Ignorance, Domestic Violence, and HIV Disclosure: A Fatal Combination

by Rashida Richardson and Catherine Hanssens

For many women forced to negotiate the parallel epidemics of HIV and domestic violence, ignorance about HIV can prove to be an additional excuse for physical violence against them.  

by Rashida Richardson and Catherine Hanssens

Since the beginning of the epidemic, ignorance about HIV has fueled stigma and bias manifested in government policies, ranging from criminalization laws to exclusion from public school and military service. This institutionalized HIV ignorance and bias can result in devastating consequences for anyone living with HIV. But for many women who are forced to negotiate the parallel epidemic of domestic violence, HIV ignorance can provide an additional excuse, or cover, for physical violence. This past week, it reportedly was offered as an excuse for the murder of a Texas woman who may have been HIV positive. Her story illustrates the pressing need to deal with both epidemics, and to issue a collective outcry against the ignorance that continues to serve as an excuse for ruining, even ending, the lives of women and men living with HIV.

Cicely Bolden, 28, of Dallas, TX, was stabbed to death by a boyfriend, reportedly after having sex with him. Police say Larry Dunn, 36, stated that he stabbed her after she told him she was HIV positive. According to press reports, Dunn told police "she killed me, so I killed her."

Of course, we cannot presume to know what happened based on news and initial police reports. We do not know whether she did have sex with him, whether she was raped, whether she was HIV positive, or whether and when she might have told Dunn she was living with HIV. What we do know is that a young woman was brutally murdered, her body found by her young children when they returned home from school, and that the man charged with her murder has stated that her HIV status justified her death.

Ignorance and hysteria still surround HIV. From "Prevention for Positives" campaigns to HIV-specific laws that make any alleged failure to disclose a felony and sex-offense, several policy decisions have created a landscape in which only those infected with HIV are assigned the responsibility for disclosure and protection of their partners, and put in jail when they do not. These policies effectively render the risks, dangers, and related responsibilities connected to all STIs – from herpes and HPV to treatment-resistant gonorrhea – invisible and irrelevant. Not only does this discourse amount to public health nonsense, it creates yet another layer of danger for HIV-positive women who have to contend with potentially violent partners.

This is all the more troubling in light of a new study on gender-based violence and HIV by Dr. Kathleen Weber, of CORE Center/Cook County Health and Hospital System and Hektoen Institute of Medicine, which she presented at the XIX International AIDS Conference in Washington, DC, in July 2012. The study found that episodes of domestic violence dramatically raise the short-term risk of death for women affected by HIV. In fact, the study found that having HIV may increase the risk of abuse.

It is time to step up efforts against the real and serious peril posed for women by HIV ignorance and domestic violence. During a press conference preceding Dr. Weber's AIDS 2012 presentation, Dr. Edward Machtinger, of the University of California, San Francisco (UCSF) noted that a possible reason for the poorer outcomes for HIV-positive women "was the lack of resources or discussion about intimate partner violence and other forms of abuse." And a 2009 Kaiser Family Foundation national survey confirmed that levels of knowledge about HIV transmission have not improved over the more than two decades since 1987.

Domestic violence against women with HIV is an important public health issue. Concerted and frank educational campaigns about the real nature of HIV's routes, risk and consequences are seriously needed and long overdue. These campaigns must include programs that embrace and cultivate all sexually active adults' responsibilities to protect their own and their partners' health. Education efforts must also include a recognition of the very real harm that has been caused by making prevention the province of only the HIV-positive. In addition, the impact that the threat of abuse has on women's ability and willingness to enter and remain in care must be addressed realistically in HIV testing, treatment and partner notification programs.

As long as state lawmakers and health officials endorse or tolerate the official treatment of HIV as evidence of a felony and sufficient basis for sex offender classification – which remains the case in dozens of states – the Larry Dunns of the world will continue to believe that HIV is, and deserves, the death penalty. The glacial pace at which policy makers recognize and respond to this reality effectively ensures that what happened to Cicely Bolden will continue to be more than an isolated incident, devastating the families and friends that these women leave behind and confirming, for those who survive, the potential deadliness of HIV disclosure.