Violence Against Women and HIV

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Most importantly: if you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the US at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)].

It is important to remember that, if someone threatens you, it is NOT your fault. You deserve to be treated with respect and to be safe. Often, women who have been abused have been humiliated to the point that they believe that they deserve whatever abuse comes their way. This is NEVER true.

Women, HIV, and Violence

According to the World Health Organization (WHO), violence against women (VAW) is a "global health problem of epidemic proportions." VAW refers to acts of violence directed toward women simply because they are women. These acts can include forms of physical, emotional, and sexual harm – or threats of harm.

VAW is extremely common, affecting as many as seven in ten women in some countries. The majority of women suffer violence at the hands of their husbands, intimate partners, or other men they know. Among women of reproductive age, "acts of violence cause more death and disability than cancer, malaria, traffic accidents and war combined. (Say NO)"

This violence has horrible consequences, both for women and their communities. Pregnant women who experience physical or sexual violence are twice as likely to have an abortion. Those who stay pregnant are 16 percent more likely to give birth to a baby who is low birth weight. Women who experience intimate partner violence are about twice as likely to experience both depression and alcohol abuse.

In March 2012, US President Obama established an interagency federal working group to look at the intersection of HIV/AIDS, violence against women and girls, and gender-based health disparities. This working group examined how violence against women and girls affects their likelihood of getting HIV and how they live with HIV. In the US, more than one in three women report having experienced rape, physical violence, or stalking in their lifetimes. Moreover, women living with HIV (HIV+) are much more likely to have experienced intimate partner violence than HIV-negative women.

In September 2013, the working group released a report of federal policy recommendations and action steps to address the intersection of HIV and violence against women. These include:

  • increasing screening for intimate partner violence and HIV among women
  • improving outcomes for HIV+ women by addressing history of violence and trauma
  • addressing factors that contribute to increased risk of violence among women living with HIV

There are several ways in which violence and HIV are connected for women. Women who are abused or fear a violent response may not be comfortable asking their partner to use protection during sex. Similarly, women in abusive relationships may not be comfortable saying no to sex if their abusive partner refuses to use protection when asked. Lastly, forced sex acts can cause cuts or scrapes that make it easier for HIV to enter the body. All of these can put women at higher risk for HIV, and make living with HIV more difficult.

Many women with HIV have a history of being physically or sexually abused before they found out about their HIV status. Several studies have shown that women with a history of physical and/or sexual abuse are more likely to become HIV+, especially if that abuse first started during childhood years. Childhood abuse is closely linked with later drug use, having multiple sexual partners, being with a male partner who is at a higher risk of HIV infection, and exchanging sex for drugs, money, or shelter. If a woman uses drugs, alcohol, or sex to escape the pain of prior abuse, she may be at increased risk of getting infected due to sharing needles and having unprotected sex. All of these factors place a woman who has been abused at a higher risk for getting HIV.

Many women may be at risk of abuse or violence because they tell their partner or the person they live with about their HIV status. One study revealed that over one in four women with HIV had been physically harmed since their HIV diagnosis. Therefore, it is important to disclose your HIV status safely (see below). Among women living with HIV, studies have also shown that trauma and violence are associated with poorer health as a result of reduced HIV drug use and decreased adherence.

Violence occurs more often in relationships in which there is a difference in power. Women living with people who are larger or stronger than they are may feel physically afraid. Also, women usually earn less than men and are more likely to be financially dependent on others. If the person a woman lives with is the one who pays the bills and provides her with a home, the woman may feel afraid, less independent, and in less control.

What Is Domestic or Intimate Partner Violence?

Domestic violence occurs when a person you are dating, living with, or married to is repeatedly harmful or threatening to you - physically, sexually, verbally, emotionally, or financially. The person doing these things will often do them to gain or keep power and control. "Intimate partner violence" is another term used to describe violence in which a current or former partner or spouse physically, sexually, or psychologically harms you.

Intimate partner violence can happen to anyone. It affects people regardless of age, race, gender, sexual orientation, education level, financial situation, or marital status. It is important to learn about how abuse happens, how to identify it, and how to end it or get away from it. If you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the US at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)].

It is important to remember that, if someone threatens you, it is NOT your fault. You deserve to be treated with respect and to be safe. Often, women who have been abused have been humiliated to the point that they believe that they deserve whatever abuse comes their way. This is NEVER true.

Intimate partner or domestic violence can take many forms. These include:

  • Verbal abuse (using words to put someone down or make them feel bad), threats, constant blame or criticism; all of these are emotionally abusive
  • Mild physical harm – like pulling hair or twisting flesh
  • Violent actions that leave marks – like hitting, slapping, pushing, beating, or throwing things
  • Extreme violence using knives or guns
  • Rape or sexual assault (being forced into sexual acts without your consent)

Domestic violence often begins with threats or emotional abuse. While these harmful words or actions may or may not lead to actual physical harm, they can still be very upsetting and scary, and leave long-term emotional scars.

While most domestic or intimate partner violence involves men assaulting women, it can also involve men assaulting their male partners, or women assaulting their male or female partners. Studies have shown that intimate partner violence can happen as often in same sex couples as it can in heterosexual couples.

Questions to Ask Yourself or Someone Who May Have Been Abused

Sometimes, it can be difficult to know if you or someone you know has been abused, because victims may confuse their partner's actions with a form of love or caring.

This list of questions might help you or someone you know identify the abusive actions of a partner or someone else in the home:

  • Do you ever feel unsafe at home?
  • Have you ever felt threatened by your partner, ex-partner, or other person in your home?
  • Are you in a relationship where you have been physically hurt?
  • Has a partner, ex-partner, or person you lived with ever:
    • Pushed, grabbed, slapped, choked, or kicked you?
    • Forced you to have sex or made you do sexual things you did not want to do?
    • Threatened to hurt you, your children, or someone close to you?
    • Stalked, followed, or monitored you (this includes checking your daily movements, emails, phone calls, and texts)?

Danger Signs in a Partner or Potential Partner

While there may not be any one profile or way to identify someone who is an abuser, you may notice your partner acting in one or more of these ways. He/she may:

  • Be overly jealous
  • Have big mood swings
  • Have an explosive temper
  • Have low self-esteem
  • Blame you for their own problems
  • Use words to make you feel bad about yourself
  • Try to control you
  • Try to keep you from your family or friends

Disclosing Safely

Sadly, many women with HIV are sexually or physically assaulted soon after they disclose their HIV status. Try to decrease this risk with the following:

  • Disclose in a semi-public place like a public park with many people around. Find a place that is private enough to have a conversation, but public enough to get help if you need it.
  • Consider disclosing with a third person present, like a friend or a health care provider
  • Meet only in public with that person until you feel safe
  • Avoid exposing others to HIV without warning them ahead of time. The risk of violence may be greater if a person feels you knowingly put them at risk or lied to them.

Decreasing Your Risk

There are no guarantees, but you can help lower your risk for domestic or intimate partner violence:

  • Most importantly, remember: if someone threatens you, it is NOT your fault. You deserve to be treated with respect and to be safe. Often, women who have been abused have been humiliated to the point that they believe that they deserve whatever abuse comes their way. This is NEVER true.
  • Do your homework. To find out information on the person you are dating (such as if he or she has a violent criminal record), consider doing a background check. There are a number of companies that provide this service for a fee. For more information, go to: http://publicrecordssearchonline.org/
  • Keep in touch with people who support you. Whether it is family, friends, a support group, peer advocate/counselor, or health care provider, do not let your relationship with any one person keep you from staying in touch with others.
  • Get help and support. If you have been physically or sexually abused in the past, it is important to get help from a mental health professional or a support group. Otherwise, the past may be more likely to repeat itself.
  • Avoid entering an abusive relationship. Be aware of the warning signs of abuse (described above), when starting relationships. If you see warning signs, the best time to leave an abuser is the first time it happens.
  • Stay informed. Learn all you can about domestic violence, even if you think you will never need to know about it.

Leaving a Violent Relationship

It is never easy to leave a relationship, and it can be especially difficult to leave one that involves domestic or intimate partner violence. The key is to have a safety plan.

  • Stay safe. Leaving your partner or someone you live with can be upsetting to that person. Make your safety (and that of your children) your top priority.
  • Be prepared. If you leave, do not forget your HIV drugs and any other medications you take, medical records, birth certificate, credit cards, checkbook, etc. Assume that anything you leave may end up in the dumpster or used to find you. It may help to leave an emergency kit with some of these items with a trusted friend, family member, or service provider. If you do not want to give the name of the person you are afraid of, you can put it in a sealed envelope and ask them to open it only if you disappear or turn up too injured to identify the person who hurt you.
  • Document. Get medical attention if needed and get photos of any injuries that show. Have photos signed and dated by medical or law enforcement personnel if possible. A friend or family member can also sign and date for future evidence.
  • Get help. Do not try to do this alone. It may be awkward or embarrassing to reach out to others, but your health and life may be at risk. If you cannot seek help for yourself, think of those who love you and may depend on you. Go to friends, the police, family, an emergency room, or a local shelter. Call the National Domestic Violence hotline at 1-800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)].

If you suffer from domestic or intimate partner violence, always remember – it is not your fault. It can happen to anyone. Anyone who physically, verbally, or sexually attacks another person is responsible for his or her actions. The most important thing is to get safe and stay safe.

Additional Resources

Select the links below for additional material related to domestic violence and HIV.

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