Thursday, February 11, 2016
According to the Center for HIV Law and Policy, women living with HIV statistically tend to be poor and women of color. These and other women living with HIV, face multiple societal and cultural barriers, and are further stigmatized because of their HIV status. Women face barriers that men with HIV do not.
The interplay of the triple stigma is no more evident than in family court. At least one half of women living with HIV report being in or having been in an abusive relationship. They experience partners controlling their medication. In some cases, their HIV positive partners consume the medication rather then seek medical help on their own. Women who seek civil protection orders must consider the likelihood of the partner's "outing" their medical condition in open court or through public documents. Often women choose not to reveal their HIV status, trading critical testimony for either privacy or the abusive partner's silence. Jane Stover addressed the difficulties of HIV positive battered women in her article Stories Absent from the Courtroom: Responding to Domestic Violence in the context of HIV-AIDS. But not all of the legal challenges originate with abusers.
Mothers living with HIV face challenges in custody matters that HIV positive fathers do not. When women are infected, particularly women of color, courts are concerned with the cause of infection. Consistent with the cultural expectation of the "perfect mother", presumptions are made around women's sexuality, including promiscuity and sex work. Reproductive rights can be impinged by physicians not understanding that for medically treated mothers, transmission between mother and fetus is nearly impossible.
Women also can be encouraged to take PrEP, the relatively new medication that has proven effective in preventing transmission. But the drug's testing was done largely with the men who have sex with men. The research leaves unanswered questions of how the drug will impact women's hormonal systems as well as bone density. Little has been done to ensure the safety of children breastfeeding from mothers who take PrEP. And transgender women need studies separate from other women.
Two organizations that focus exclusively on the needs of women living with HIV are creating change. Positive Women's Network has conducted research on the barriers faced by HIV positive women and SisterLove assists women living with HIV in resolving their health care challenges, including reproductive health. The greatest health care challenge may be how to make health care and research systems gender inclusive when addressing solutions for those living with HIV.