Violence A s Cause or Consequence of HIV For W omen I n England Sophie Strachan Positively UK

1. Violence As Cause or Consequence of HIV For Women In England Sophie Strachan Positively UK

2. Introduction A summary of the findings from the Sophia Forums recent report on the experiences of women living with HIV in relation to Gender-Based Violence.

3. Feasibility Study • Exploring the potential for a national investigation into violence as a cause and/or consequence of HIV for women in England. • Involving: surveying organisations accessed by women living with HIV who have experienced GBV • In-depth interviews with staff from HIV support organisations, providing services for women living with HIV to explore the above issues in more depth • Consulting relevant stakeholders about evidence gaps at the intersection of HIV and GBV • Running a stakeholders event

4. Findings • The study found: • Few HIV support organisations accessed by women routinely collect data about women’s experiences of GBV • Few GBV support organisations collect data about a women's HIV status • Among migrant women, GBV may have taken place in their home country and may be on-going in the UK • Women living with HIV and experiencing GBV deal with multiple ‘layers of stigma’ and complex health and personal issues

5. Further Findings • There are questions around who is best placed to identify women experiencing GBV and what effective care pathways can be established • Finite resources mean that there is sometimes a reluctance to develop partnership working between HIV and GBV organisations • Gaps in responses: • Due to insufficient lead time to obtain clearance required by police and prisons there is no gathering of information from: • London metropolitan police • Prisons • Department of health • Home Office • Health protection agency

6. Recommendations • A good practice guidance toolkit should be developed in order to recognise the variety of challenges faced by women living with HIV • Training packages should be developed that challenge cultural norms of the acceptability of GBV against women living with HIV • There needs to be a more thorough mapping of HIV support services and a proactive development of partnerships with sectors that are already involved in elements of this work • In the longer term, mixed method research is needed to delineate the true extent of the HIV/GBV intersection and to understand the impact of BGV at both the individual and societal level.

7. HIV Behind Bars Looking in-depth at Human Rights Abuse in UK prisons including Gender-Based Violence

8. What is Gender Based Violence ? ‘ Violence against positive women is any act, structure or process in which power is exerted in such a way as to cause physical, sexual, psychological, financial or legal harm to women living with HIV’ Hale &Vazquez, 2011

9. Identifying forms of Gender Based Violence prior to imprisonment • Sexual violence such as rape, coercion and sex work. Multiple trauma through genocide, loss of family, rape by soldiers/prison guards • Childhood sexual abuse, molestation, exposure to family violence • Imbalance of power within relationships imbedded in our culture/social conformity. Most women are not aware they are experiencing gender based violence • Ostracised by family/community due to HIV status. Psychological violence with use of shaming language, silencing the partner (women) • Poverty drives coercion into drug trafficking, distorted belief due to living with HIV of nothing to lose and promise of financial gain, access to treatment.

10. Our experience of supporting women in prison • A large percentage of the women currently serving sentences are migrants who have been used as drug mules • Average sentence is between 18 months and 12 years • All of them have experienced GBV prior to being imprisoned and experience it from within the prison and from family members • The women are not able to acknowledge the full extent of their trauma pre imprisonment (lack of insight to what constitutes violence, trying to deal with the trauma of separation children, family • The stigma and discrimination they experience directly or indirectly within prison itself, be that linked to their HIV, a mother being incarcerated, mental health, drug user, sex worker, or sexual orientation • Women are re-traumatised on entering prison

11. Basic Human Rights • Article 8 Right to Privacy and Dignity • Article 3 Freedom from torture, inhumane and degrading treatment and punishment

12. Institutional Abuse • A quote from a women currently in prison, one officer who continues to bully her, said in front of another women ‘she does not need any help, what she needs is to be dead’ • Misuse of power- A women with a severe mobility condition arrived late at the dispensing hatch for medication, the nurse shut the hatch in the women's face and told her to come back in the afternoon, knowing that she needed to take her antiretroviral medication as prescribed. • Emotional Abuse- A women in prison being told she is making up her health problems and being a pain, having her walking stick taken off her by health care staff so she couldn’t move a round the prison.

13. Institutional Abuse • Direct discrimination from staff and people incarcerated • Confidentiality is compromised in prison, frequently not upheld at all. Staff dispensing ARV’s in front of other people incarcerated, increases anxiety for the person living with HIV regarding potential persecution • Despite raising the issue of discrimination with appropriate governors in the prison it is not addressed effectively as women still report on-going psychological and emotional abuse, this has resulted in women being moved to different prisons due to the severity of discrimination and it then continues in the next prison • Right to confidentiality, privacy and freedom of speech denied when prison officers insist on remaining present in consultations when visiting hospital appointments.

14. Equality for All?? • Successive Governments have committed to ‘equitable’ healthcare for people in prison with that received by the general public from the NHS • BUT… • People living with HIV in UK prisons are frequently denied immediate access to life saving medication, with waiting times of up to 5 months. • Emotional and psychological support is not available to support the needs of those living with HIV or diagnosed in prison. • Time and staff constraints frequently leaves hospital appointments not attended or adequate health care not given due to poor communication, patient cannot be prepared for certain procedures.

15. Conclusion Violence is used to achieve and assert power and control over others. Violence is at the very core of the prison structure, immediate loss of liberty and freedom brings about intense feelings of powerlessness and oppression for women. We have seen today the multiple layers of how violence is acted out. These women have already experienced immense emotional and at time physical pain, uprooted and dispersed from their families and communities. In failing to act we remain in collusion with the perpetrators of violence

16. Supporting Women Vulnerable to Gender Based Violence

17. Thank you Our reports can be accessed via our website: www.positivelyuk.org Sophia Forum website: http://www.sophiaforum.net/events/launch-of-report-on-gbv-and-hiv-in-england.html Study on Prostitution in London 2012 http://www.eavesforwomen.org.uk/news-events/news/CapitalExploits sstrachan@positivelyuk.org