As doctors specializing in the clinical care of women living with HIV, we often get questions about breastfeeding and the transmission of HIV.
Here’s just one e-mail we received from an infectious disease specialist outside Ontario:
“I am seeing a young African woman as a patient who is HIV positive, had advanced disease, but now is suppressed. She is pregnant and had two deliveries in Africa, where she was encouraged to breastfeed. She is still quite adamant about breastfeeding despite my counselling otherwise. How do you manage these situations and what is your approach to this?”
By Allison Carter, Jessica Whitbread and Angela Kaida
“I went through a long period, seems like ancient history now, but I remember when I was first diagnosed, I felt so dirty. Like everything about me was, I suppose, unsafe and unclean and my blood was just full of crap. Just the whole thing was very internalized… For the most part now, I feel loveable. I feel good about myself. I just feel like I’ve still got a lot to offer and give and that I can be part of a strong, healthy relationship, despite the difficulties, I suppose.” —Anonymous quote by a woman living with HIV
The emergence of PrEP has highlighted important gender inequalities in HIV transmission and HIV prevention. PrEP, or pre-exposure prophylaxis, is a drug that HIV-negative people (including women!) can take to help prevent HIV; however, most discussions about PrEP focus on men. Despite representing fewer new HIV infections than men, women also need innovative HIV prevention methods.
A global study released last year revealed alarming figures concerning women living with HIV and violence. Among 945 women living with HIV from 94 countries who participated in the study, 89 per cent reported having experienced or feared violence before, since and/or because of their HIV diagnosis. Violence they experienced was reported to be higher after HIV diagnosis from their intimate partner and others in their social network. The troubling nexus between HIV and gender-based violence spurred the Canadian HIV/AIDS Legal Network, HIV & AIDS Legal Clinic Ontario and METRAC to produce a legal information guide for women living with HIV who are facing — or at risk of — “intimate partner violence” — that is, physical, sexual or psychological harm from a current or former partner or spouse.
In addition to being an exceedingly common experience among women living with HIV, intimate partner violence and HIV are both stigmatized, isolating people who are affected. Intimate partner violence also increases women’s vulnerability to HIV. Women who have violent partners are more likely to have forced sex, are less likely to negotiate condom use, and are more likely to be abused when they insist on condom use— which poses greater risks of HIV transmission.
Decades after the emergence of HIV, disclosure remains one of the biggest challenges for women living with HIV. There’s nothing easy or straightforward about it. When thinking about whether to tell someone about their HIV-positive status, women must consider a range of possible results, for themselves as well as their families.
Some women find that disclosure can help bring peace of mind, with more freedom from fear and stress. Being able to talk honestly about their health and get day-to-day support can be a relief. Very close relationships involve sharing, vulnerability and listening, and sometimes women find that disclosure leads to more open discussions, tighter connections and stronger intimacy.
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.