"HIV & Domestic Violence" – Kimberly Russell and Judi Noble – 9/8/05

we are delighted to welcome the first time to our council this morning so please join me in welcoming kyra leave in June so you’re already had my short bio I had to introduce myself my name is very less long physician assistant I worked here at long beach memorial or children’s pediatric and families or the center for about two and a half meters until just recently where I left to between august to several human services in Asia and market specialist what I want to talk to you guys about today is HIV and AIDS mostly as that is my background and Jude is going to stand up and give you all a little bit of information i’m sure you know very well about domestic violence but make senator linkages community obviously since you’re having this topic you understand there is a connection between the two and I I’m just going over basic definitions a lot of virtually no already a lot of information they already have but if you would please just take note maybe you can talk to some of your patients about this and people you see every day so that you’re educating them because I think that’s really the take-home message today so again the purpose is just to identify the connections between HIV and mustard violence and to clarify definitions risk factors symptoms statistics and at the end also very important to encourage prevention intestine so what is the connection between HIV and domestic violence when I was given the opportunity to put this together I honestly I’ve learned so much just thinking about it because i think i got so stuck thinking about HIV and although i was seeing a lot of signs of domestic violence when I was treating patients I didn’t really put together and how common risk factors and warning signs are for both so this slide kind of puts together that information obviously both are going to pray against the vulnerable both um they’re unavoidable there are both very stigmatized in our community misunderstood ignored and unfortunately both very well could be lethal so when I was speaking with Judy about this we were getting ready to do this together we came at it obviously from different backgrounds and we’re trying to figure out is whether it’s people with HIV that are both more likely to be victims of abuse or become a users or if it’s the other way around you see victims of abuse and abusers more likely to acquire HIV and I think it goes both ways it’s your CV right I just made some notes about both situations you’re going to have anger and rage regarding a diagnosis of HIV which may lend itself to someone becoming abusive people feeling a sense of depression or loss of self worth when you’re talking about victims of abuse or users again that loss of self work self work their loss of bargaining power to be able to stand up for themselves and say no in a situation where they may be put Saul’s at risk for HIV so I’m not sure about what you all are seeing but I put together some some anecdotes of what I was seeing when I was practicing and taking care of people with HIV what I did find is that and this is / web search women who have violent and domineering partners of a fifty percent increase of acquiring HIV many women as you know are very afraid to even discuss the use of condoms with their partners if they have a violent or promiscuous history because just bringing up the topic is going to cause potentially a violent reaction I’m not sure how much you all know about living on a download or to be living a secret life that we’ve been hearing so much about in pretty much all cultures primarily african-american and Hispanic men is what we were seeing in my practice where you have men that had wives or girlfriends and families but they were unfortunately having this a secret life where maybe they had homosexual tendencies or would never identify civil sexual or gay because it was sick accepted in their communities but they would go and have secret lives that no one was aware of a querer jivey many of the times because they weren’t using protection and then come home and infect their wives or girlfriends and we saw so much of that where women because we the clinic is mostly family centered and about ninety percent of the adult programs women and the women that we saw most often found out their diagnosis when they went in for their pregnancy

tests for their screening when they were pregnant luckily they were given an HIV test at the time because we can prevent the child from getting HIV but that was at the time if they found out they had no idea they were even at risk because they were not in this relationship they were you know happily married or in a very happy you know time in their life pregnant going in for prenatal care and no idea that they were at risk or you need to get tested so unfortunately we’re seeing that they were you know victimized and became subject to the risky behavior of their partner and I guess he kind of look at that as a type of abuse if you think about it one of the statistics that Judy pulled up when it’s that forty-two percent of murdered women are killed by their intimate partners and that doesn’t even incorporate the additional percentage if you were to look at HIV as a type of murder that these partners are giving to their partners so what I’m hoping today to give you as the message is that we need to educate ourselves about each epidemic obviously you all have been very educated and well versed in domestic violence what I’d like to educate you about HIV keep it in mind when you’re talking with people scream for your patience to show the people that you come in contact with every day because they are so connected and never make assumptions about risk factors don’t think that because you’re looking at someone you know that they may or may not be at risk for HIV because you don’t know any one of us could be at risk and hopefully we’re going to distinct eyes this disease as well as I know you’re making to do stigmatize domestic violence and have people talk about it more openly and we can do that through education and acceptance so again please forgive me if I am speaking at a level that’s below you as far as your HIV knowledge but I’m going to use some basic slides that I’ve used in a community to talk to college age students to help them understand the basics of HIV so that they can make better decisions so what I we start out with is just the difference in the definition human immunodeficiency virus which is HIV defined and HIV affects your immune system if your HIV infected you will have a drop in your immune function and you will have less of an ability to fight off infection it is a virus that causes AIDS and a is defined as acquired immune deficiency syndrome is characterized by opportunistic infections that is infections that take the opportunity that you have a low immune function like PCP which is the moment that you can learn about perhaps or wasting there’s a list of about twenty opportunistic infections that would define you at that point it’s having an AIDS diagnosis define to have AIDS if your t-cell count which is one of your white blood cells that fights infection drops below 200 it’s just an arbitrary number it which basically have a lowered immune system to point that you will start wiring opportunistic infections and if you just to give you a sense healthy people not HIV infected people have about a thousand T cells so again basic slide HIV is carried in four bodies Lewis I always go through this just because there are so many myths surrounding how you can get HIV blood semen vaginal zoo breast milk be aware that there are myths I mean a lot of people are not aware that you cannot get HIV through saliva that you can’t get it to sweat or tears so these are these are questions that if you start talking about HIV might find people have questions about it most of transmission as we all may very well no one of the interesting points and the wonders that I love my job so much is the mother to child transmission rates that have drastically declined pregnant women without treatment about 184 will transmit HIV to their child’s pregnant women with treatment so obviously the point is that they know they’re positive that they’re getting I’m here early and you’re getting texts offer to them which is law in California is actually less than one percent chance that the baby will become infected with HIV symptoms and treatment just briefly if you are HIV infected initially about one to two months after exposure you may have very mild flu-like symptoms not everyone has them but you may develop a flu-like illness if you know you’ve had risky behavior about two months ago then that should be alarming otherwise you may just write it off and let it pass

because it very well will pass just like any old or flu that we need to work through but the key is is don’t be worried about every flu-like illness you did just think about what your risky your risk behavior has been treatment again there’s 26 medications right now on the market for HIV they’re all very effective very potent very difficult i will add it’s not no big deal anymore just because there’s medications available very difficult to adhere to and the side effects are very difficult to handle but they’ve made huge chances distance available for people who have no insurance aids drug assistance program there are combination doses that try to make efforts there’s been a lot of effort made to make it easier on the patients but hopefully we could prevent as opposed to treat the disease I just wanted to talk a little bit about the connection I don’t want to too much on a tangent here but the point in this is that for some reason it sexually transmitted diseases are discussed more openly they’re less less stigma somehow surrounding chlamydia gonorrhea syphilis and it may be something that you hear when you’re talking to your patients because they’ll they’ll openly talk about it whereas you know HIV is completely off-limits they will talk about it they won’t get tested perhaps but when they’re talking about STDs be aware that this is a huge problem if someone’s talking about being treated for chlamydia STDs can raise the risk for HIV infection due to five times so any time that any one of your patients is willing to go get a test or go to their doctor to get a test for any sexually transmitted infection make sure they know to include HIV okay and also open up the communication there what’s happening is some of I mean obviously people you’re seeing are already victims may already be at risk for domestic violence so you’re going to be talking about how they can even help them with communication in their relationships but a lot of times we stop you know when I was doing primary care about three years ago three and a half years ago we would see people coming in with positive video tests and they didn’t find anything other than the antibiotic they didn’t want to know how to talk to their partner they didn’t want to know what it really meant as far as the fidelity issues they didn’t want to know anything that you want to talk about they just want to take the medicine to go home and how their life the way it was before so what’s happening as far as communication obviously there’s a lot of fear and insecurity there three flares went under review statistics and these are statistics from 2004 in 2004 they were saying that since 2002 the number of women living with HIV has increased in every region of the world in many parts of the world marriage and long-term monogamous relationships do not protect women from HIV there’s some statistics here about Asia and sub-saharan Africa one that i found particularly interesting is that in zambia only eleven percent of women believed that they had the right to ask their puzzles to use a condom even if he had proven himself to be unfaithful or with HIV positive so that’s what we’re dealing with in africa and whatever maybe when I will talk to college students about this was saying you know that’s not the case here you have every right to say no you have every right to ask you have this there shouldn’t be such a feeling that you have you don’t have to say here and I know that’s an idea ideal perfect world but that’s what I think a lot of young people need to hear just a global summary talking about HIV and AIDS the total number of people living with HIV 2004 is just under 40 million people newly infected so again this is world statistics just under 5 million so we’ve made advances in fewer infections but again unfortunately she doesn’t where we saw a slight upswing to sign new infections out of nowhere and you know for especially here in the United States where we pride ourselves in being so educated we still were seeing many people becoming newly infected aids deaths in 2004 and that has been on the decline because of these medications are keeping people alive longer is around 3 million so just a recap kind of put it in perspective 14,000 new infections in the world a day 2004 ninety-five percent of those are in low and middle income countries so almost 2,000 are in children under 15 years of age about 12,000 are persons

aged 15 to 49 of which fifty percent are women and that has been problem in the day when we you know kind of looked at HIV as a gay disease or back in the day when we didn’t think it was going to affect any other demographic you know some people felt sick and now we’re talking about HIV and women as fifty percent of people with new infections are women okay and I know you see a huge number of your clients are women just so a world view if you look at where you’re seeing HIV in adults and children obviously sub-saharan Africa 25 million there it’s it’s just incredible North America you know we’re on the map we’re definitely there 1,000,000 and then estimated number of adults and children newly infected with HIV in 2004 North America 44,000 but look at the rest of the world and you’re still having three million new infections in sub-saharan Africa in one year this is an old slide but I think it’s very important to look at the racial trend you look here you see that white non-hispanic is on the decline and our minority groups black and Hispanic are on their way up and actually if you look here this ends at 2002 but for the last three years Hispanic has been making more than a rising trend these are some of Judy’s statistics just talking about domestic violence you may be very familiar with these every nine minutes in this country someone’s insulted four million women are physically abused by their husband or living partners each year and it just puts into perspective that these are two very silent epidemics some more statistics here I want to talk about prevention and testing I’ll talk about some of the methods of testing there is whenever anyone goes in to get a test for HIV what the test is looking for is the antibody it’s looking for your body’s response to HIV virus to be being exposed to HIV so it’s not looking for the antigen it’s not looking for the virus if you get a standard HIV test it’s looking for your body’s reaction or response terror to the exposure so your body’s development of an antibody and the reason I i mentioned that and go to so much detail is because people will go in maybe the week after they’ve been risky and they have risky behavior and that’s not going to tell you definitively whether or not you have acquired HIV or explode expose yourself to HIV because it takes our bodies at least three weeks and up to six months to develop the antibody okay so we want to make sure that if you’re seeing people who are admitting to risky behavior or how concern about some behavior that they’ve had that you explain to them that you’re welcome to real going to test tomorrow but they need to get a subsequent tests to confirm it and they’ll tell you that hopefully in a good Center they’ll tell them you know that the nation there are more definitive tests in pregnancy we don’t rely on an antibody test if we have a pregnant woman who were concerned about we see this a lot actually maybe she had an antibody test and it came back positive or even if it was negative a lot of times if she has high risk behavior and this happened a lot when you saw women without pretty no care showing up to the labor and delivery room just ready to go the rapid test is an antibody test but what dr. Vegas would do and she was not sure how many of you know her name but she’s the expert is a dude HIV DNA testing and so that is looking for the vibrancy so that is going to be definitive so that you can get that person on treatment immediately especially in pregnancy you want to make sure that you take there is an oral test and there is a rapid test where you can get results much more quickly and this is a big problem people aren’t going back to the results so they build up the courage to go get a test but they have to wait two weeks from the results and they fall off they don’t go back they don’t find out the result and so guess they had a test they feel good check out the list i had my test they never found out what that they were positive or negative and a lot of times it’s difficult if it was an anonymous test there’s no way to track that person so early detection is critical and what I advise is testing every six months for

your high risk people this is ideal situation i understand that i made this slide and it’s kind of laughable i don’t think that it’s true to life and especially in the setting of domestic violence I don’t know that you’re having a conversation as early before you have sex with your partner it’s a view server or you know in the situation where you’re you don’t have to say about having sex or you can ask them what their statuses obviously that’s ideal limiting alcohol and drug use during sex there’s a much higher increase rate of having risky behavior where you might not use protection or you might engage in an activities that would put you at higher risk if you are drinking more intoxicated I have a list here we can go back here if any of you are interested in the end for different places that you can find information or give to your client’s about testing and I’ll come back here at the end you’re interested just want to put this is my final spider on my pass the microphone over to Judy but just please hear what I said I kind of went through it quickly and I’m happy to talk to separately if you have other questions if I didn’t get into anything you have questions about again it was somewhat basic information about HIV but I’m hoping you’ll pass it along i’m not sure the education level the people you’re talking with but hopefully hammering home that this is something that you all need to be talking about you need to be aware that this is happening that this is a silent epidemic you’re seeing your your patients or your clients this is very real in their lives and they are probably not that aware of it educate yourself which is hopefully what I helped to do a little bit today screen everyone that you see for risk factors for HIV when you’re talking to them about domestic violence and other risk factors in their life never make assumptions I have a million stories I could talk to you about so many patients that I’ve seen where it was not thought that they would ever be an ATM somebody with HIV and so they were never offered a test and now they’re living with the disease that could have managed so much easier if they knew earlier or they could have done is somewhere talk to about it and we need to be stigmatized we need to stop thinking of this as such as stigmatize disease educate your clients and build a an environment where you accept them no matter what thank you can well a good job I feel like I’m going to be preaching to the choir here is a lot of your domestic violence so forgive me if I am redundance this was a true privilege for me to investigate a little more how HIV does affect women and men especially when in domestic violence community I do workshops throughout California and this brought light to shame she’s going deeper underground for especially for women and for the silence it’s it’s even more silencing these are the different types of news as you’re all aware of I the sexual abuses came talked about the whatever whatever I start as I went is that women who are in the have HIV or that women that are involved with partners that are promiscuous that Kim has set and that are the violence these women have job they don’t have a stay they don’t think hansa even though most the time in violent relationships they don’t have a say it’s usually if they do so now it is the time when when violence will escalate to a sharp degree but if they are in fear of having a partner that has a sexually transmitted disease the risk of saying of even talking and reaching the subject of have saying could we talk about using a condom will also escalate because of course we all know that domestic violence is more about it is about anger but it is more about power and control carsten there this is the definition of domestic violence this is the most exhaustive one that I could find that I use a lot use of physical force restraint of threads to force the Capellan to do something against one’s

really ugly harm to self cohabitant family or another father of one’s child it includes but is not limited to hitting by threats as a weapon sexual assault pushing slapping choking on line on agarose physical or psychological intimidation of control may be maintained through such means of stalking harassment threats against children pets see these are some of the signs and symptoms of individuals which I know that you know but as I was again as I was investigating the HIV population what what was brought to my attention is that if the woman is specially the homosexual community community if they are in a relationship with someone they have HIV if they are in a bit use of relationship they will go more underground rather than calling and reporting it why do you think that is even even take a guess well I just found it fascinating that number one they are so protective of their partner that if they have HIV and has not been reported if they’re abused and they the police come and they go to the hostel or they are taken into a shelter guess what happens they’d have to report their partners identity and they are so afraid it goes back to all the socio-economical reasons of why of these views when women and then stay in abusive relationships it’s it’s fear of losing a partner but in their case it’s fear of losing a whole community and it’s almost it’s almost a double shame it’s a double burden for them because they they have a community that has to them but when they go out into a community and they know their sexual i don’t have an exposed and they have HIV it’s a double burden for them so just like Kim headset they tend to go underground again more depressed suicide is is on the rise in this community so even though this is some of the obvious denial and minimizing of courses is huge it’s huge in this community as well where they look like women that have women ambien but think that was thinking of them and we’re searching on women women with childhood views are much more likely to enter into abusive relationships course instrumentals we know that but and they’re more likely not to have a voice of how to set boundaries of how to say no they are in this and the minimization is while I’ve been here before this is what I’m going with all my life so this this must be me it’s about me so self hatred comes in some projection comes in and when HIV is involved that it’s almost like oh I deserve this especially if they’ve acquired HIV prior to entering into a new relationship with someone and so it’s it’s very shaming and it’s very depleting and it depletes them of their power to to enable themselves unless they’ve got good community and good undergirding of counseling to get out there make decisions for themselves so you have a double burden can’t say no and we’re going to have a disease that stigmatized and they’re ostracized from the community so isolation is huge and isolation becomes even more prevalent the cycles of violence we all know the cycles of violence but this is again it’s perpetrated even deeper into the HIV community the first phase of course being that they sense that they’re beginning to their partner is beginning to escalate there was something more of a control they’re sensing more of verbal abuse or emotional abuse maybe the dog is getting hit so they’re starting to tip toe or they’re starting to pull away and then eventually phase two comes which is the actual active physical violence when that happens why most women stay and Wednesday in relationships ensures all have you known for a while is that they wait for phase 3 it’s the honeymoon stage it’s stage of why they’d be down a relationship in the first place it’s where the flowers come or or the promises come I’ll never do it again it’s where the romance begins again it’s it’s the security happens it’s a place of feeling safe once again even if it’s for a moment it’s for moments and it takes away from the stress of having to have relives is one case too it’s a relief and it’s a place where they think well maybe this time maybe this time but usually the perpetrator is they relive

and rewrite reality if they are not truly but I call me Penton they’ll rewrite realities and we know it even even if you independent hits you know if you didn’t have a you if you weren’t infected with HIV I can handle this relationship a lot better it goes out to the to the if onlys and it’s always usually if the victims fault and it goes back but it’s HIV there’s such a course in with them such a shame that said I am and it’s a toxic shame i would say I mins take yeah but I am mistake and I deal with I haven’t really dealt with women that have had HIV but I dealt with thing I’ve have had STDs and it is it does it does perpetrate and gives a hand that leans a hang on to them staying in a relationship because they have a belief system that says I won’t be able to find anybody to love me everything it’s it’s very sad and this is so this is my my my powerpoint that I use when I do workshops and says that their abuses don’t take space one what we do is we give family of classes on boundary setting to women relationships if it’s in phase one if it’s verbal abuse if it’s emotional abuse if it’s if it’s even property damage if it hasn’t gone to them being physically threatened or violated then many times there is help and just teaching them showing them who they are giving them power and encouraging them to know their identity of who they are of course if it avisas is stage two and the physical violence is prevalent I do this too and as I teach my counselors let your supervisor and over a ton of safety it’s hard to offer a plan of safety when there are an underground this is a challenge I think it’s a new challenge it’s it really woke me up to them the women out there and men who are hiding because of this issue this is the safety planets minimal was it was pretty condensed for the free interested in I have whole safety plan that we use and if you can get to them and you can extend your hand to them as as advisors as professionals as people in the medical community know that this is this true that he I’m sure most of love you know this but when you are discussing leaving with it with a woman who’s going to do this leaving is the most dangerous time for any for anybody to leave a relationship it is the most dangerous time it’s the time when when murders happen at the time when physical violence when I left my relationship it was the worst beating I had ever received and i received a mistake brutal beatings but when i chose to leave that was the moon was the worst time for me and it’s because of the loss of power and control this is my take home message that the best vaccine for HIV and domestic violence is empowerment it’s the best way to reverse this epidemic and then I know of and until we can change the apathy into strength so I thank you so much for your time and your attention and the fruit ask us can any questions that we stimulated some good heartfelt conversation with yourself and they hopefully brought an awareness as it did for both Kevin myself to a new level of women and men thank you any questions is the GL what you say that down low it’s the lingo that they right moving on the downlow was the term that they gave and it’s actually not that new with talking more and more about it for sure somebody were very familiar with it but basically it’s living the secret life sip they had over special on it it’s basically a scenario where you have one life you have a family maybe you have kids you have if you just have a girlfriend when you’re living with a girlfriend you’re in a relationship this is one life and then you have the need to go have another life maybe because it’s you have tendencies towards homosexuality but you never identify as gay never be accepted in culture or you you know it could be I guess when they talk about download their top having relationships with another person

of the same sex and keeping that as your secret life and then not talking about it and going home and that’s the problem that obviously is a viscous behavior that’s going on most often not protected and you’re going home and infesting you know the family so is Lisa a heel is that usually the changing to the sexual activity or write down low i think it just means like secret anyone ever want to add to that in your experience one of the things that I sometimes a client pays for their partners men early sometimes certain to control that you were talking about that sometimes medication that some of the fear of exposure is used he’s a way to control that is used as a way either to threaten me like that or to control the victim in terms of lack of medical there are situations where the partner becomes the carrot so they’re in that position of power to adult vacation well I think it can either be at the point prior to being take your right medication folic acid function well disability put in that situation here other other questions and please join me in thanking again totally Angie