Why is there a National Day of Action to End Violence Against Women Living with HIV?

• Women living with HIV are twice as likely to experience intimate partner violence (IPV) and five times as likely to experience lifetime sexual assault as the general population of women.
• Data also shows that women of trans experience, who are the population most affected by HIV in the U.S., are at elevated risk for violent hate crimes, which all too often are deadly.  
• Disclosure of HIV status can increase vulnerability to violence, including tragic situations where women with HIV have been murdered following disclosure of their HIV status.

Violence can thus have devastating consequences on health outcomes of women living with HIV (WLHIV). WLHIV who have experienced recent abuse or the threat of abuse are less likely to be linked to care; half as likely to be on antiretroviral treatment (ART); and much less likely to achieve viral suppression when prescribed ART. They are also five times more likely than women without HIV to be currently suffering from post-traumatic stress disorder (PTSD).

But interpersonal violence does not exist in a vacuum. Violence against women living with and most vulnerable to HIV is enabled by the systems, structures, institutions and social norms that consider us disposable. This is what we call systemic violence—when systems and institutions, including those responsible for our health, dignity, and security, perpetrate harm against us rather than protecting us. For WLHIV, this systemic violence takes many different forms.

This October 23, 2017, on Positive Women’s Network – USA’s National Day of Action to End Violence Against Women Living with HIV, we are highlighting intersections between economic security, health and violence against women living with HIV.

Understanding the Intersections: Economic Insecurity, Health, and Violence

In the United States, the richest country in the world, people with HIV have been forced to rely on a complex patchwork of systems to access health care. Prior to the passage of the Affordable Care Act (ACA), pre-existing condition exclusions for health insurance required people diagnosed with chronic illness (and many others) to identify alternative means to secure costly health care and treatment.

The Ryan White program and Medicaid, among others, have been essential to assuring access to health care and treatment for WLHIV. Statistics show that 40% of U.S. residents living with HIV depend on Medicaid to access health care. For women, that figure may be even higher: a recent survey of PWN-USA’s membership (N=250) showed that 44% relied on Medicaid, 33% on Ryan White (non-ADAP), and 24% on the Ryan White AIDS Drugs Assistance program. The same survey found that 42% of PWN members rely on the Supplemental Nutrition Assistance Program (SNAP, also known as food stamps or EBT). Both the Ryan White program and Medicaid require women living with HIV to be poor in order to qualify for services.

For women of trans experience, these issues may be further complicated:  finding employment may be difficult due to barriers ranging from outright discrimination to not having identity documents that match their gender expression.

When we are poor, we are more vulnerable to violence, including deadly violence. Poverty can make leaving an abusive relationship a bigger risk. Homelessness and housing insecurity increase vulnerability to interpersonal and community violence.

2017 has seen endless attacks on the nation’s already frayed, inadequate social safety net from the White House and Republican-led Congress. The continuous efforts to dismantle Medicaid and to erode the protections and essential health benefits guaranteed by the Affordable Care Act, as well as the so-called Department of Justice’s rollbacks of civil rights and anti-discrimination protections, threaten to leave still more women living with and vulnerable to HIV in dangerous situations with few or no possibilities of improvement or escape. The administration’s ongoing attacks on low-income people are a direct attack on women living with HIV. They make us more vulnerable to violence in all its forms.

To end violence against women living with HIV and support women with HIV in healing from violence and trauma, we must advance an economic security agenda for people living with HIV.

An Economic Security Agenda for People Living with HIV includes:

• Ensuring access to affordable, high quality health care, including abortion and contraception, regardless of gender, gender identity, age, ability to pay, pre-existing conditions, or immigration status.
• Resisting any efforts to dismantle and disrupt health care for low-income communities, and opposing proposals or policies that require people to be sick or unreasonably poor in order to access health care.
• Fighting to expand Medicaid and to support universal health care proposals at the state and federal level.
• Opposing any attempts to cut or restrict social security and Supplemental Security Income.
• Supporting robust and uninterrupted funding for the Supplemental Nutrition Assistance Program (SNAP) and for the Children’s Health Insurance Program (CHIP).
• Lifting all bans on accessing food stamps, housing and cash assistance for people convicted of a felony.
• Supporting the integration of employment and vocational rehabilitation programs and services for PLHIV into HIV care and service delivery settings.
• Supporting and advancing legislation that reduces barriers to employment for people of trans experience.
• Advancing programmatic and service delivery solutions that support women living with HIV in finding safety and healing from trauma and violence.

To look at our 2016 resources on the intersections between policing, criminalization and violence against women living with HIV, click here.

To see our 2015 resources demanding trauma-informed care and services for women living with HIV, click here.