No (wo)man is an island…and neither is Britain when it comes to violence and HIV

sophiaEmma Bell, Susan Bewley, Silvia Petretti, Lynda Shentall, and Alice Welbourn.

Intimate Partner Violence (IPV) [1], increases the vulnerability of women and girls to acquiring HIV. Research from Asia, Africa, Latin America, and now the UK shows that gender based violence, of which IPV is one part, is also experienced by women with HIV—often precipitated or exacerbated by discovery of their HIV status. Indeed, even the seemingly benign offer of testing for HIV in pregnancy is, itself, potentially dangerous. Pregnancy alone is an established risk factor for partner violence and femicide and there are many international reports of women being beaten or raped by their partners upon an HIV diagnosis. They may be thrown out of their homes, lose custody of their children, have their confidentiality violated and have nowhere to turn for support. Such violence, be it psychological, physical, sexual, financial, or legal is devastating. But additional institutional violence from healthcare settings also happens.

In Indonesia, sub-Saharan Africa, Chile and beyond, women with HIV have experienced forced or coerced sterilization. Last August, the Namibian High Court upheld a claim against its Ministry of Health, lodged by five courageous women with HIV, who had discovered that they had been sterilised post-partum. The court pronounced that no woman should be subjected to signing such sterilization documents during labour. Since this landmark decision, other governments have taken notice of similar stories in their own countries, recognising severe unethical violations of women’s bodily autonomy and possible compensation claims. Less extreme challenges are also experienced here in the UK. Healthcare workers have refused to care for, and humiliated, women with HIV. A pregnant woman was asked last year why on earth she was pregnant when she had HIV, despite clear British HIV Association (BHIVA) guidelines. Many HIV service organisations have stories of women with HIV who experience intimate partner violence, wider gender based violence from family and community, and institutional violence in healthcare settings. Doctors need to take these shortfalls in compassion, caring, confidentiality, and human rights very seriously.

A small group of women with HIV presented a poster at the 2012 BHIVA conference, alongside clinicians from the Homerton Hospital presenting a paper that showed that over 50% of their female patients with HIV had experienced gender based violence. So, here too in the UK, violence and HIV are surely reciprocally linked, with women experiencing multiple layers of stigma that hinder their ability to seek care, treatment, and support. Yet to date, the Home Office Violence against Women and Girls strategy has made no mention of HIV. This silence must change. Women who test positive for HIV need to know their rights will be respected and that they will be supported and safe, everywhere. Moreover, as former UN High Commissioner for Human Rights, Mary Robinson, states, what happens in the West influences other jurisdictions’ actions—or inactions. So we need to get things right here urgently. Today the Sophia Forum launches a report in the House of Lords on experiences of gender based violence for women with HIV in the UK. We hope this will help us to catch up with the rest of the world’s awareness of these issues—and lead us to ensuring that women with HIV are safe.

Emma Bell, independent consultant, London.
Susan Bewley, professor of complex obstetrics, Kings College, London.
Silvia Petretti, deputy CEO, Positively UK, London.
Lynda Shentall, director of services, George House Trust, Manchester.
Alice Welbourn, founding director, Salamander Trust, London. Author for correspondence.

1. All authors are trustees of the Sophia Forum

We declare that none of us have conflicting interests with the contents of this blog, other than the professional and/or personal commitment of us all to address the issues therein.