Washington D.C., USA, 22-27 July 2012www.aids2012.org

“We Walk With Fear”Experiences of HIV Criminalization and Disclosure Amongst African and Caribbean Migrant Women in

Ontario, Canada

Presented by:Marvelous Muchenje

Women’s Health in Women’s Hands CHC

Washington D.C., USA, 22-27 July 2012www.aids2012.org

No conflict of Interest

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Roots of Vulnerability to HIV/AIDS for Black Women in Canada

Vulnerability is unique and deeply rooted in:– Socio-cultural and structural factors that intersect with - Gender,

race, class, political and economic conditions

Lack of economic opportunitiesDeprivation of rights to autonomy and sexual

control over their bodiesCultural practices that increase risk of

infectionLimited educational opportunities

Washington D.C., USA, 22-27 July 2012www.aids2012.org

HIV Diagnosis

• Start of the journey……..• Great distress, shock, disorientation, disbelief, denial,

devastation, etc

• Complex experiences of loss:– Feelings of being victimized, regret, sadness, loss of

future dreams, hopelessness, fear, withdrawal, isolation, depression, suicidal thoughts, anger, etc

– Anxiety and grieving

• Period of coping, adjustment and acceptance

Washington D.C., USA, 22-27 July 2012www.aids2012.org

HIV

Dis

clos

ure

Washington D.C., USA, 22-27 July 2012www.aids2012.org

HIV DisclosureHIV positive status disclosure is:

– an ongoing process– intimately personal and has considerable effects on families and

communities

Impacts access to information and services

Should be a component of support and care services offered for people living with HIV

Is a journey involving a number of stages

Washington D.C., USA, 22-27 July 2012www.aids2012.org

DISCLOSURE

Is disclosure necessary?

Dis

clos

ure

Pro

cess

5.Accessing Potential Outcomes

4.Establishing

Motivation for

Disclosure

3.Evaluating the

Disclosure

Environment

2.Education

and Preparation

1. Acceptance and Empowerment

HIV Diagnosis

Washington D.C., USA, 22-27 July 2012www.aids2012.org

“To Tell or Not to Tell”Confidentiality of medical informationRacist experiences with healthcare providers

Fear of:accusations of infidelityPartner abandonmentCommunity rejectionStigma and discriminationViolenceWithdrawal of immigration sponsorship

Washington D.C., USA, 22-27 July 2012www.aids2012.org

“To Tell or Not to Tell” Feelings of shameIdeas that if practicing safer sex there is no

need to discloseRamification against family members,

communityLack of disclosure skillsInformation regarding their HIV status used

against them in the criminal justice system

Washington D.C., USA, 22-27 July 2012www.aids2012.org

“HIV is not hurting me, but your ignorance

is …………”

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Criminalization of HIV Transmission, Exposure, or Non-Disclosure

Lack of clarity of law can adversely impact :– personal, social, behavioral and sexual choices

and decision making capacitiesAggravates the risk of violence and abuse

Reinforces gender inequalities

Promotes fear and stigma

Creates distrust in relation with health service professionals

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Criminalization of HIV Transmission, Exposure, or Non-Disclosure

Criminalization due to overrepresentation of ACB in corrections

Institutional racism in justice system

Lack of resources and support

Knowledge burdens on ASO and other health care providers with no experience providing legal support

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Criminalization of HIV Transmission, Exposure, or Non-Disclosure

Lack of awareness and knowledge of the law and how it applies to HIV transmission

Lack of awareness of HIV/AIDS transmission, disease progress and prevention

Police harassment, coercion and intimidation of people living with HIV e.g. sex workers, homeless

Relationship between police and media stakeholders

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Media coverage

Washington D.C., USA, 22-27 July 2012www.aids2012.org

RecommendationsBuilding cross-sectoral knowledge

capacities around:– HIV transmission, Prevention, Criminalization

Further investigation and discussion of alternatives to criminalization– Mediation, Counselling, Restorative justice, Education, Support

services

Increase emphasis on the responsibilities of those seronegative

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Recommendation Increased resources for organizations to do targeted

outreach to ACB population in their primary language

Building relationships amongst: – ASOs, government stakeholders, ethno-specific

community leaders/agencies, media stakeholders, legal/justice stakeholders

Address the structural barriers:– colonialism, – oppression,– systemic racism and discrimination

Washington D.C., USA, 22-27 July 2012www.aids2012.org