Charlie is not unique. For many women and men trapped in abusive situations, their HIV status is a significant contributing factor, both to the violence itself and to their fear of leaving. And HIV-related violence doesn't stop there.
Charlie's life had become a nightmare.
At first his relationship with David had seemed like a dream come true. Kicked out of his parents' home at 16 for being gay, Charlie turned to hustling to survive. He was 18 years old when he met David, who took him in, gave him a home, and helped him find a job. They even talked about David supporting him while he went back to school. For a couple of years life was fine -- a stable home, regular meals, an affectionate partner, and sex that was hot and safe.
Fine, that is, except for David's jealousy.
In the beginning it was just little jokes about wanting Charlie all to himself. Then it was getting angry at Charlie because some guy had cruised him on the street. Eventually David started accusing Charlie of having sex with other men and demanded to know where he was all the time. He even called him at work several times a day. It all happened so gradually that Charlie couldn't remember exactly when he had stopped talking to friends or going out anywhere except with David.
What he could remember was the first time David hit him.
Charlie hadn't been feeling good for a while and had gone to a clinic where the doctor suggested that he test for HIV. The words "Your test results are positive" changed his life forever. He ran home to David, trying not to cry on the street. He was sure that David would know what to do.
But when he told David, tears streaming down his cheeks, David had screamed, "You little slut!" and smacked him hard across the face. That was when the nightmare began. David refused to wear a condom after that, saying, "What do you care? You've already got it!"
When Charlie resisted, David hit him again.
It seemed to get worse every day, but Charlie couldn't imagine a life without David. Each episode was followed by David's remorse and promises that it would never happen again . . . until it did. Once Charlie threatened to leave if the hitting didn't stop. David just laughed and said, "Where the hell would you go, back to the streets? You'd better stay with me, because nobody else is going to want you now."
And Charlie stayed -- his dreams shattered, his love turned to fear, and the sex with David, which he had enjoyed so much, turned to rape.
It isn't possible to say exactly how many Charlies there are, because statistics about HIV-related violence are scarce and difficult to compile. The challenge is to distinguish where HIV issues appear in the context of violence. Very often the HIV factor is overlooked, unacknowledged, or unrecognized. Only two programs -- New York's Gay and Lesbian Anti-Violence Project, or AVP, and Community United Against Violence in San Francisco -- track such HIV-related violence cases. Even then, the HIV factor is sometimes folded into other categories.
Defining HIV-Related Violence
Laura Edidin is Managing Attorney and Coordinator of the HIV-related Violence Program at AVP. According to her, HIV-related violence is not limited to domestic violence but appears as a factor in bias crime, harassment, police misconduct, and sexual assault and rape. She also stresses that violence against people with HIV or who are perceived to have HIV is not necessarily physical. In fact, the AVP definition of HIV-related violence is "whenever a person is victimized by his or her actual or perceived HIV status." Along the same lines, AVP defines domestic violence as "any act that tries to control, coerce, or dominate." The patterns of behavior that fit these definitions include psychological and sexual abuse, financial control, and physical or verbal harassment. Whatever the manifestation, it is all part of the same intent on behalf of perpetrators -- to wound or control someone because of his or her HIV status.
Besides hitting or beating, HIV-related domestic violence includes using a partner's positive status as a means of humiliation or as an excuse to have sex outside the relationship. It includes revealing, or threatening to reveal, a person's HIV status to friends, family, coworkers, or immigration authorities unless that person does what the abuser wants.
HIV-related domestic violence is not limited to instances where a negative individual commits violence against someone with HIV or AIDS. A positive perpetrator may, for example, force a partner (negative or positive) to have unprotected sex, or risk transmitting the virus when a violent episode becomes bloody. An HIV-positive parent, overwhelmed by dealing with illness and the demands of parenting, may abuse his or her children.
Although New York's new Partner Notification Law is not yet in effect, it is causing great concern among agencies that deal with domestic violence because the implications for potential violence are vast. According to the National Women's Health Information Center, the CDC is studying whether partner notification will discourage women at high risk from seeking HIV testing and counseling out of fear that their partners will harm them physically. Edidin voices the concerns of many service providers: "Part of contact tracing is that an abusive person may be contacted. Even though the person who tested remains anonymous, the abuser may be able to figure out who that person is. Contact tracing can also provoke violence if the partner takes the positive test result as evidence of infidelity, or if it is a young person living at home with parents. Also, once the law goes into effect, a visit from a Health Department person doing contact tracing, or a note from the Health Department left on the door can alert a landlord or neighbors to a person's possible HIV status, thereby putting that person at risk for bias violence or harassment."
Where we work is often a second home and our coworkers a second family. but it can also be a cutthroat environment where people do rotten things to promote themselves by tearing down others. HIV can become a tool in the hands of an unscrupulous colleague or supervisor and used as a means to force PWAs to do work outside their job descriptions, prevent them from advancement, or harass them into leaving.
HIV-Related Bias Crimes
Incidents defined by AVP as HIV-related bias crimes range from muggings or assaults -- the street crimes -- to abuse or neglect by service providers to harassment by neighbors, landlords, family, or coworkers. Episodes can be based on an individual's actual or perceived HIV status. For example, a person leaving an AIDS service organization is heckled on the street. He or she may not be HIV-positive, but the situation can nevertheless be dangerous.
Bias language is often a warning shot fired before a situation escalates to physical violence. Perpetrators will use AIDS-phobic or homophobic language as a test to gauge the target's response or the reaction of passers-by or to embolden themselves. Edidin points out that, while crime in New York City has declined overall, bias crime against lesbians and gays is actually on the rise, and these attacks are sometimes accompanied by AIDS-phobic language. As she describes it, "Perpetrators see people on the street who look sick or weak and, especially in a gay-identified neighborhood, assume, rightly or wrongly, that the victim has AIDS, and target them for a bias assault or mugging. Since the onset of protease inhibitors, the number of such cases has diminished, but they are still part of AVP's caseload."
Abuse or neglect by service providers includes employees of government or social service agencies taking advantage of or being unresponsive to a client with AIDS, or paramedics at the scene of an accident refusing to help an injured person they think might be infected. Another example of bias crime is the con artist who befriends people with HIV/AIDS and then steals money or induces them to sign over property, bank accounts, or insurance policies. These perpetrators may even be friends or loved ones.
Harassment is another significant aspect of bias crime. A landlord may know or surmise a tenant's HIV status because of receiving a rent subsidy, seeing mail from an AIDS service organization, or thinking the tenant is gay and leaping to a diagnosis of AIDS. If that tenant is a long-term resident of a stabilized New York apartment, that landlord has a powerful financial incentive to try to force the tenant out, and a powerful new weapon to do it with.
Harassment of tenants by landlords may take the time-tested form of trying to force people out of a building by refusing to make repairs, sometimes resulting in unsanitary and unhealthy conditions that can be especially dangerous to someone with a compromised immune system. It may also be accomplished by revealing a tenant's status to others in the building or by making threats. One client came to AVP for help when she returned home to find the word "AIDS" spray-painted on the door of her apartment after a confrontation with a neighbor. Edidin encourages people to report any such actions: "Discrimination and harassment create an environment that makes violence possible. Day-to-day harassment takes so much out of you. Physical violence is very traumatic, but other forms can be just as devastating."
Reporting HIV-Related Violence
How a bias crime is reported has many implications. New York State does not have a hate crimes law, a matter of bitter dispute in Albany between representatives who understand the need for such legislation and powerful legislators who have blocked proposed bills from the floor of the legislature. The New York City Police Department, however, does have a bias unit that investigates hate crimes and compiles statistics, fueled by the advocacy efforts of AVP and other lobbying groups.
Many people who have been on the receiving end of HIV-related violence are embarrassed and reluctant to report what has been said or done to them -- there is often a great deal of shame and self-blame involved. In some circles, even the word "victim" has taken on a negative connotation. But Edidin feels that it is important to make the connection between discrimination, prejudice, and physical violence. And standing up and reporting a crime can also help to take away some of the shame, putting a target of violence back on the path to self-empowerment.
AVP advocates with the New York City Police Department on behalf of those subjected to HIV-related violence. In addition to similar work with the Department of AIDS Services and other service agencies, AVP travels to police precincts throughout the city giving sensitivity trainings that help police officers to recognize bias when a crime is reported and to identify actions of their own that may put someone at risk for violence. For example: Someone with AIDS is arrested and put into a lockup with other prisoners awaiting arraignment. He or she asks the guard for access to medication, and the police officer -- willfully or inadvertently -- reveals that person's HIV status to the other prisoners. Now, besides being in trouble with the law and possibly being denied access to needed meds, our PWA is at risk for harassment, physical violence, or rape.
Of course, for many targets of violence, going to the police is not seen as a great option because of previous bad experiences or because the perpetrator is a police officer. People of color, lesbians and gays, immigrants, the poor, and the young often feel the police are prejudiced and fear that they will be revictimized. Edidin acknowledges this situation and pledges that AVP will work with such individuals to provide accompaniment to go to the police or to develop alternative options.
The Legal Aid Society's Prisoners' Rights Project is prosecuting a lawsuit against New York State on behalf of all HIV-positive prisoners because newly arrested prisoners are denied access to medications. According to Jack Beck, a lawyer with the Project, this can be significant for anyone on life-sustaining medications, but it is absolutely crucial for someone taking protease inhibitors, which demand strict adherence to a regimen and where failure to adhere may result in the body becoming intolerant to the medication.
Prisons are particularly dangerous places in other ways as well. According to Stuart Kingma of the United Nations Program on HIV and AIDS, as quoted by the CDC's National AIDS Clearinghouse, "The number of HIV-infected prisoners is in some cases up to 10 times the level seen in local populations. Prisons offer ideal conditions for the spread of the virus including intravenous drug use, tattooing, sexual tension and an atmosphere of fear and violence." This atmosphere is particularly intense for people with HIV and AIDS, who are often targeted for violence by both guards and other prisoners because of their HIV status.
The Impact Of HIV-Related Violence
It is well established that stress -- by itself or in combination with HIV or other factors -- is an immune suppressant. The consequences of violence, whatever the circumstances, can be particularly severe for people with already compromised immune systems -- people with AIDS, for example. Many people who have experienced HIV-related violence suffer from depression, which can make it difficult to stay on a medication schedule, sleep, or get out of bed. It can result in nightmares, poor eating habits, and/or fear of leaving the house.
Edidin suggests that anyone who has been subjected to HIV-related violence, even in the absence of physical injuries that obviously require medical care, should report the incident to her or his doctor. Checking T-cell and viral load numbers is one way of monitoring the physical impact of the trauma. Edidin also recommends seeking counseling to help deal with the immediate trauma and whatever may be being triggered about their HIV status. Very often the experience of HIV-related violence will bring up the same emotional and psychological issues that the were raised by the initial news of a positive test result.
Standing Up To HIV-Related Violence
So what can you do if you have been the target of HIV-related violence? In New York, to start with, you can call AVP or the organizations linsted on page 20. AVP is the only organization in New York City that offers its broad array of services to LGTB and HIV-positive populations, and its ability to look at all of the issues at once provides a unique perspective.
Founded in 1980 and funded in part by the AIDS Institute, AVP operates a 24-hour bilingual (English/Spanish) hotline, support groups, referrals, short-term one-on-one counseling, legal services, education, outreach, and advocacy. The agency does not work with the perpetrators of violence, but will refer them to other resources. And, despite its name, you don't have to identify as lesbian or gay to obtain services.
AVP's counseling philosophy is never to tell someone what to do, but rather to help individuals understand what their options are and understand the consequences of those options, and then to connect them with the services and support they need. A violent experience often leaves a person feeling powerless, with a life that is out of control. The other strength of the AVP counseling approach is that its goal is to return power to the individual and help that person choose the options that will help him or her heal. As Edidin puts it, "A person may have a great civil lawsuit against a perpetrator, but if they want to move on as quickly as possible this may not be the best option. A lawsuit would entail testifying at least twice and reliving the violence day after day during a prolonged court case. We will encourage a client to follow the path which seems to work in their best interest. Whatever option they choose, we're there to support them."
In the case of domestic violence, an advocate from the agency may help a person get new housing, move to a shelter, or, in the case of public housing, work with a social worker to expedite a petition for new housing or serve a notice of eviction on the perpetrator. The advocate can help get an order of protection and help the person understand what other legal issues may be involved.
Because most clients at AVP are lesbian or gay, they do not have access to the city's Family Court, where a petitioner must be related by blood or marriage to the abuser or they must have a child in common to get an order of protection. If, however, there is a child involved, gays and lesbians may still qualify for that court's protection -- for example, a person who was in a heterosexual relationship and had a child, later came out as gay or lesbian, and is now being harassed by the child's other parent, who threatens to take the child away or deny visitation because the person is gay and/or has HIV/AIDS. If there is no child involved and the person wants to press charges, AVP will help walk an abused individual through the process of having the perpetrator arrested and obtaining an order of protection through means other than petitioning the Family Court.
AVP will accompany individuals filing criminal complaints and help guide them through the labyrinth of New York's criminal justice system. The aim is to make sure that the system treats them with dignity and fairness, and AVP works very closely with the District Attorney's office. When a client complains of not being taken seriously or that the prosecutor is not prosecuting vigorously enough, someone from AVP will call the DA's office on that person's behalf. Sometimes it is a matter of helping to correct the situation, and sometimes it is a matter of explaining more clearly to the client where they are in the process.
Other support services include working through a safety plan. If someone is being harassed on the street, for example, a safety plan may mean changing that person's daily route to work or making sure he or she does not walk alone. It may also mean accompanying a person to a court date to offer moral support. Occasionally AVP will represent a client directly in court, but for the most part individuals who need legal representation are connected to other organizations that can best help them. In cases where an individual is afraid to leave an abusive situation because her or his immigration status is also a factor, for example, AVP might make a referral to someone like the GMHC Legal Department, which may take on the case as an immigration issue focusing on domestic violence rather than on a HIV-related basis.
There are many other organizations you can reach out to if you have been the target of violence (see sidebar). An Internet search for "domestic violence" showed 139,964 responses, and "domestic violence -- AIDS" showed 26,324. A random search of 150 sites showed many organizations around the country that treat AIDS-related issues and violence-related issues at the same agency. The only site that made the connection between HIV and violence, however, was -- you guessed it -- AVP.
Frank Abdale, the author of Community-Based Nutrition Support for People with HIV and AIDS -- A Technical Assistance Manual, has worked with people with HIV and AIDS for over ten years. He is now a program development consultant in the nonprofit sector and is a frequent contributor to Body Positive.
This article was provided by Body Positive. It is a part of the publication Body Positive.