Women, HIV and stigma

The stigma associated with HIV has existed since the epidemic’s beginning. Stigma is a mark of disgrace, a characteristic of shame or dishonour. HIV stigma comes from a fear of the illness, becoming HIV positive, the risk activities connected with transmission and/or from the lack of information around HIV. Stigma can be found in the general public, with friends and family, social service and health care professionals. It is prevalent, it is pervasive, and it greatly influences the daily lives of those living with HIV.

All people living with HIV experience stigma, and women are no exception. In 2009 women accounted for 26.2% of all HIV positive test results in the country, a significant increase in comparison to the rate of 11.7% prior to 1999.

Recently, the Times Colonist (a Victoria newspaper), ran this article about one woman’s battle with HIV related stigma. Of course the woman featured in this article was so fearful of stigma that her name had to kept anonymous. “Having this stigma is so anguishing” she shared, “it takes away some of the quality of life”. Not only her own quality of life, the woman expresses concerns about the possible quality of life for her family. As sole breadwinner her employment is critical and she would not run the risk of informing her boss about her status.

These concerns are comment among women living with HIV and we cannot talk about women without talking about the impact that HIV related stigma has on their families. What happens to women also happens to their families, and passing the stigma associated with being HIV positive onto their family can be a key concern for positive women. Women may also worry about the stigma associated with having children as an HIV positive women, and their reproductive choices might be challenged as family, friends or professionals  limit their options to conceive.

The stigma associated with HIV is underpinned by many factors, and women, as an already marginalized group, experience unique overlapping levels of stigma. Stigma limits access to treatment and supports, increases isolation and decreases the overall health and wellness of those living with HIV.

 Each person living with HIV will have a distinctive experience and understanding of the way stigma has influenced his or her life. So, how can we help combat stigma? One of the easiest and best ways to fight stigma is to simply be informed. Arm yourself with knowledge about HIV and how it is transmitted. The next step is to be prepared to share that information with others. AIDS Calgary has lots of resources, if you want to know more about anything HIV related please get in touch.

References:

CanadianAIDS Society

Stigma and coping strategies among HIV-positive women are complex and overlapping  

An avoidable transmission

UNAIDS:  https://www.unaids.org/en/media/unaids/contentassets/dataimport/publications/irc-pub06/jc999-humrightsviol_en.pdf

Alberta Positive Voices Conference

The Alberta Positive Voices Conference (APVC) is a bi-annual event that brings together people living with HIV/AIDS from across the province to learn about better health management and new advances in the pandemic while providing opportunities to form networks of friendship and support. Current estimates show that over 71,000 Canadians have HIV/AIDS, including more than 4,000 Albertans. This year’s conference, Back to our Roots; Building our Future, will be held March 15-17, in Nordegg, Alberta and it will bring together 100 people living with HIV/AIDS and their spouses/partners for what has been described as a life changing experience.

This APVC is unique because it is planned and delivered by people living with HIV/AIDS for and to people living with HIV/AIDS. Positive individuals participate at all levels; as planners, committee members, speakers and attendees. Positive Voices epitomizes the MIPA principle: the meaningful involvement of people with HIV/AIDS.

The APVC was first started in 1999; hosted and organized by Living Positive and held at the Grey Nuns Centre in Edmonton. From that time through today it has been hosted by HIV Edmonton, Central Alberta AIDS Network, Wood Buffalo HIV Society and AIDS Calgary with growth at each event to impact positively on the lives of over 700 Persons Living with HIV/AIDS in Alberta.

The APVC is funded through the Alberta Community Council on HIV and additional funders and donors and hosted for 2013 for the first time by Lethbridge HIV Connection. The APVC all inclusive scholarship provides transportation to the conference and back via Calgary, Edmonton and Red Deer pick up locations and includes all meals, snacks, conference supplies and accommodations.

The APVC works to break isolation, foster self-esteem, growth and understanding of living with HIV/AIDS while building the capacity of future leaders living with HIV/AIDS to better inform policy and services, break the isolation created by HIV stigma and discrimination and build personal advocacy skills in PLWHIV/AIDS in Alberta.

The APVC is currently accepting abstract submissions for the conference, seeking additional sponsors and donors to provide the best experience possible.

For additional information contact:
Mark Randall: bakrboy@hotmail.com
Phone: 403-669-9936
Fax: 403-263-7358 – APVC Committee Chair

  

Supreme Court of Canada Clarifies HIV Non-disclosure and Canadian Criminal Law

The following article was written by AIDS Calgary’s Community Engagement Coordinator.

On October 5th, 2012 the Supreme Court of Canada (SCC) released a judgment regarding the criminality of HIV non-disclosure to sexual partners. Since its 1998 ruling in the Henry Gerard Cuerrier case, the onus has been on persons living with HIV to disclose their HIV+ status to sexual partners where there was a ‘significant risk of bodily harm’. The charge most often pursued when a complainant came forward was that of either sexual assault or aggravated sexual assault under the Criminal Code of Canada. These are extremely serious charges and can lead to life in prison. The legal test of whether or not sexual relations between people posed a ‘significant risk of bodily harm’ had become interpreted and applied differently in each of over 130 cases prosecuted before Canadian courts. The result was significant differences of opinion between lawyers, judges, doctors, and those living with HIV about what constituted a ‘significant risk of bodily harm’. Some of the prosecutions ended in guilty verdicts while others saw verdicts of not guilty being delivered.

During the 14 years since Cuerrier science and medicine have revolutionized the treatment for HIV to such an extent that a person can have a ‘low’ or even ‘undetectable’ viral load. Although the HIV is still in the body, the amount of the virus is tremendously diminished, which logically implies that so too is the significant risk of transmission. The HIV is still present, but can be so in a much reduced amount if anti-retroviral treatment is ongoing. The SCC’s ruling has taken into consideration this advancement of science and medicine.

The Supreme Court of Canada concluded in its decision:

…………”that the Cuerrier requirement of ‘significant risk of serious bodily harm’ should be read as requiring disclosure of HIV status if there is a ‘realistic possibility of transmission of HIV.’ If there is no realistic possibility of transmission of HIV, failure to disclose that one has HIV will not constitute fraud vitiating consent to sexual relations under [Criminal Code of Canada] s.265(3)(c).”

The highest Court in the land goes on to state that “a realistic possibility of transmission of HIV is negated if: (i) the accused’s viral load at the time of sexual relations was low, AND (author’s emphasis) (ii) condom protection was used.” This decision has inspired many to weigh in with their opinion. Some are not supportive (Canadian HIV/AIDS Legal Network) and some are supportive, as is the community member’s opinion that follows:

Contrary to many people’s disagreeing responses, I happen to like the Supreme Court of Canada’s ruling. First, the Court has recognized that the ‘significant risk of bodily harm’ cannot mean any risk, however small. Second, the values of autonomy and equality enshrined in the Canadian Charter of Rights and Freedoms support respecting the interest of a person to choose whether to consent to sex with a particular person or not. Third, I believe the decision will encourage citizens to seek testing for HIV. I am convinced that prior to this ruling, people intentionally did not get an HIV test fearing it would be positive and they would be legally compelled to disclose their HIV+ status to sexual partners. Now, I believe more people will get HIV testing and if a positive result ensues, then they will seriously discuss with their doctor whether or not to begin medications. Regular medical check-ups will monitor viral load which, with medications, can be ‘low’ and likely ‘undetectable’. Someone who knows their status, their viral load is low, and uses condoms consistently will know that the law’s view is clear: there is no ‘realistic possibility of transmission of HIV.’ I see the decision helping all persons living with HIV in Canada feel equal before the law, despite what others might think.

Lets Talk About Online Disclosure

ACAA had the opportunity to share a fantastic video from one of our volunteers. The video details his own personal story of being a young gay man living with HIV and the stigma he faces regarding online disclosure. We are very proud of this individual for sharing his story. We hope you enjoy it!



The views and opinions expressed in this video are soley those of the original authors and other contributors. These views and opinions do not necessarily represent those of AIDS Calgary Awareness Association, the staff, and/or any/all contributors to this site.

"It's never just HIV": Thoughts on the controversial NYC Health Department's Public Service Announcement

People are talking! There have been controversial discussions about the new public service announcement (PSA) “It’s Never Just HIV”(click here to watch).

This PSA was released by the New York City Health Department to target gay men with the goal of increasing condom use. It features graphic images depicting what health conditions could be developed as a result of living with HIV.

The New York City Health Department has evoked a lot of emotionally charged opinions through this PSA, which are divided by those who agree with the graphic message and those who strongly oppose it. Those who are for the PSA’s messaging style feel that it is an effective educational tool as it strongly promotes prevention. Many believe an HIV PSA message should be in your face, as HIV is a serious disease. Some long term survivors and individuals who lost friends to the virus in the early days, believe that younger generations are not scared of contracting HIV anymore, that the fear of contraction has been lost. Advocates for this PSA also believe that indulging the perception that HIV is easily manageable needs to be examined, because living with HIV and taking medications is not really that easy at all.

Other arguments which defend this PSA believe that scare tactics and fear based messaging actually helped to change behaviors in the 80’s so why wouldn’t it work now? In their opinion, people should take HIV seriously, as seriously as presented in this PSA.

The opposing argument to the messaging strategy around “It’s Never Just HIV”, feel this ad is stigmatizing and demonizing. They believe the PSA singles out gay men and increases feelings of guilt and shame towards being gay and/or engaging in anal sex. There has been much discussion around the idea that effective prevention messaging should not engage in fear mongering, but instead go beyond condom use; there are much larger behavioral and societal issues that should be addressed when the dealing with why some individuals won’t use condoms. This group also believes the PSA creates a false sense of what it is actually like for people who are living with HIV and are able to live long, healthy lives. Those who oppose the harsh images and tone of the PSA also argue the ad will deter people from getting tested and could deter people living with HIV from taking their medications for fear of stigma and discrimination.

As an AIDS Service Organization who is engaged in prevention and support work, we at AIDS Calgary recognize there is a fine line of how to present certain messaging and engage our audience. It is important that people who are HIV negative understand the realities of living with HIV and how serious the effects of HIV are. On the other hand, it is important to promote that HIV has changed, it is no longer a death sentence and if you are living with HIV or newly diagnosed, there is every opportunity to live a full and healthy life.

This is a controversial subject and as a whole we’ve yet to figure out how to ensure both of these messages are being communicated and heard.

We’d love to hear from you! What do you think of the ad? Will the message work and promote condom use?

Sources:http://www.youtube.com/watch?v=d0ANiu3YdJg

This blog article was written by our Community Strategies Team Leader.

Equal Rights - A Letter to the Editor of the Calgary Herald

On March 11, 2011, the Calgary Herald published "Ottawa says it’s not obligated to protect prostitutes". In response to this article AIDS Calgary Awareness Association submitted a Letter to the Editor of the Herald, which has been published in today’s paper. However, due to space restrictions only a partial version of the letter has been printed. Below is a full version of our rebuttal to this issue.

The federal government has made claims that it is not obligated to protect a section of the population, this is not only frightening but these claims encourage notions of stigma and segregation. This denial of protection from our government is a violation of sex workers basic human rights and instills the idea that because a person is a sex worker, they deserve any mistreatment or abuse they incur in their profession.

As members of the Canadian work force, we are afforded the right to work in a safe
environment, with our general health and well-being protected by various governmental and social organizations. True, sex workers enter into their trade with known obstacles and dangers; however, so do many other professionals, including police officers, health care professionals and manual labourers. It is our human right as Canadians which allows us to be treated and protected equally.

Prostitution is legal in Canada, although due to its criminalization under sections 210-213, sex workers are not afforded the same rights to their chosen profession as the rest of the work force. There is also a double standard among the criminalization of sex work, where it is legal to have sex on camera and get paid for the purpose of Adult Films, be an exotic dancer and work in an erotic massage parlor. It is unfair to separate how one part of sex work is more acceptable from the other, which leads to further segregation and stereotypes.

Our government should acknowledge the criminalization of prostitution only encourages violence and abuse towards sex workers by forcing them to work alone and in isolated and dangerous areas. This isolation, and fear of criminal charges, prevents sex workers from properly screening dates, communicating to fellow sex workers information about dangerous clients or negotiating safer sex and prohibits them from accessing proper health education and services.

The most horrific part about Ottawa saying it is not obliged to protect sex workers is that it sends the message that endangering a sex workers safety is acceptable as they are knowingly putting themselves at risk. What about the multiple sex workers who were brutally murdered by Robert Pickton? Should those women’s lives be valued less because of the work that they do?

To read the Calgary Herald version, click here.

Great Opportunities and Community Strength

My role as AIDS Calgary’s HIV Education and Awareness Today (HEAT) outreach worker, has afforded me many great opportunities to connect with other Gay, MSM and Trans men outreach workers from across the country. For example, most recently HEAT was recognized on a national level and I was invited to participate in two National Advisory Groups (NAG). The role I have accepted will involve the development of a survey which will be distributed to Gay, MSM, and Trans men across the country. Unfortunately, due to my overwhelming schedule I couldn’t accept both roles, so I was able to connect my Edmonton counter part with this opportunity instead. With the participation of representatives from both Calgary and Edmonton, Alberta is a well represented voice to both NAGs looking at Gay, MSM and Trans Men’s issues on a national level. The participation in both of these NAGs also allowed my Albertan counterpart and I the opportunity to attend the Gay Men’s Health Summit presented by the Gay Men’s Sexual Health Alliance and partner organizations.

This conference was a great opportunity to network with other Gay, MSM, and Trans men’s community outreach workers and organizations, and also provided a platform for educational resources. A few workshops that I was able to participate in were: “Integrating Trans Men into HIV prevention”, “Closets, Companions, Challenges: Seniors, Sex and Sexuality” and “Community Engagement through New, Mobile & Social Media”.

All of these workshops were allowed for dynamic discussion and interesting perspective. My personal favorite being the “Community Engagement through New, Mobile & Social Media”, where we learned about the iPhone application developed for accessing various health services in Toronto and Montreal, and eventually to be launched in Vancouver.

The remainder of the conference included subject specific presentations from individuals and organizations. These presentations were followed by an expert panel discussion and break out groups which focused on challenges and answer questions. Each presentation wrapped up with an open floor question period for participants to further explore the issues and discussions that evolved from the session.

Some of these presentations looked at very specific topics such as the “Gay Agenda Revealed”, “Challenges from the Bathhouse”, “Black and Queer: Contradictions and Paradoxes in Gay Men’s Culture”, “Masculinity and Queer Identities” and “Syndemics, Resilience and Gay Men’s Health”. These presentations looked at the past, current and future challenges, stigmas and lack of services in Gay, MSM and Trans Men’s health.

I left this conference exhausted and at the same time incredibly empowered and connected to other great Gay, MSM, Trans men’s organizations and service providers from across Canada and US. Although I feel Gay, MSM and Trans Men are still challenged by many stigmas (societal and self imposed) within our country, conferences like this one highlight that there are incredible programs in place and future programs in development that support and strengthen our community. This strength will allow us to start addressing Gay, MSM and Trans Men’s health for all that it is; the heart, mind, body and soul and not just the area between our knees and belly button.

This article was submitted by the AIDS Calgary HEAT Program Coordinator. HEAT (HIV Education and Awareness Today) is a program designed to address HIV/STI education, awareness and prevention in the gay men/MSM community.

International Sex Workers Rights Day

March 3rd, 2011 will mark the 10th annual International Sex Workers Rights Day. This event originally began in India when thousands of sex workers gathered at a sex worker festival. At the time, the members of this group wanted people to realize that sex workers in third world countries are no different from ones in first world nations. Sex workers in this group wanted their voices to be heard and their rights to be respected. Since that event, sex worker groups around the world began to mark that day, naming it the International Sex Workers Rights Day. The Shift program understands the importance of sex workers rights, and utilizes a human rights based approach when working with people in the sex trade. When the Shift program first developed in 2007, Shift has annually observed March 3rd as a way to honour the rights of sex workers everywhere.

In preparation for this year’s International Sex Workers Rights Day, Shift has put together a committee comprised of community members and sex workers. The committee’s intent for this year’s event is to bring awareness to community members about the rights of local sex workers. The committee has hired Antyx, (formerly known as All Nations Theatre) to perform short, interactive scenes that will examine the common stereotypes, misconceptions, and human rights violations that sex workers are constantly faced with. The performance will be used as a means to begin a dialogue amongst community members and provide a platform for deeper discussions about this often misconceived topic. The committee hopes that the interactive theatre will raise community awareness, as well as inspire a shift in perception around stigmas attached to sex work.

The event will be held on Friday March 4th from 7pm-9pm at the Eau Clare Market community space-202, 200 Barclay Parade SW
Calgary, AB T2P 4R5.

If you would like more information contact Shift: (403) 237-8171.

This article was submitted by an AIDS Calgary Practicum Student.

HIV and Domestic Violence

Different social determinants of health have been well known to affect the wellbeing of individuals living with HIV. Stigma, discrimination, and some religious/ cultural convictions as well as other factors have the potential to hinder one’s ability to access services to improve health and wellness. In Canada, and around the world, abuse has also received a lot of attention due to the outcomes it is associated with. Abuse within this context includes; physical violence, sexual abuse, emotional abuse, neglect, and financial/economic abuse.

Researchers at the University of Calgary conducted a study to identify the impact of domestic violence victimization on people living with HIV. The study was conducted with 853 patients of the Southern Alberta Clinic (SAC). 34% of patients reported experiencing abuse. Of those, more than half reported childhood abuse or abuse within a previous relationship. 16% reported abuse within their current relationships (Siemieniuk, Krentz, Gish and Gill, 764).

Results from the study confirm the link between abuse and HIV infection in developing nations. Previous studies indicate that women who experience different forms of abuse have higher mortality rates (763). They were also more likely to engage in high-risk activities including: multiple concurrent sexual partners, unprotected sex and injection drug use.

Victims of violence typically delay accessing services from health care providers. Of the study participants, 27% accessed services from SAC more than 90 days after the time of diagnosis compared to 19% of people who reported no abuse (765). It is also important to note that people experiencing abuse were also more likely to miss scheduled doctor appointments. Once in care, they requested more personal support and social work services than their non-abused peers (765).

Some other key findings from the study suggest that women are not the only group at risk. Gay and/or bisexual men and Aboriginal people are disproportionally represented among people experiencing abuse (767).

Results from the study suggest there is a strong relationship between domestic violence victimization and HIV. The impact of domestic violence on individuals leads to poor health outcomes such as mental health disorders and an increased use of medical resources (768). Domestic violence screening is an important first step to identifying individuals who may be suffering from abuse and its consequences. This will enable HIV caregivers to facilitate the most appropriate intervention for each client.

Works Cited
Siemieuniuk R., Krentz, H.B., Gish, J.A., Gill, M.J. “Domestic Violence Screening: Prevalence and Outcomes in a Canadian HIV Population. Aids Patient Care and STDs 24.12 (2010) 763-780

Additional Resources
Intimate Partner Violence and HIV/AIDS

This article was submitted by an AIDS Calgary Outreach Worker.