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.