October 25, 2011
Abusive relationships are linked to about 12 percent of HIV infections among U.S. women, according to a recent University of Pennsylvania School of Nursing study. HIV-related shame and stigma often play a role in such relationships, said Evany Turk, a peer advocate for the Living Positively Project at the University of Chicago Comer Children's Hospital.
"A lot of these young women, especially black girls, have never been told they are worth anything," said Turk. "Many of them are former wards of the state growing up in poverty. They've never had parents to tell them they're wonderful or they're beautiful or they're loved."
For some, the threat of HIV is seen as less dangerous than a confrontation with their partner about anything, including condom use, Turk said. "They perceive men as having so much more power than they have," she said.
"He tells her, 'I can do whatever I want to you because you're [HIV-positive and] damaged goods,'" Turk recalled about one recently infected young female client whose abusive, HIV-positive boyfriend always refused to use condoms. "She's sure that's how she got it," Turk said.
Coercive strategies are even more effective if the woman sees herself as "damaged," said Anne Teitelman, one of the study's authors. "Partner abuse is the most overt form of what we're talking about. But there are other types of coercion, which is emotional manipulation. There is a self-silencing among some younger teens and they don't feel they can speak up about their own sexuality. And if a guy pressures them [about not using a condom], he doesn't have to pressure too much."
Young women need to learn condom negotiating skills before sexual debut; how to ensure the condom is on and stays on during sex; how to define healthy and unhealthy relationships; and how to recognize when negotiating strategies are not working and safely leave a relationship, Teitelman said.