Here’s one of the least-discussed but more startling facts about HIV among women in America: As many as half of women living with the virus report a history of sexual abuse in their childhood, according to the U.S. Centers for Disease Control and Prevention.
So Dr. Gail Wyatt, working with her colleagues at the University of California, Los Angles and CDC, have designed what CDC says is the nation’s first prevention program specifically crafted for those women. And given the dynamics of the female epidemic – Blacks account for 69 percent of new infections among women – the program is tailored for African American and Latina women in particular.
During the CDC’s National HIV Prevention Conference in Atlanta this June, Dr. Wyatt presented some refreshingly good news from the study: participants were one and half times more likely to report healthier sexual behavior than a control group of women not participating in the program, including 100 percent condom use.
BlackAIDS.org editor Kai Wright spoke with Dr. Wyatt about her work.
BlackAIDS.org: Give me the back of the envelope version of what the project is doing and has found.
Dr. Wyatt: This is an issue that our society hasn’t totally embraced as one of concern. A person with a history of child sexual abuse doesn’t always tell, so many times it’s not possible to know whether there needs to be some sort of family support or therapy or intervention. But many children do tell, and they are punished because parents may blame them in some way for these events occurring. And the events themselves have to do with someone else making decisions about your body, many times insisting on silence, many times exposing children to sexual experiences that are far beyond their age or even desire to know anything about for that particular time in their life. They often involve force. And for two out of the three women in our study, a family member was involved.
So these are severe experiences that we found that HIV positive women tended to have, even when we compared positive women to negative women with similar background characteristics.
And so we, at UCLA and my team, felt that an intervention that specifically targeted these experiences, and that not only helped women cope with past trauma but also living with HIV and the responsibility that requires, would be an intervention that fills the gap from those programs that simply teach condom use and risk reduction without really asking why people engage in high-risk sexual behavior. Or asking what kinds of experiences place them at increased risk.
One thing you mentioned in Atlanta was that we think, ‘Why not just get out of these relationships if they’re abusive or not positive, why would you persist in things that are damaging to you?’ And you said we don’t think about the notion that any relationship may be better than no relationship.
Right. Availability of relationships and partners has a lot to do with why people stay in the ones that they’re in. It isn’t always that there’s other fish in the sea, and particularly for African American women. Finding another partner isn’t always easy. And the likelihood of finding and maintaining relationships if you’re HIV positive is also challenging, and I think significantly more challenging than it is for an HIV positive man.
And that’s because… ?
The availability of a partner places men in a premium position; they are usually the ones who choose their relationships. Women today, particularly African American women, feel that there is a shortage of men — and there is. They are either not interested in women, dead, or in prison. And there are fewer men in the African American community. So relationship building is not an easy task, and many women feel that they’re competing against other women who will do anything.
Why look at positive women?
Well, we looked at both positive and negative women in order to compare similarities and differences in the way their relationships work out, and to better understand how being HIV positive might affect a woman’s relationships. And so when I’m answering questions based on why women stay in abusive relationships, it’s based on a longitudinal study that was funded by the National Institutes of Mental Health. For seven years, we followed 157 women — African American, Latina, European American women. And then from that study we developed an intervention for African American and Latina women.
So what are the dynamics that impact adherence to treatment regimens?
People with abuse histories tend to be distrustful of people who work on their bodies. So they may doctor shop, which means they go to a number of practitioners, go to emergency rooms where no one has a history on them. And as a consequence, not really have to deal on an intimate level with their bodies and how they function -– certainly not to discuss past painful experiences that may be embarrassing or humiliating for them to describe. And many health professionals don’t ask. So the issue never comes up. But we find that women tend not to pay attention to their bodies in the same way, and want to avoid exams and discussions that have to do with their adherence.
And explain to me what exactly the intervention you developed does?
First, this is a community sample of women throughout Los Angeles County. They were not necessarily in clinics; many of these women were not taking medication at all. And I think that’s an important issue because many times clinic studies give a completely different picture in minority communities. They’re of people receiving the medicine. So when you’re not taking medicine, you’re not in any studies on HIV and risk taking behaviors. Secondly, we described sexual abuse as an unwanted experience that occurred before the age of 18 with a relative or non-relative. So women didn’t necessarily define their own experiences as sexual abuse. Many in fact blamed themselves for the incidents occurring.
The intervention lasted 11 weeks, with a trained facilitator and co-facilitator who was herself HIV positive with a history of child sexual abuse. So that women, African American and Latina women, had an opportunity to meet together in groups and to discuss their histories of violence and trauma, and their attempts to cope with HIV and to really put together a strategy for reducing high risk sexual behavior using group support, learning skills of negotiation and also learning how to cope more effectively with their past histories of abuse.
And through that you were able to measure a decrease in risk behavior?
Yes. And we were also able to measure an increase in adherence to HIV medication. If they were not on medication, they went on medication or went to the doctor, and began the regiment.
So it sounds like just getting folks to start talking about this past experience and how it impacts today.
Talk about it, not be ashamed of it, and to also meet other women who have had similar experiences. And making the connection between past experiences, when someone takes advantage of you, and current experiences, where they may be willfully selecting partners who take advantage of them. Most of these women were infected by partners, they were men they loved or were married to. And it was a very painful experience to come to grips with the fact that two people had taken advantage of them in their lives, maybe more.
So that the infection then becomes a second form of abuse.
Exactly. So we’ve taken that design of the study and now we have an ongoing study with men, with hopes that we can find the same kinds of effectiveness in the intervention with men who are HIV positive and have histories of child sexual abuse.
Kai Wright is editor of BlackAIDS.org.