Violence Against Women and HIV

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Table of Contents

• Gender-Based Violence
• Women, HIV, and Violence
• What Is Domestic or Intimate Partner Violence?
• Questions to Ask Yourself or Someone Who May Have Been Abused
• Danger Signs in a Partner or Potential Partner
• Disclosing Safely
• Decreasing Your Risk
• Leaving a Violent Relationship

Most importantly: if you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the US at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)], or text START to 88788. You can also search for a safe space online at Domestic Shelters.

It is important to remember that, if someone threatens you, it is NOT your fault. You deserve to be treated with respect and to be safe. Often, women who have been abused have been humiliated so much, they believe that they deserve whatever abuse they are experiencing. This is NEVER true.

"I will no longer take responsibility for the abuse I've received from the people I loved. I now know, it is NOT my fault." Jay Blount, peer navigator, Christie's Place

Gender-Based Violence

According to the World Health Organization (WHO), violence against women is a "global health problem of epidemic proportions." Violence against women refers to acts of violence directed toward women simply because they are women. It is a kind of gender-based violence – acts of harm done to people based on their sex or gender. These acts can include physical, emotional, and sexual harm – or threats of harm. Gender-based violence is rooted in gender inequality. Often, women do not think these acts are violence, either because they are considered normal in their society or because they occur so often that they seem normal. Violence against women is extremely common, affecting as many as seven in ten women in some countries. Women can also experience violence at the hands of their female partners. Among women of reproductive age, "acts of violence cause more death and disability than cancer, malaria, traffic accidents and war combined," according to UN Women.

Often, women do not think these acts are violence, either because they are considered normal in their society or because they occur so often that they seem normal.

Worldwide, transgender (trans) and gender nonconforming people, particularly women of trans experience, face extraordinary levels of physical and sexual violence and even murder. Rampant transphobia (bias against people who do not fit rigid gender norms) in many societies increases this vulnerability to violence. Alarming rates of violence and murder against trans women around the world have increased in the past decade. The majority of women suffer violence at the hands of their husbands, intimate male partners, or other men they know. A large US survey of trans people found that more than half of those who responded experienced some form of violence from intimate partners.

This violence has horrible consequences, both for women and their communities. The WHO reports that in 2020, 47,000 women and girls were killed by their intimate partners or other family members. Women who experience intimate partner violence are about twice as likely to experience both depression and alcohol abuse than women who have not experienced such violence. The damaging effects of this violence on women's emotional and physical health also affect the children and family members who depend on the women.

Women, HIV, and Violence

In September 2013, a working group convened by then-president Obama released a report of federal policy recommendations and action steps to address the intersection of HIV and violence against women. Recommendations include:

• increasing screening for intimate partner violence and HIV among women
• improving outcomes for women living with HIV by addressing histories of violence and trauma
• addressing factors that add to increased risk of violence among women living with HIV

There are several ways in which violence and HIV are connected for women. Women who are abused or fear a violent response may not be comfortable asking their partner to use protection (e.g., a condom) during sex. Similarly, women in abusive relationships may not be comfortable saying no to sex if their abusive partner refuses to use protection when asked. Lastly, forced sex acts can cause cuts, scrapes, or tears that make it easier for HIV to enter the body. All of these issues can make women more vulnerable to acquiring HIV and make living with HIV more difficult.

Several studies have shown that women with a history of physical and/or sexual abuse are more likely to be living with HIV, especially if that abuse first started during their childhood.

One tool that HIV-negative women can use to prevent acquiring HIV without their partners' cooperation is PrEP, or pre-exposure prophylaxis. PrEP refers to taking HIV drugs before being exposed to HIV to avoid acquiring the virus. For more information on how PrEP works and if it might be right for you, see our fact sheet on PrEP for Women.

Many women living with HIV had been physically or sexually abused before they found out about their HIV status. Several studies have shown that women with a history of physical and/or sexual abuse are more likely to be living with HIV, especially if that abuse first started during their childhood. Childhood abuse is closely linked with later drug use, having multiple sexual partners, being with a male partner who is more vulnerable to living with HIV, and exchanging sex for drugs, money, or shelter. If a woman uses drugs, alcohol, or sex to escape the pain of prior abuse, she may be at increased risk of acquiring HIV from sharing injection equipment or having sex without condoms or other barriers.

Many women may be at risk of abuse or violence because they tell their partner or the person they live with about their HIV status. One study revealed that over one in four women living with HIV had been physically harmed since their HIV diagnosis. Therefore, when you choose to disclose your HIV status, it is important to do so safely (see below). Among women living with HIV, studies have also shown that trauma and violence are associated with lower adherence to HIV drug regimens and therefore poorer health outcomes. For more information on the connection between trauma and HIV among women, see our fact sheet on Trauma and HIV.

Violence occurs more often in relationships in which one partner is more powerful than the other. Women living with people who are larger or stronger than they are may feel physically afraid. Also, women usually earn less money than men and are more likely to depend financially on others. Women who experience abuse are less likely to get out of the abusive relationship if they rely solely on their abuser's financial support.

What Is Domestic or Intimate Partner Violence?

Domestic violence occurs when a person you are dating, living with, or are married to is repeatedly harming or threatening you — physically, sexually, verbally, emotionally, or financially. The person doing these things will often do them to gain or keep power and control. "Intimate partner violence" (IPV) is another term used to describe violence in which a current or former partner or spouse physically, sexually, or psychologically harms you.

IPV can happen to anyone. It affects people of any age, race, gender, sexual orientation, educational level, financial situation, or marital status. It is important to learn about how abuse happens, how to identify it, and how to end it or get away from it.

Important: If you are feeling threatened right now, call 911 in the US or the National Domestic Violence hotline in the US at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)], or text START to 88788. You can also search for a safe space online at Domestic Shelters.

Intimate partner or domestic violence can take many forms. These include:

• Verbal abuse (using words to put someone down or make them feel bad), threats, constant blame or criticism; all of these are emotionally abusive
• Mild physical harm – like pulling hair or twisting flesh
• Violent actions that leave marks – like hitting, slapping, pushing, beating, or throwing things
• Extreme violence using knives or guns
• Rape or sexual assault (being forced into sexual acts that you do not agree to)
• Economic or financial abuse (e.g., preventing someone from getting a job, making them ask for money)
• Intimidation – making someone afraid by threatening them, giving them nasty looks, destroying property, harming pets, etc.
• Isolation – controlling what someone does, who they talk to, where they go, what they wear, what they read or watch, etc.
• Using threats to pressure or force (e.g., threatening suicide, reporting someone to immigration, threatening to take children away)
• Treating a partner like a servant, acting like the dominant partner is the 'king of the castle,' etc. 

Domestic violence often begins with threats or emotional abuse. While these harmful words or actions may or may not lead to actual physical harm, they can still be very upsetting and scary, and leave long-term emotional scars.

While most IPV or domestic violence involves men assaulting women, it can also involve men assaulting their male partners, or women assaulting their male or female partners. Studies have shown that IPV can happen as often in same-sex couples as it can in heterosexual couples.

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Questions to Ask Yourself or Someone Who May Have Been Abused

Sometimes, it can be difficult to know if you or someone you know has been abused, because victims may confuse their partner's actions with a form of love or caring.

This list of questions might help you or someone you know identify the abusive actions of a partner or someone else in the home:

• Do you ever feel unsafe at home?
• Have you ever felt threatened by your partner, ex-partner, or other person in your home?
• Are you in a relationship where you have been physically hurt?
• Has a partner, ex-partner, or person you live(d) with ever:
  • Pushed, grabbed, slapped, choked, or kicked you?
  • Forced you to have sex or made you do sexual things you did not want to do?
  • Threatened to hurt you, your children, or someone close to you?
  • Stalked, followed, or monitored you (this includes checking your daily movements, emails, phone calls, and texts)?
  • Kept you from seeing your friends or family? Told you where you could or could not go? 
  • Prevented you from getting a job, or limited your access to money?

Danger Signs in a Partner or Potential Partner

While there may not be any one profile or way to identify a person who is abusive, you may notice your partner acting in one or more of these ways. He/she may:

• Be overly jealous
• Have big mood swings
• Have an explosive temper
• Have low self-esteem
• Blame you for their own problems
• Use words to make you feel bad about yourself
• Try to control you (e.g., limiting where you go, how much money you have, what you buy)
• Try to keep you from your family or friends

Disclosing Safely

Sadly, many women living with HIV are sexually or physically attacked soon after they disclose their HIV status. Here are some tips on how to reduce the risk of becoming a victim of sexual or physical attack before, during, and/or after disclosure:

• Disclose in a semi-public place, such as a public park with many people around. Find a place that is private enough to have a conversation, but public enough to get help if you need it.
• Consider disclosing with a third person, such as a friend or a healthcare provider, there
• Meet only in public with the person to whom you are disclosing until you feel safe
• Avoid exposing others to HIV without warning them ahead of time. The risk of violence may be greater if a person feels you knowingly put them at risk or lied to them. In the US, your county health department may have a program that can disclose for you anonymously (your name is not shared), or it may provide services to help you disclose safely.

Decreasing Your Risk

There are no guarantees, but you can help lower your risk for IPV or domestic violence:

• Do your homework. To find out information about the person you are dating (such as if he or she has a violent criminal record), consider doing a background check. In the US, there are a number of companies that provide this service for a fee.
• Keep in touch with people who support you. Whether it is family, friends, a support group, peer advocate/counselor, or healthcare provider, do not let your relationship with any one person keep you from staying in touch with others.
• Get help and support. If you have been physically or sexually abused in the past, it is important to get help from a mental health professional or a support group. Otherwise, the past may be more likely to repeat itself.
• Avoid entering an abusive relationship. Be aware of the warning signs of abuse (described above) when starting relationships. If you see warning signs, the best time to leave is the first time any type of abuse happens.
• Stay informed. Learn all you can about domestic violence, even if you think you will never need to know about it.
• Build financial independence. Having your own source of income or savings can help you avoid being trapped in a situation you cannot leave.

Leaving a Violent Relationship

It is never easy to leave a relationship, and it can be especially difficult to leave one that involves intimate partner or domestic violence. The key is to have a safety plan.

• Stay safe. Leaving your partner or someone you live with can be upsetting to that person. Make your safety (and that of your children) your top priority.
• Be prepared. If you leave, do not forget your HIV drugs and any other medications you take, medical records, birth certificates (yours and your children's), credit cards, checkbook, etc. Assume that anything you leave behind may end up in the dumpster or be used to find you. It may help to leave an emergency kit with some of these items with a trusted friend, family member, or service provider. If you do not want to give the name of the person you are afraid of, you can put it in a sealed envelope and ask them to open it only if you disappear or become too injured to identify the person who hurt you.
• Document. Get medical attention if needed and get photos of any injuries that show. Have photos signed and dated by medical or law enforcement personnel if possible. A friend or family member can also sign and date for future evidence.
• Get help. Do not try to do this alone. It may be awkward or embarrassing to reach out to others, but your health and life may be at risk. If you cannot seek help for yourself, think of those who love you and may depend on you. Go to friends, the police, family, an emergency room, or a local shelter.

In the US, call the National Domestic Violence hotline at 1-800-799-SAFE [1-800-799 -7233; or 1-800-787-3224 (TTY)], or text START to 88788.You can also search for a safe space online at Domestic Shelters. 

If you have experienced domestic or intimate partner violence, always remember – it is NOT your fault. It can happen to anyone. Anyone who physically, verbally, or sexually attacks another person is responsible for his or her actions. The most important thing is to get safe and stay safe.

The Well Project has compiled a list of additional Resources on the Intersection of Women, HIV and Violence. Take a look at the resources we have gathered: personal stories, scientific data, policy efforts, reports, community-based toolkits, and hotlines for women in need of support.