A majority of women living with HIV in Canada report a history of verbal, physical, and/or sexual violence from partners, according to a study published in Women’s Health. And one fifth of the women in the study, especially Indigenous women and Black women, reported that Canada’s HIV non-disclosure laws had led to increased violence.
Canada has one of the highest number of HIV criminalisation cases globally. HIV status non-disclosure is considered a crime unless condoms are used and a person’s viral load is less than 1,500, regardless of whether HIV transmission occurred.
Non-disclosure is considered to invalidate informed consent, so it is most often prosecuted as a sexual assault or even an aggravated sexual assault which can lead to life imprisonment and/or lifelong branding as a sexual offender.
The criminalisation laws fail to account for gendered drivers of HIV acquisition, including gender-based violence and power imbalances that can lead to male partners being in control of decisions about condom use. Ironically, these sexual assault laws that resulted from women’s activism against gender-based violence are now disproportionately impacting women who have experienced violence.
As previously reported by aidsmap, previous qualitative research that looked at how HIV criminalisation laws impacted women living with HIV in Canada showed that women had little knowledge of the law, which they found to be confusing and concerning. They believed the law to be a social and legal injustice that represented sexual surveillance.
The previous research found that the women also believed the law increased their vulnerability to violence, citing the legal obligation to disclose to abusive partners, questions about whether they were obliged to disclose during sexual assault or rape, and the threat of being accused of non-disclosure being used as leverage by abusive or vindictive partners.
Indeed, in one Canadian case, a woman living with HIV reported her partner for domestic violence. However, she was also prosecuted when her abusive partner alleged that a single act of sex without a condom occurred prior to her sharing her HIV status at the start of a four-year relationship in which she did disclose her HIV status and no HIV transmission occurred.
Led by Dr Sophie Patterson of Simon Fraser University and colleagues from the BC Centre for Excellence in HIV/AIDS, researchers set out to quantify the impact of criminalsation of HIV non-disclosure on the health and rights of women living with HIV in Canada.
They analysed data from the Canadian Women’s Sexual and Reproductive Health observational cohort study (CHIWOS). Women living with HIV play a key role in the CHIWOS study as peer research associates who shape the research agenda, administer surveys, and help with interpreting and disseminating study findings.
Researchers recruited women aged 16 and older living with HIV from British Columbia, Ontario, and Quebec between 2013 and 2015 through personal networks, clinics, social media, and HIV /AIDS service organisations. Special attention was paid to recruiting women under-represented in research, including young women, transgender women, Indigenous women, and women who use drugs.
An initial survey was followed by two more waves of data collection in 18-month intervals, ending in September 2019. The second and third wave looked at awareness, understanding, and the impact of HIV criminalisation laws.
The current study included women who had completed all three waves of data collection and focused on whether HIV crimalisation laws had increased violence for the women and/or impacted their sexual decision-making.
A total of 619 women were included in the study. Most (41%) were White, followed by African/Caribbean/Black (38%), and Indigenous (15%). The median age was 46 (range 39-53). Participants lived in Ontario (44%), Quebec (31%) and British Columbia (24%). Over half (55%) were born in Canada.
Most (63%) participants had an income at or below poverty guidelines of $20,000 CAD, but few (7%) were unstably housed or homeless. Over a third (35%) had a history of incarceration, around half (51%) had ever used illicit drugs, and 26% reported a history of sex work (data was missing from 72 women on this variable).
“18% had experienced violence upon disclosing their HIV status to a partner.”
Most (88%) of participants identified as heterosexual and around a third were in a relationship. Most (86%) had ever experienced verbal, sexual, or physical violence as an adult; 26% of women reported current violence. Eighteen per cent had experienced violence upon disclosing their HIV status to a partner.
Most (92%) had a self-reported undetectable viral load at the time of the interview, 95% reported being on antiretroviral therapy and just under half (47%) had symptoms of depression.
Overall, 21% of the women agreed or strongly agreed that HIV non-disclosure laws had increased their experience of violence from sexual partners. After controlling for other factors in multivariate logistic regression, women of non-White ethnicity were more likely to experience increased violence due to the laws (aOR: 1.75, 95% CI, 1.11, 2.76), as were those who had unstable housing (aOR: 2.32, 95% CI: 1.14, 4.74) or experienced high stigma (aOR: 2.43, 95% CI: 1.56, 3.79).
Thirty-seven per cent of the women had chosen not to have sex with a new partner because of the laws. In bivariate analysis, this intentional abstinence was more common among women who had reported that the laws increased their experience of violence than those who didn’t (67% vs 29%, p > 0.001).
Twenty per cent of women had disclosed their status to partners in front of a witness due to concerns about the non-disclosure laws; this was higher among women who reported increased violence stemming from the laws (39%) compared to those who hadn’t (16%, p < 0.001).
Findings from this study underscored the previous qualitative findings that HIV non-disclosure laws are a structural driver of increased violence against women living with HIV, and that these laws intersect with other forms of oppression, such as stigma and racism.
These laws, sometimes touted as protecting women, are harming women living with HIV and limiting their ability to live and love without fear. The researchers call for combatting HIV stigma and reaffirming women’s rights to satisfying sexual lives through gender-transformative, sex-positive, evidence-based messaging.