan to work for a community health organization. I also plan to obtain a Doctor of Medicine degree in the future. That degree coupled with my M.P.H. will truly allow me to be an agent of change in a society where health disparities run rampant. Ultimately, my goal in life is to improve the lives of others. I am a firm believer in the mantra “be the change you want to see in the world,” and my plan is to do just that.

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Hello, my name is Lailaa. I am a 23 year old graduate student studying public health at Morehouse School of Medicine in Atlanta. I am working with SisterLove to increase awareness of HIV/AIDS and reproductive justice. As you may have seen in the news over the past couple of years, the number of those living with HIV/AIDS has decreased worldwide; but not for black people, and especially not for black women. In the US, African American women account for 49% of new cases of HIV (http://www.diversityinc.com/public/2790.cfm). In 2004, the last year such data is available from the Centers for Disease Control (CDC), HIV infection was:

• the leading cause of death for black women aged 25–34 years;
• the 3rd leading cause of death for black women aged 35–44 years; and
• the 4th leading cause of death for black women aged 45–54 years.

I don’t know about you, but when I learned this, I was appalled! Our aunts, our sisters, our mothers….are dying. To truly make a difference, to keep more Black women from being affected by HIV/AIDS, we have to educate ourselves about behaviors that contribute to the spread of this disease. I am contributing to this blog to educate others about a behavior that increases women’s risk of contracting HIV. There are many behaviors which contribute to the spread of HIV/AIDS. The most common of these are having unprotected sex and intravenous drug use. Safer sex, or always using condoms, and other latex or plastic barriers, is the best way to prevent the transmission of HIV when engaging in vaginal, anal or oral sex. By using new needles (clean works), intravenous drug users can reduce their exposure to the virus that causes AIDS. Today I chose to write about a situation that most people probably do not associate with the spread of HIV. That situation is domestic violence.

Research has shown that women who are physically and sexually abused are more likely to contract HIV. Women in relationships with violent men rarely have the power to resist when their mate initiates sex. A woman who depends on her partner economically cannot afford to jeopardize her relationship even when she suspects that her mate may be living with HIV or another sexually transmitted infection or has multiple sexual partners.¹ Women in relationships with violent men are also rarely in a position to insist that their mate use a condom. This imbalance of power prevents women from reducing their risk and results in them being more likely to contract HIV.

So what can women in situations like these do to get help? There are many organizations that provide resources for women experiencing domestic violence. Two of these are The National Domestic Violence Hotline (1-800-799-SAFE and http://www.ndvh.org/), and the National Coalition Against Domestic Violence (http://www.ncadv.org/). Both organization’s website includes information for women in violent relationships.

Women who are living with HIV/AIDS are actually at a greater risk for domestic violence because of their HIV status. More than one in five women with HIV are physically harmed after being diagnosed. Of these women, almost half said that they felt that the physical aggression they suffered resulted directly from another’s anger about their HIV status² .

It is really a shame that a woman cannot tell a partner her HIV status without being afraid that she will be physically hurt by him or her. While most domestic violence involves men assaulting women, it can also involve men assaulting their male partners, or women assaulting their male or female partners. Domestic violence is more common in the lesbian community than was formerly believed².

I did, however, find some great tips, provided by The Well Project: Domestic Violence and HIV, for women about disclosing their HIV status:

• Avoid exposing others to HIV without telling them, ahead of time, of your HIV status. The risk of violence may be greater if a person feels you knowingly put them at risk or lied to them.

• Disclose your HIV status in a semi-public place, like a public park with many people around. Pick a location that is private enough to have a conversation, but public enough to get help if you need it.

• Consider disclosing your HIV status with a third person present, like a friend or a health professional.

• If you feel at all threatened by a person’s reaction to knowing your HIV status, keep meetings with this person public for a few weeks.

Well, I hope the information I have provided will spark your interest and inspire you to start a dialogue with a friend, a co-worker, or even someone you may be sitting next to at the hair dresser. Tell that woman what you have learned. Every conversation about how to prevent HIV/AIDS counts. You never know, you may be saving a life.

I will leave you with a few websites as resources on AIDS and domestic violence.

• ¹The Women’s Human Rights Program at The Advocates for Human Rights: Stop Violence Against Women - Domestic Violence, HIV/AIDS and Other Sexually Transmitted Infections:
  http://www.stopvaw.org/Domestic_Violence_HIV_AIDS_and_Other_STIs.html
  
  
• Pan American Health Organization: Gender Based Violence and HIV/AIDS
  http://www.paho.org/English/ad/ge/Viol-HIV_FS0705.pdf

• ²The Well Project: Article titled “Domestic Violence and HIV” by Sandra K. Trisdale, Ph.D.
  http://www.thewellproject.org/en_US/Womens_Center/Domestic_Violence_and_HIV.jsp
  
  
• Harvard School of Public Health: Literature Review on the subject of HIV/AIDS and Gender Based Violence:
  http://www.hsph.harvard.edu/pihhr/files/Final_Literature_Review.pdf
  
  
• The Body: Article titled “Women, Healthcare and Violence” by Carmen Retzlaff, MPH
  http://www.thebody.com/content/treat/art12224.html
  
  
• HIV/AIDS Among Women

http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm

HIV and Ethnicity-Based Health Disparities

Mina Rasheed | SisterLove, Inc. MPH Intern
Born and Raised in Atlanta, GA (briefly lived in New Orleans, LA). Graduated from North Atlanta High School.

Undergraduate School Experience: Graduated from Georgia State University in December of 2007 with a Bachelor’s of Science Degree in Exercise Science

Graduate School Experience: Master of Public Health Candidate 2010 at Morehouse School of Medicine; Concentration/Track- Health Education and Health Promotion

General Public Health Interests: Underserved populations; Physical activity in adolescents; Nutrition; Cardiovascular disease in older populations

Hobbies: Reading; Enjoying time with family and friends; Sports; Volunteering

Favorite quote: “Education is the passport to the future, for tomorrow belongs to those who prepare for it today.” Malcolm X

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This whole blogging thing is new for me and honestly I was a little intimidated by the thought of writing about HIIV/AIDS and reproductive justice. As far as I’m concerned, who would want to read my thoughts on these issues? Who am I? What insight can I provide? I’m just a graduate student, certainly not an expert in the field -- yet. But then I thought about it. It’s not always the expert who has the most impact in a community. Often it’s the person with a real connection to a community who has the most impact. With this in mind, I warmed to the blogging idea.

My blog is in no way meant to provide expert advice. It is just a way for me to share my thoughts and passion about the health of minorities and other underserved communities. I intend to share what I have learned, and am learning, and provide insights that may be new with others.

My specific interests in public health stem from my family history of chronic diseases; these have included chronic obstructive pulmonary disease (COPD) and diabetes. I’ve watched as those debilitating diseases have affected not only my family members but also friends and others in my community. After learning that African Americans are disproportionately affected by many devastating disorders, I was compelled to find out why. Why are African Americans more susceptible to certain diseases than other populations? Why don’t we have adequate access to health information and care? Why are we less likely to get diagnosed with certain diseases yet more likely to die from them when we are diagnosed? Why us? So many questions plagued me.

The medical community has long reported that African Americans are more likely to be diagnosed with many unhealthy conditions and diseases. This list includes high blood pressure, obesity, diabetes, certain cancers, stroke and, for over a decade now, HIV. The statistics are frightening. The Black AIDS Institute, the first Black HIV/AIDS policy center dedicated to reducing HIV/AIDS health disparities, reported that in 2006:

• AIDS remained the leading cause of death among Black women between 25-34 years of age and was the second leading cause of death among Black men between 35-44 years of age;

• In the 33 states with mature HIV reporting systems, Black women represented 65% of new HIV/AIDS diagnoses among women in 2006; and

• Black women are 23 times more likely to be diagnosed with AIDS than white women.

Is it too much to ask for a healthcare system that provides equal care to all regardless of race, gender, class, socioeconomic status, or health status? Is it too much to ask for a healthcare system that responds to the frightening health statistics shared above? Are we so focused on protecting the profits of health insurance and pharmaceutical companies that we neglect to provide adequate care? I could continue with this laundry list of questions.

The sometimes daunting, yet exciting, task for me and other health professionals is figuring out new ways to remedy these problems. Increasing awareness of the ethnicity based disparities that characterize the AIDS epidemic is a step in toward addressing and reversing these disparities.

It is imperative that health care delivery be restructured to deal with sexual and reproductive justice issues that affect African-American women. According to the article, Can Cultural Competency Reduce Racial And Ethnic Health Disparities? A Review And Conceptual Model, the authors suggest that racial and ethnic minorities have been linked to a lower likelihood of having a regular source of care, fewer physician visits, and lower total health-care expenditures. There are also studies that illustrate that along with improvements in economic and social conditions, and physical environments, appropriate implementation of sound cultural competency techniques in delivering health services could go a long way toward reducing these health disparities. Having health care professionals that are culturally competent can lead to a better understanding between the patient and the provider which, in turn, can cause the patient to be less apprehensive to medical advice and procedures. I also encourage including more lay health workers from the community who are properly trained by health care professionals to address sexual and reproductive justice issues. Most people will be more receptive to someone they know or who at least looks like them in comparison to a physician or other provider. For example, a woman may be more encouraged to get tested for HIV if someone they know expresses his or her concern about the issue.

Many interdisciplinary health care strategies can be used to address sexual and reproductive justice issues. Religion is a major part of the African-American community and I think it’s important for it to be tapped into as a resource for disseminating health information. More hospitals and health care organizations need to begin partnerships with places of worship in order to make women aware of sexual and reproductive justice issues. Places of worship are great venues to the message across to many women and men of different ages and backgrounds. Partnerships between places of employment and health care providers are also great strategies. Providing free counseling to women who are being abused or workshops on prenatal care in places of employment can be a channel to educating more women.

Not only are the aforementioned suggestions useful for helping to decrease health disparities in our minority and underserved communities, but this blog itself is also a step in the right direction. The media, including television, radio, and internet, can join with the health care systems as advocates for sexual and reproductive justice. By bringing these issues to the forefront and making it accessible to countless numbers of people, I hope that I have contributed to increasing awareness about health disparities and provided some useful information about ways to reverse their effects.

References
Brach, C., & Fraserirector, I. (2000). Can Cultural Competency Reduce Racial And Ethnic Health Disparities? A Review And Conceptual Model. Medical Care Research and Review , 57 (1), 181-217.
Fiscella, K., Franks, P., Doescher, M., & Saver, B. G. (2002). Disparities in Health Care by Race, Ethnicity, and Language Among the Insured. Medical Care , 40 (1), 52-59.

Reproductive Justice and HIV: They are Not Going Away

Dahlia Bell | SisterLove, Inc. MPH Intern
Dahlia Bell has been on the front lines of advocacy and activism for HIV/AIDS and the community well before relocating to the Atlanta area in early 2004. Originally from the state of New York, Dahlia was born in Poughkeepsie and raised in Middletown, about an hour from the heart of New York City. Dahlia graduated from Vassar College with a degree in Psychology and a Correlate Sequence in Africana Studies. She recently worked for AID Atlanta, Inc., providing comprehensive case management and educational services to women affected by, and living with, HIV/AIDS. She is currently contracted with The Children and Teenager's Foundation, Inc. to provide in-home behavioral counseling and therapy to at-risk youth and their families. Dahlia presently holds the position of Project Manager and Coordinator with Faith Christian Center, Inc. and Andre Butler Ministries headquartered in Atlanta. She is also pursuing her Masters of Public Health Degree from the Morehouse School of Medicine in Atlanta, Georgia, where she resides.

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When I agreed to blog for SisterLove, I was both excited and frustrated. I was excited because I would finally have a place to share information and express my thoughts and feelings about HIV/AIDS and women’s health — two topics I am very passionate about. I was frustrated because I knew that I had so much to say but didn’t know where to begin. How would I find my voice? If, or when I did, who would want to listen? Would my words make a difference? Despite my anxiety, my passion for these topics forced me to move beyond my fear.

After an interesting conversation with two guys, both about my age, I suddenly knew where to begin. I talked with them about my work with women living with, and affected by, HIV/AIDS. One of them asked a question that I often get whenever I tell people that I have worked in an AIDS clinic. He wanted to know if the women with whom I worked still had sex, got married, and had children. When I told them that my clients led normal lives that often included sexual relationships, marriage, and healthy children, they both seemed amazed. The one who had asked the question openly expressed his disgust at the thought of women with HIV/AIDS having sex with people who were not infected. My other friend was also disgusted. And then it happened. One of the guys said that he wished there was a way to force HIV-positive women to tell everyone about their HIV status so that people who were not infected could avoid them. Even though I have heard this before, I couldn’t believe that I was hearing it again. Hearing it again in 2009 when so much progress has been made since HIV first appeared on the scene 26 years ago. He actually suggested that women with HIV/AIDS didn’t have a right to keep their status confidential. As I said, I have heard such things before, mainly from those who are not infected, and mainly from men. It’s as if women with HIV/AIDS are no longer human beings, no longer capable of loving, no longer worthy of being loved. It’s as if they’re damaged goods who serve no place in society except as objects of public humiliation. Injustice always follows this type of ignorance.

Should women living with HIV/AIDS be allowed to maintain healthy sexual relationships (regardless of their partner’s HIV status), birth children, and have the right to control their reproduction? Just imagine a male legislator, or even a female one, feeling as my male friends. Such beliefs and prejudices could lead to legislation that forces people to reveal their HIV status or takes funding away from organizations that work with people with HIV/AIDS. We can’t afford to take this kind of ignorance and prejudice lightly. This type of blatant discrimination would seriously affect women who are already facing major health challenges and hinder organizations dedicated to serving them.

My conversation with the men led me to think more about women, HIV/AIDS, and reproductive rights. The rate of HIV and AIDS among women, particularly African American women, is rising steadily and does not seem to be slowing down. We have to accept that we can’t consider how AIDS affects women without also considering that AIDS is an issue of reproductive justice. The term, reproductive justice, is relatively new, having appeared in the past few years. It was coined by a group of Black female activists to acknowledge the many issues that are related to women ’s sexual and reproductive health and rights. It was important to these activists that we all understand and acknowledge that achieving reproductive justice must involve challenging racism, sexism, gender and ethnicity based health disparities, economic injustice, and human rights violations that affect the lives of women all over the world. In looking at reproductive justice it is obvious that HIV/AIDS is most definitely included.


Reproductive injustice, particularly in regard to women infected with, and affected by, HIV/AIDS, is not going away any time soon. To bring about positive change we need more opportunities to talk openly about the rights of women, especially as it pertains to their positive or negative HIV status. I am not angry with my friends for how they feel. I know that too many in our society already feel the same way and will continue to feel this way. I hope that the information I shared with my friends caused them to reconsider their attitudes and beliefs, and maybe even left them with a different impression of HIV-positive women. I hope they now understand that an AIDS diagnosis is not a mark of shame and that being diagnosed does not change your status as a human being. I hope that others in our society engage in similar conversations. I hope that those living with HIV/AIDS are no longer isolated and ostracized and feel safe to manage their diagnosis without fear of injustice. We can’t leave it up to organizations like SisterLove and AID Atlanta to shoulder the responsibility to change our world and fight for justice. We each have to do our part. Every conversation and every action contributes to change. The recent 2008 presidential election reminded us of the power one person can have to change a social condition. I took the time to educate my male friends. It didn’t seem like a big action at the time but now I see that it was a step, a positive step, toward the change that we need.

The Miseducation of HIV/AIDS and Breastfeeding: What is the Risk?

Ayanna Robinson | SisterLove, Inc. - MPH Intern

Ayanna Robinson was born and raised in Cincinnati, Ohio. She moved to Atlanta in 2003 to attend Spelman College. As a Biology major, she enjoyed learning about the different systems in the body, including the reproductive system. She combined her passion for biomedical research with her desire to serve her community and decided to attend Morehouse School of Medicine. At Morehouse School of Medicine, Ayanna is enrolled as a first year Master of Public Health (MPH) student with a concentration in Health Education and Health Promotion. A vegetarian for twelve years, her public health interests revolve around chronic disease and diet/nutrition. With an upbeat outlook on life, her motto is “All that we are is the result of what we have thought. The mind is everything. What we think is what we become.”

While I am open to embarking on all new, positive, and enlightening experiences, in this lifetime I can honestly say that I never imagined myself blogging for reproductive justice. And actually, before coming on board with SisterLove, I wasn’t exactly sure what reproductive justice was or even all the topics that it includes. So this will be an interesting journey. I will forewarn that as a mother of a beautiful baby girl, barely past her first year of life, and as a graduate student in the field of Public Health, 86% of my thoughts naturally turn to motherhood or school. It work likes this -- someone says “blog about reproductive justice”. I immediately think “breastfeeding”. Then from a public health stand point I think of promoting breastfeeding because of its benefits to mommies and babies. And because of my work with SisterLove I realize it is important to recognize the tie between “breastfeeding” and “HIV/AIDS”. And so, the plot, along with my mission, thickens.

Considering the many benefits of breastfeeding, I’ve always wondered why many minority women, especially African American women, opt not to breastfeed. With the proper information and a strong support network, I’m sure more women would choose to breastfeed. That’s my public health side coming out. But then I remember another group of women who, despite their personal preferences, would never get the chance to -- or have a reasonable option to -- breastfeed at all.

Until now, I never questioned or gave a second thought to the CDC, World Health Organization, and other medical experts’ advice that mothers living with HIV or AIDS should not breastfeed and should seek alternative/”safer” methods for feeding their babies. So for me and the rest of American society, women living with HIV and AIDS do not have the choice, or right, to breastfeed. Some recent studies, however, question the risk of mother to child transmission of HIV through nursing.

In many developing countries, infant formula is not readily available. Formula can’t be found ‘within the walking distance’ like it is in the U.S.. Or, better yet, formula isn’t affordable or culturally acceptable. And even when infant formula is available, it may not be a safe alternative because of the lack of water, or the lack of an uncontaminated water source. For these reasons there are many mothers with HIV and AIDS living in less industrialized nations who breastfeed their babies, despite medical warnings regarding HIV transmission. So the question remains, how risky is it for HIV-positive women to breastfeed?

Early research showed that breastfeeding increases the risk of mother-to-child transmission of HIV. The most often cited source for this conclusion, which is used to drive home the recommendation against breastfeeding for mothers with HIV or AIDS, is a study published by Dunn in 1992. However, in this study “breastfeeding” was not clearly defined. Other researchers have distinguished “exclusive breastfeeding” (defined as a diet consisting solely of breast milk) from a “mixed feedings” diet which is one that consists of breast milk and formula. Recent studies actually show that there is no additional risk of mother to child transmission of HIV if the baby is exclusively breastfed in comparison to not being breastfed at all (Coutsoudis et al, 1999). A study done in South Africa showed that by 6 months, babies who had been exclusively breastfed for 3 months still had lower rates of infection (18%) than never breastfed (19%) or mixed fed babies (26%) (Coutsoudis et al, 1999).

Some breastfeeding advocates now argue that exclusive breastfeeding should continue to be promoted for the first six months of life, despite the mothers’ HIV status. Breastfeeding gives the babies all necessary nutrients, builds a healthy immune system, and decreases the risk of developing certain disorders. But from a public health standpoint, prevention is definitely important when confronting HIV/AIDS and there is still a risk of transmitting HIV when breastfeeding. While I don’t believe that this newer research should cause HIV positive mothers to completely disregard warnings given by medical experts, I do believe that mothers should be properly educated on the risks and benefits of breastfeeding so that they can make the best decision for themselves and their babies. The inconsistencies in research, especially when it comes to clearly defining methods of “breastfeeding”, and the lack of available and accessible feeding options when alternative feeding methods are recommended, limit women’s right to make an informed choice.

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Sources:

Coutsoudis, et al, (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study, The Lancet 354: 471-6. See also correspondence in The Lancet 354: 1901–4.

Dunn, et al (1992) Risk of human immunodeficiency virus type 1 transmission through breastfeeding The Lancet 340: 585-8.

Pamela Morrison, IBCLC. Mothers and Babies and HIV: What is the Risk of Breastfeeding? AnotherLook. http://www.anotherlook.org/papers/e/index.php