Category Archives: Violence Against Women

Retraumatization: The Increased Risk of HIV Transmission among Abuse and Assault Victims

While the transmission of HIV and the causes of HIV-related death are actually more complicated—and even more nuanced—than public discussion would let on, a few presumptions about it remain fairly accurate.

For women who are marginalized in their communities, who are victims of abuse or assault, and who are economically or socially dependent on a spouse, the risk of them contracting HIV or dying from multiple complications from AIDS is simply greater than that of women fortunate enough to not be subjected to these circumstances. Take these scenarios:

  • The power dynamic in an abusive relationship may prohibit women from being able to protect herself from a partner who refuses to wear a condom
  • Women in poverty and those who need to rely on a partner for financial support may have greater risk of comorbid infections than women of economic independence. They are less likely to have the health insurance and relationship with a healthcare provider that would support HIV testing and provide the essential—and expensive—HIV medications to ensure a healthy life and lower the risk of co-morbid infections
  • People without social support, living in fear of what an HIV-positive diagnosis means, or those who have reason to fear stigma around personal behavior when seeking treatment are less likely to know where to access treatment or seek it out because of that fear, stigma and lack of support

Common sense would seem to support these statements. But until recently, the pathways of infection were not always clear, and while the conclusions above seemed certainly reasonable, specific data to support them had been difficult to collect. Two recent studies led by a UCSF-researcher have changed that. One synthesized what is known about PTSD and exposure to trauma among HIV-positive women, and the other explored the root of this relationship.

The results were remarkable. HIV-positive women had between two and six times the rates of childhood and adult physical and sexual abuse, and PTSD. The snapshot of risk behaviors among HIV-positive women was sobering:

  Sample size Number (%) of participants with each characteristic
Sexual activity
Any sexual activity in the past 6 months 113 61 (54.0%)
 With a main partnerMedian number of main partners (if any) 61 43 (70.5%)1 (range 1–2)
 With casual partnersMedian number of casual partners (if any)a 61 23 (37.7%)1 (range 1–25)
Sex with any HIV negative or unknown serostatus partners (if sexually active) in the last 6 months 61 51 (83.6%)
 Disclosure of HIV status less than all of the time with these partners 51 29 (56.9%)
 Using condoms less than all of the time with these partners 51 31 (60.8%)
 Detectable viral load 51 30 (58.8%)
 Disclosure of HIV status less than all of the time, and using condoms less than all of the time, and a detectable viral load 51 16 (31.4%)
Substance use (any, recent)
Cigarettes 110 71 (64.5%)
Alcohol 111 50 (45.0%)
Marijuana 111 39 (35.1%)
Crack/cocaine, heroin, and/or methamphetamines 111 45 (40.5%)
IDUb 112 11 (9.8%)
 IDU who share needles 11 5 (45.5%)
 IDU who have a detectable viral load 11 6 (54.5%)

aOne participant had a very high number of sexual partners (N = 250) and was excluded from the analysis; b IDU injection drug use; ©2012 Machtinger, et al. (retrieved December 16, 2012.)

There were striking findings in terms of both HIV treatment failure and the impact of the above risk behavior in these women, bringing us the first real data hoping to explain this relationship. Those who suffered from recent trauma had more than four times the odds of anti-retroviral (ART) failure while on treatment than HIV-positive non-victims—and this was seemingly not due to self-reported poor adherence to the medication. One potential explanation offered by the study authors is that abuse and trauma interfere with an individual’s ability to stay on a consistent medication schedule, which is essential for control of the virus. Other studies have confirmed that abuse manifest as control, in which a male partner prevents his HIV-positive female partner from accessing services at a clinic out of fear that the stigma of HIV would be attached to him.

HIV-positive victims of recent trauma also all reported experiencing what the study calls “coerced sex,” and have over three times the odds of un-traumatized women of having sex with HIV-negative or status-unknown individuals. They had greater than four times the odds of inconsistent condom use, potentially exposing those casual partners to the virus. While high-risk sex behavior is always a factor in HIV-transmission, HIV-positive individuals who adhere consistently to HIV treatments are significantly less likely to infect HIV-negative partners during sex. So the lack of treatment adherence among traumatized HIV-positive women combined with the risky sex behavior is a great concern.

Interestingly, these figures were only significant among women who experienced recent trauma, indicating that the ongoing—not merely one occurrence—circumstances of abuse are the key to the relationship between HIV-infection and HIV-related illness and death. This can actually be seen as a snapshot of hope—if we are able to offer abuse, assault, and PTSD victims the appropriate support to heal from the experiences, we may be able to weaken the HIV/trauma relationship.

These studies draw a clear line between victims of assault and trauma and both the spread of HIV within their communities and the increased risk of HIV-related illness and death. But interestingly, the risk goes much deeper than these socioeconomic circumstances. The conversation around HIV transmission is generally split into one of two categories: social and behavioral—risky activity, injection drug use, the prejudicial judgment of sex workers; and medical and clinical—how the virus infiltrates the immune system, takes over cells, and how it is and isn’t suppressed with antiretroviral medications. What isn’t usually discussed is the possible combination of these two categories and how together they create a perfect storm for potential infection.

Recent studies have shown that those individuals suffering from PTSD had significantly higher rates of cytomegalovirus (CMV) in their body. A virus that is found in between 50%-80% of adults in the United States, CMV remains largely undetected—latent, suppressed, unproblematic—in healthy individuals. It’s also seen as a marker of immune health and function, and of the body’s ability to control potential infections. Given that 30% of American women with HIV/AIDS have PTSD (five times the national average), the potential relationship between their HIV-status and even further compromised immune function could lead to a myriad of comorbid infections and premature death. Other research has also shown that additional biological mechanisms may prevent ART-treatment from being as effective as possible, including high cortisol (stress hormone) levels. Not only do these victims have to fight against abuse and assault, they have been left without the essential social support to decrease risky behaviors that may expose others to the virus, and their own bodies are in revolt.

Collecting this kind of information is difficult. It requires consistent and positive communication between women and providers, unobstructed access to medical care and uninterrupted ART treatment, and of course, in this example, most importantly—removal from an abusive environment.

The combination of immunosuppression due to PTSD, the detectable rates of HIV in traumatized women whose viral loads are not suppressed by consistent anti-retroviral treatments, and the concurrent risk behaviors of abused HIV-positive women, all contribute to higher rates of HIV-infection in communities, as well as the potential for co-morbid infections and HIV-related death. Until these women are able to find the essential social and community support, free from abuse and trauma, and until their access to care and preventative measures are fully realized, the relationship between trauma and HIV will only deepen.

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Filed under Epidemiology and Population Health, Feminism, Health Behavior, Mental Health, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Violence Against Women, Women's Health

Think Domestic Violence is Funny?

A whole slew of people who aren’t afraid to admit that they think domestic violence is a total joke made it clear last night when the Twitterverse erupted during Chris Brown’s performance. Other writers have well articulated the reasons why I was upset to see him perform, much less have him so vocally supported – a standing ovation? Really?  Frankly, I was surprised that there was restraint in showing Rihanna’s reaction to his numbers.

Despite the outpouring of affection for this man, I was still shocked to see the responses of women watching around the country. Trigger warning for abuse – here are some responses to his performance via Twitter:

“I’d let Chris Brown beat me up anytime ;) #womanbeater”

“Like I’ve said multiple times before, Chris Brown can beat me all he wants…I’d do anything to have him oh my”

“chris brown can beat me all he wants, he is flawless”

“Chris brown.. please beat me ;).”

“I’d let chris brown beat me any day ;).”

“I’d let chris brown punch me in the face”

“I don’t know why Rihanna complained. Chris Brown could beat me up anytime he wanted to.”

What do we gather from these tweets? (Full list here, again, trigger warning.) These go beyond the lack-of-filter in-the-moment tweets that often get people in trouble because they show that these people have a clear understanding of his actions – no one here is pleading ignorance to his abusive history or denouncing it while commenting on his performance. They are doing just the opposite, celebrating and glorifying his violence. Taking it further, they sexualize it as they coyingly ask him – instruct him – to beat them whenever he wants as an acceptable, warranted, and defensible act for being lucky enough to be his partner. The winky smiley faces, the promotion of his supposed flawlessness, the admission that they would suffer innumerable beatings just to be with him, capped off with the dismissal of Rihanna’s rightful decision to report him as a mere “complaint” – we have a major problem here. Combined with a collective short-term memory problem (all those rallying screams at the Grammy’s last night), these messages serve to tell domestic violence victims that they are overreacting, that they should not “complain” if their assailant is considered talented and desired by so many women, that abuse is entirely excusable when perpetrated by a superstar with mass appeal, and very disturbingly, that violence is, of all things, so so sexy (“i wish chris brown would punch me!” begged one tweet). The claim that they would “let” a man punch them in the face does nothing but support the dangerous stereotype that women want to be beaten, that it turns them on.

What a way to let Chris Brown forget about what he’s done. Not only does he get to say that he supposedly regrets his actions, but if he ever felt a creeping of guilt or was actually on some path to understanding what he’s done and why it’s so disturbing and utterly unacceptable – you know, the tough mental work that is required to be rehabilitated – all he’d need to do is head over to Twitter and type his own name into a search. He’d be greeted by plenty of women and men not only excusing his actions, but praising them, supporting them, begging him to repeat them. We’ve got a really long way to go, here.

Update: Charmingly, Chris Brown responded to his critics on his on Twitter page, before it seems his handlers thought it best he stay silent on the issue.

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Filed under Pop Culture, Violence, Violence Against Women

Ready for 2012?

I certainly am! In case you’re interested, here are some interesting stats for INTY for 2011:

Top Five Posts of the Year:

Good Riddance, Paterno

Duke Nukem – Seriously?

Beyonce – A Word

Yes, Summer’s Eve Has Bad Marketing. Oh, and the Product is Not Good for You

I Still Don’t Think Yoplait Gets It

An interesting mix, indeed! Check them out if you missed them. And for kicks, my favorite Google searches that brought people to my blog:

* “does summer’s eve cause yeast infections”

* “disney feather duster” (which brought them to the Billy Bush post)

* “self-image”

* “i think i’m a feminist” (yay!)

* “consent”

* “abortion”

* “feminism does not necessarily mean hating men”

* “equinox advertisements jealous” (which brought them here)

* “eating disorders”

* “miss usa”

* “eroticization of girls”

* “sexualization of girls”

* “sexualized advertising”

* “advertising desensitization”

* “advertising and behavior”

* “real housewives ignorant” (the RHOBH post did get a lot of comments)

* “gay stereotypes in reality television” (Zel’s guest post)

* “gender identity”

* “adolescent/human development”

* “mitch albom accept who you are and revel in it” (which took them here…showing Albom not reveling in it)

And some creepy and disturbing searches that hopefully led searchers to this blog and perhaps taught them something:

* “how to get any woman to drop her panties”

* “how do young girls get hotter”

* “funny rape jokes”

* “sexy women lying on train tracks”

* “in duke do you need to use the vibrator on the woman”

* “how to take a feminist down a peg”

* “how to take a woman down a peg”

Well, that about sums it up! Looking forward to many more conversations in the upcoming year!

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Filed under Advertising, Child Development and Child Health, Defining Gender, Education, Feminism, Gender Stereotyping, Health Education, Media, Politics, Pop Culture, Public Health, Rape and Sexual Assault, Sexism, Violence, Violence Against Women

Not That I Necessarily Expect BravoTV to be Educational…

But nonetheless, the way the domestic abuse issues in Taylor’s marriage were drawn out and discussed on last Monday’s Real Housewives of Beverly Hills merits a bit of a chat.

I don’t want to do any scolding because I tend to think there’s a lot of misinformation about domestic abuse and intimate partner violence, and the women of this cast seem to be trapped in the bubble of the misinformed. The entire episode was pretty hard to watch (nothing new there – look at what I put myself through just so I can analyze media!), not least of all the immensely uncomfortable tea party scene. It started with Adrienne and Paul (I’m sorry I can’t stop to explain every character, if you aren’t as fascinated by this as I, see bios on the BravoTV site), having a celebratory dinner and Adrienne broaching the subject of Taylor’s fragile state. The sincerity of this concern is hard to gauge, as is the sincerity of anything on these shows, but she seems to wonder why Taylor seems to be on the verge of a breakdown 24/7, and tentatively brings up that Taylor had told some of the other ladies that her husband, Russell, was physically abusing her. The revelations are, of course, greatly illuminated by Russell’s suicide this past summer, after which his history of abuse became more prominently displayed above the fold of tabloids. Paul’s response to this was “Nah…I know Russell. I just don’t believe it, he’s a great guy, he wouldn’t do that.”

The speculation continues at the tea party, which was so unsettling in no small part because it truly appeared to be the pinnacle of Taylor’s undoing. She seemed exhausted and overwhelmed, very much on the edge. She was breaking down, and it was painful to watch.

The women kept saying they didn’t know what to believe because they had never seen the abuse, they had never seen Russell hit Taylor. But moments later, Camille exclaims that they all knew of her injuries – at whose hands did they assume her jaw had been broken or her face smashed in, as they referenced? Not the man with two restraining orders against him from former wives and girlfriends, and with a record of beating his first wife when she was pregnant?

People generally don’t witness domestic violence. People generally don’t witness rape. We know they occur. Abusers frequently seem like charming, engaging, or friendly folks to the outside world. So do many criminals. This is a kind of control tactic, in which the victim’s testimonies can be negated by the public reputation of the abuser. Ted Bundy’s neighbors testified that he was a generous family man, but whoops, in his spare time he brutally kidnapped, raped, and murdered over 30 women. Appearances can be deceiving. We all know this, and we must get past the assumption that someone who presents themselves publicly in one way can’t have an entirely different private persona. Russell seems to have quite a violent history, and abuse allegations are rarely isolated. Personally, the footage of Russell I’ve seen has made me uncomfortable, as it always seemed controlled rage was simmering just under the surface. He didn’t like to leave Taylor with her friends, and I recall last season that when they were on a trip to Vegas he had her leave with him when he wanted to remove himself from the party instead of allowing her to socialize. Seemingly small actions like this can often be part of a larger orchestration of control that the abuser holds over the abused – particularly in regards to isolating them from their networks.

The tea party mock intervention continues, as Adrienne then claims she can’t get her head around someone who just doesn’t leave a man who is abusing her and putting her daughter at risk. She says this in a frustrated tone, as though Taylor is weak, weaker than them, because she didn’t stand up and walk out. She says, in fact, that she doesn’t understand where Taylor’s “willpower is.” This shows grave misunderstanding of the dynamics of partner violence; Adrienne is certainly not alone in thinking this.

People don’t leave because they’re terrified. Because they are not financially and economically independent. Because they’re worried the abuser will find them and the abuse will be even more intense, more vicious, possibly result in their death. Because they’re embarrassed and humiliated or are worried about more people discovering the truth. Because they have survived by protecting themselves with rationalizations and forms of denial, and leaving means confronting an overwhelmingly scary reality that often induces post-traumatic stress and requires a steady, uncompromising support system. Because they are used to a cycle of violence, followed by intense proclamations of love and dedication from the abuser, followed by manipulation, followed by violence again. Because they feel trapped. Because they have often been isolated by the abusive partner from their friends and family.

Taylor likely felt all of these things. She herself expressed that she had been a child in a home rife with domestic violence, and we know that children who witness abuse are more likely to have it replicated in their own marriages. She was married to an extremely powerful man in Los Angeles, and was likely worried that his status would aid in making her independent search for a job, home, and new social circle, exceedingly difficult. She appears to have no significant familial relationships to which she could reach out and seek refuge, her group of friends don’t have the reputation of being particularly warm and welcoming. She probably worried about what would become of her daughter – what if her daughter was targeted by Russell when they left? She may have been embarrassed, that’s not uncommon. She may have wanted to avoid being called exactly what some people seem to already assume – weak. She may have worried that people would wonder about her character and why she had chosen this person if he was abusive. She may have worried that, very sadly, she deserved it. Especially if it was a behavior she was used to witnessing as a child. She may have thought, concerningly, that no one would believe her. People aren’t believing her now, which likely confirms her earlier concerns; she may have thought she would be worse off if she were traversing a world by herself, 5 year-old daughter in tow, with everyone thinking she’s a liar. She probably was lured back into the relationship by the very cycle of domestic violence so many victims and survivors are familiar with.

Perhaps some individuals think if they were in Taylor’s shoes that they would be “strong” enough to leave. The reality is, domestic violence is a deeply complex issue, and it is very difficult to assume how one might handle the situation given how complicated it is.

An egregiously irresponsible “article” snidely remarked that Taylor didn’t want to lose Russell’s money, and that’s why she didn’t come forward. I’m the first to point out the materialism of this series franchise, but in the case of an abuse victim, it has less to do with fear of losing one’s jewels and furs than it does with fears of losing one’s life. And concerns about caring for a child on their own, concerns about the community siding with the abuser and icing her out, concerns about getting a protection or restraining order, concerns about being stalked. Her coming out and being more explicit with the abuse details after his death is indicative of how terrified she likely felt. If she had previously come out as publicly as she recently has, I’m sure she felt that the consequences at the hands of Russell could have been far greater.

In short (or not so short), this episode could have come with a Bravo TV PSA after its airing. But then I wouldn’t have been able to write this.

Thoughts? Follow me on Twitter.

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Filed under Education, Health Education, Mental Health, Violence, Violence Against Women