PWN-USA Salutes Progress and Identifies Opportunities for Women in the New National HIV/AIDS Strategy

FOR IMMEDIATE RELEASE

Contact: Olivia Ford, oford@pwn-usa.org / 347-553-5174

July 31, 2015 –Yesterday, the White House Office of National AIDS Policy (ONAP) unveiled the newest version of the US National HIV/AIDS Strategy (NHAS, or Strategy), updated to 2020. Positive Women’s Network – USA (PWN-USA), a national membership body of women living with HIV, applauds the Strategy’s stated commitment to address the effects of past and current trauma in HIV care, and its expansion of priority populations which now include Black women, transgender women, youth, and people in the Southern states.

5things_nhas2020_crop
Credit: AIDS.gov.

“This new version of the Strategy corrects a number of the omissions pointed out in our gender audit of the initial version of the Strategy,” says Naina Khanna, Executive Director of PWN-USA. The new NHAS maintains the previous version’s overall goals of reducing new HIV cases and HIV related health inequities, improving health outcomes, and achieving a more coordinated national HIV response. In light of stark statistics and ongoing calls from advocates for federal recognition of the impact of HIV on Black women and Southern residents, the Strategy now includes a metric to measure progress toward reducing new HIV cases among these two overlapping groups.

However, the Strategy does not explicitly address disparities in health outcomes for Black women already living with HIV, whose death rates dwarf those of their white counterparts. Transgender women, who face astronomical HIV rates and high vulnerability to violence, are on a short list for indicators to be developed to measure progress in serving them under the new Strategy, but no such indicator exists as of the Strategy’s launch.

Following years of advocacy by PWN-USA leaders, the 30 for 30 Campaign, and others, the work of the Federal Interagency Working Group on the Intersections of Violence Against Women, HIV, and Gender-related Health Disparities has been integrated into the steps and recommended actions of the new Strategy. The Strategy also includes language committing to explore trauma-informed approaches to women’s HIV care.

Nevertheless, despite copious evidence that sexual and reproductive rights of people living with HIV are routinely violated, there is still no mention of reproductive health or rights, and sexual health of people with HIV is only marginally addressed, in the new NHAS.

A federal plan for putting the Strategy’s commitments into action is expected before the end of this year. PWN-USA encourages ONAP to take advantage of this opportunity to strengthen the Strategy’s effectiveness, including but not limited to: incorporating explicit language and metrics around sexual and reproductive health and overall quality of life for women living with HIV; developing indicators to support HIV prevention and care for transgender women; addressing root causes of poor health outcomes among Black women living with HIV; and developing a plan to address mental health, including high rates of depression as barriers to quality of life for women living with HIV.

We commend ONAP for its efforts to ensure greater responsiveness to the needs of women, transgender women, and youth in the new National HIV/AIDS Strategy, and look forward to working in partnership to support implementation over the next five years.

More Information:

30 for 30 Campaign Applauds Inclusion of Women’s Health Needs in New National HIV/AIDS Strategy

Full text of the Strategy

Infographic: National HIV/AIDS Strategy: Updated To 2020 – What You Need To Know

Infographic: National HIV/AIDS Strategy: Updated To 2020 – 5 Major Changes Since 2010

President’s Executive Order — Implementing the National HIV/AIDS Strategy for the United States for 2015-2020

Updating the National HIV/AIDS Strategy: Vote for the Recommendations Most Vital to Women with HIV!

Can you believe it’s been almost FIVE YEARS since the first National HIV/AIDS Strategy (NHAS) was released in July 2010?

The NHAS is a plan created under President Obama to comprehensively address the domestic HIV epidemic. The first NHAS included four main goals: 1) reducing the number of new HIV infections 2) increasing access to care for people living with HIV 3) addressing population-level disparities in prevention, care and treatment and 4) improving coordination of HIV programs and funding across federal agencies.

The first NHAS addressed some issues which are really important to women with HIV, including repealing HIV criminalization laws and expanding employment opportunities for people with HIV. But it missed the boat on others – failing to mention sexual and reproductive healthcare for people with HIV, failing to talk about the high rates of trauma and violence that impact women with HIV, and not meaningfully addressing the specific needs of transgender women.

Now, the White House Office of National AIDS Policy (ONAP) is soliciting input for the next National HIV/AIDS Strategy, which will be released this summer. This new Strategy (NHAS 2.0) will help to guide priorities for the domestic epidemic, likely for the next five years – which means it will go into the next Administration. It’s critically important that the voices of women with HIV and those who care about us are heard in this process.

The deadline to provide input ends this Friday, May 22nd. Here’s how to provide input:
1. Go to: https://nhas.uservoice.com
You can enter your email address to create a profile.
2. You will see that the opportunity to provide input is grouped into “feedback forums” according to the four goals of the National HIV/AIDS Strategy. You can click on any of the feedback forums to see which ideas have already been proposed.
3. Once you have access to a profile, you have two options:
a. Vote for a recommendation that has already been proposed
b. Propose a new recommendation
You can do both of these.
Note that you get 25 votes per feedback forum. You can vote for multiple recommendations, and you can also cast more than one vote per recommendation.

There are a lot of good recommendations already proposed in the forum. Also, a few weeks ago, PWN-USA released our own top five recommendations for the next National HIV/AIDS Strategy. In line with PWN-USA’s policy agenda and NHAS recommendations, here are just a few of the recommendations which have been proposed on ONAP’s forum that we think are really important. Click the links below to read more about each one. Starred (***) items are drawn from PWN-USA’s five top recommendations!

1. Reducing new HIV infections
a. Lift the ban on federal funding for syringe exchange
2. Increasing access to care & improving health outcomes for people living with HIV (PLHIV)
a***. Develop a minimum standard of care for PLHIV which includes sexual and reproductive healthcare, trauma-informed care, supportive services, and more.
b. Ensure gender-responsive, trauma-informed, coordinated and comprehensive care (this is very similar to the one above).

c***. Announce a national initiative focused on addressing inequity in access to care and poor health outcomes among Black women living with HIV

d***. Launch a national initiative to enhance culturally relevant prevention and care for transgender women
e. Ensure that PLHIV have access to healthy food: “Food as Medicine”
f. Increase and prioritize funding for services that link PLHIV into care
g. Preserve and support women-focused community-based HIV organizations
h. Integrate the work of the Federal Interagency Working Group on HIV and Violence against Women into the NHAS by instituting metrics on addressing trauma and violence

3. Addressing disparities and health inequities
a***. Fund research and development of women-controlled HIV prevention tools
b. Mandate comprehensive sex education in schools, and eliminate support for abstinence-only education
c. Eliminate state-level HIV criminalization laws

Are you excited yet? Ready, set, go vote before this Friday, May 22! (https://nhas.uservoice.com)

PWN-USA Teams with Healthcare Providers to Release New Model for Trauma-Informed Care

FOR IMMEDIATE RELEASE

Contact: Olivia Ford – oford@pwn-usa.org – 347.553.5174

May 6, 2015 – Today, Positive Women’s Network – USA (PWN-USA), a national membership body of women with HIV, is proud to announce the release of a new model for bringing trauma awareness and healing into primary healthcare settings. The conceptual framework, developed in partnership with University of California – San Francisco (UCSF) clinician-researchers, provides a practical guide to help providers incorporate trauma-informed care into clinical practice.

“Trauma-informed care is the missing ingredient to engage women with HIV in care successfully and to ensure good health outcomes,” says Naina Khanna, Executive Director of PWN-USA, who co-authored the paper presenting the new model. Rates of intimate partner violence and post-traumatic stress disorder are estimated to be 55% and 30%, respectively – much higher than national rates – among women with HIV.

“HIV care and treatment cannot work if women can’t get to the healthcare provider in the first place, because they have trauma-adaptive coping mechanisms getting in the way of showing up,” Khanna says, “or because unaddressed trauma and a healthcare environment that ignores trauma are making it difficult for a woman to communicate with her provider about what her real healthcare needs are.”

The model was published today in the journal Women’s Health Issues, and calls trauma-informed primary care “a practical and ethical imperative for women’s health and wellbeing.”

“Addressing trauma is our opportunity to move beyond treatment to actual healing for women with HIV,” Khanna explains. Advocates believe that failure to heal from the effects of current and past trauma explains the crater in the HIV care continuum for women: Only  70% of women with HIV link to care, and fewer than half remain connected to care.

The paper’s lead author, Edward L. Machtinger, MD, director of the Women’s HIV Program at UCSF, called understanding the link between trauma and overall health “an epiphany for clinicians.”

“Many of us have spent years struggling to help our patients be genuinely healthy and strong, but did not realize that there was a missing ingredient in our care model,” said Machtinger, a pioneer in trauma-informed care research and practice.

“Because trauma is so common, we need to critically examine how the healthcare environment affects not only patients, but also providers and staff,” said Leigh Kimberg, MD, UCSF Professor of Medicine at San Francisco Hospital and Trauma Center and the paper’s senior author, in a recent statement. “By adopting foundational trauma-informed practices and policies, healthcare providers and staff promote increased safety, reliability, trust, and empathy to create a more healing environment for everyone.”

The changing landscape of healthcare delivery, and of the HIV care system, finds the US at a critical moment of opportunity to transform these systems. While the first National HIV/AIDS Strategy failed to address the parallel epidemic of violence and trauma among women, President Obama’s creation of an Interagency Federal Working Group on the Intersection of HIV/AIDS, Violence Against Women and Girls, and Gender-Related Health Disparities was an attempt to correct this oversight.

The next National HIV/AIDS Strategy will soon be released, and must fully integrate the Federal Interagency Workgroup’s call for trauma-informed approaches to be implemented in all settings where women with HIV receive care and services. The recently published care model provides a blueprint for providers to begin to make this vital commitment to their clients.

Figure 1. A framework for trauma-informed primary care

A framework for trauma-informed primary care.
A framework for trauma-informed primary care.

Read the full text of the paper, “From Treatment to Healing: The Promise of Trauma-Informed Primary Care,” in the journal Women’s Health Issues

Read the San Francisco Chronicle article “UCSF team: trauma screening should be standard in health care” (PDF)

Women with HIV Must Be a Priority in the Next US National HIV/AIDS Strategy

Download a PDF version of this document.

The next National HIV/AIDS Strategy (NHAS) must include factors vital to the survival and well-being of women living with HIV. Women continue to account for nearly a third of the estimated 1.2 million people living with HIV in the US, and rates of morbidity and mortality among women are high.[i] The next NHAS must address the unique needs of women living with HIV and must include priorities that extend beyond the HIV care continuum.

BACKGROUND:

HIV mortality rates among women reflect stark racial and gender disparities. Although women with HIV are more likely to be tested and to know their HIV status than men who have sex with men (MSM), among those retained in care, women have lower antiretroviral medication use and lower rates of viral suppression.[ii] Mortality rates among women with HIV reveal that Black women have significantly higher death rates than White women (16.7 to 1).[iii] In a 2013 study, researchers determined that youth were less likely to be linked to care, retained in care, and virally suppressed,[iv] indicating that the specific clinical care and support needs of women and youth living with HIV are inadequately addressed in existing healthcare systems. Researchers have documented multiple barriers to engagement in care for women living with HIV, including lack of transportation, child care responsibilities,[v] lack of financial resources, inability to take time off work for medical appointments, and symptoms of clinical depression.[vi] Approximately 30% of women with HIV are currently living with post-traumatic stress disorder (PTSD).[vii] These factors contribute to poor health outcomes and increased likelihood of death among women living with HIV.[viii]

The HIV epidemic among women is primarily an epidemic among women of color.[ix] Further, women with HIV overwhelmingly live in poverty, and are reliant on public healthcare services.[x] A 2009 report by the National Institutes of Health found that a third of transgender women in the US are living with HIV, and the majority of transgender women diagnosed with HIV are women of color.[xi] Women with HIV occupy spaces where the impacts of racism, patriarchy, poverty, trauma, and HIV intersect; services for women must proactively address this.

In addition, the HIV epidemic among women is geographically concentrated. 10 states account for nearly 70% of all HIV cases among women.i Nine Southern states and the Northeast region shoulder a disproportionate burden of the HIV epidemic among women, with New York and Florida alone accounting for nearly 70,000 women and girls living with HIV.[xii]

Expanding services that effectively link and retain women living with HIV in care and ensuring the offer of antiretroviral therapy are critical. However, viral suppression cannot serve as a proxy for optimal health outcomes for women living with HIV. Women with HIV also experience disproportionate intimate partner violence and trauma, and hold significant responsibility in caring for other family members. These multiple burdens are exacerbated by the effects of racism, sexism, and poverty. Further, as HIV has become a chronic, manageable condition, and as the population of women with HIV has aged, needs have expanded beyond medical care to include quality of life issues, such as mental health and employment-related services. For women, addressing HIV in 2015 demands a multi-pronged response, one that accounts for the various interconnected factors shaping their lives and looks towards securing health, dignity, and long-term well-being.

As a national membership body of women living with HIV, Positive Women’s Network-USA recommends the following 5 priority actions for the Office of National AIDS Policy (ONAP) in developing the next National HIV/AIDS Strategy:

  1. Meaningfully Involve Networks of People Living with HIV

Recommendation: ONAP should consider networks of people living with HIV (PLHIV) as key consultative partners – particularly the US People Living with HIV Caucus, the largest and most representative national coalition of people with HIV – in all issues pertaining to the PLHIV community. PLHIV networks are accountable to the constituencies they represent, are in regular contact with people with HIV throughout the country, and can bring significant expertise, experience and accountable representation to bear on planning and decision-making processes pertaining to policies and programs that impact our lives.

  1. Expand Gender-Responsive HIV Services to Holistically Address Women’s Needs and Improve Health Outcomes of Women with HIV

Recommendation 1: Develop a minimum standard of care for women with HIV who receive healthcare from any payer source. Such a standard should be adopted by the Centers for Medicare and Medicaid Services (CMS) as well as by the Ryan White Program. The following components should be included:

  • Culturally relevant care that affirms the sexual and reproductive healthcare needs of women with HIV at all life stages and of all gender identities, including transgender women.
  • High-quality clinical care – including affordable, accessible medication and insurance payment in areas where Medicaid has not been expanded under the ACA.
  • Trauma-informed care practices, including screening and intervention for lifetime abuse and intimate partner violence, in HIV clinical and community-based settings.
  • Services that facilitate women’s access to care as needed, including: childcare, transportation, substance use and mental health services, and housing.

Recommendation 2:  Define and implement a standard of gender-responsive care for people with HIV that includes the above sets of services. Prioritize funding for models that meet this standard within the Ryan White Program.

  1. Expand Access to Care and Improve Quality of Care for Black Women Living with HIV

Recommendation 1: ONAP should develop an initiative focused on improving quality of care and access to care for Black women living with HIV, with a focus on the geographic regions where Black women are most impacted.

Recommendation 2: ONAP should mandate anti-racism training for providers, clinicians, public health departments, and AIDS service organizations in geographic locations where at least 30% of people living with HIV are people of color.

  1. Increase Access to Culturally Relevant Prevention and Care for Transgender Women

Recommendation 1: All CDC- and HRSA-funded sites should adopt the two-step question: what was your assigned sex at birth and what gender do you identify as now?

Recommendation 2: ONAP must monitor ACA implementation to ensure fully inclusive and comprehensive healthcare delivery that addresses the needs of transgender women living with HIV, with a particular emphasis on transgender women of color.

  1. HIV Prevention Methods Must Prioritize Women and Be Responsive to Their Unique Needs

Recommendation: Prioritize the research, development and dissemination of HIV prevention methods that can be controlled by women.

Download a PDF version of this document.


 

[i] http://kff.org/hivaids/fact-sheet/women-and-hivaids-in-the-united-states/

[ii] Dombrowski, Julia C. et al. High Levels of Antiretroviral Use and Viral Suppression among Persons in HIV Care in the United States, 2010. Journal of acquired immune deficiency syndromes (1999) 63.3 (2013): 299–306. PMC. Web. 6 Apr. 2015.

[iii] http://www.cdc.gov/hiv/pdf/q-z/cdc-hiv-surveillance-in-women-2013.pdf

[iv] Hall H, Frazier EL, Rhodes P, et al. Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States. JAMA Intern Med. 2013;173(14):1337-1344.

[v] Stein MD, Crystal S, Cunningham WE, et al. Delays in seeking HIV care due to competing caregiver responsibilities. Am J Public Health 2000;90:1138-40.

[vi] Cook JA, Cohen MH, Burke J, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. J Acquir Immune Defic Syndr 2002;30:401-9.

[vii] Machtinger, E. L., T. C. Wilson, J. E. Haberer, and D. S. Weiss. “Psychological trauma and PTSD in HIV-positive women: a meta-analysis.” AIDS and Behavior 16, no. 8 (2012): 2091-2100.

[viii]Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA 2001;285:1466-74.

[ix] http://www.cdc.gov/hiv/pdf/q-z/cdc-hiv-surveillance-in-women-2013.pdf

[x] Women’s Interagency HIV Study: https://statepiaps.jhsph.edu/wihs/invest-info/dossier.pdf, and The HIV Cost and Services Utilization Study: http://www.rand.org/pubs/research_briefs/RB4523/index1.html.

[xi] http://www.cdc.gov/hiv/risk/transgender/

[xii] Reif, Susan, et al. HIV Diagnoses, Prevalence, and Outcomes in Nine Southern States, J. Community Health, Dec. 2014, https://southernaids.files.wordpress.com/2015/01/hiv-diagnoses-prevalence-and-outcomes-in-nine-southern-states-final.pdf

Do All Black Lives Matter?

On National Black HIV/AIDS Awareness Day, Amplifying the Voices of Women, Youth, and Transgender Women

FOR IMMEDIATE RELEASE

Contact: Olivia Ford, oford.pwnusa@gmail.com / 347.553.5174

February 7, 2015 – This National Black HIV/AIDS Awareness Day (NBHAAD), Black women remain 20 times more likely than their white counterparts to be diagnosed with HIV in their lives – and Black women get sicker, and die faster, from HIV-related complications than white women.

Women living with HIV are overwhelmingly Black women. Throughout the three-plus-decade history of HIV in the US, this has always held true. No demographic shift made it so; Black women have always been most heavily impacted by HIV.

National-Black-HIV-AIDS-Awareness-Day-Carousel-5_HomeThis NBHAAD occurs against the backdrop of a national, intersectional movement asserting that #BlackLivesMatter, with unprecedented focus on the realities of pervasive threat under which African Americans live. But do all Black Lives Matter in all arenas? Where is the federal attention for the myriad concerns of Black transgender women, who face interpersonal and structural violence, devastating rates of HIV incidence, and outrageously poor health outcomes? The National Black HIV/AIDS Awareness Day toolkit does not include a single mention of Black transgender women, who sources report have a life expectancy of 35 years.

Where is the federal attention for Black women, who were present only by implication in the first-ever National HIV/AIDS Strategy? The President’s 2016 budget, released earlier this week, held all parts of the life-saving Ryan White program intact – except, for the second year in a row, the one part of Ryan White designed to serve women and youth. An attack on services for women with HIV is, by virtue of statistics, an attack on services for Black women. In a world where Black women are consistently devalued, this sends a dangerous signal about the value of women’s lives, health, and well-being.

There is a growing body of research into the effects of past or recent trauma on overall health, and the tremendous potential benefits of trauma-informed care for women with HIV. Addressing and healing trauma has been called the “missing ingredient” to providing truly high-quality care for women with HIV. And Black women, including transgender women, disproportionately experience virtually all circumstances that have been shown to cause trauma – for instance, poverty, histories of racism, incarceration, the constant, looming threat of physical violence by police.

Does the Office of National AIDS Policy (ONAP) believe that #AllBlackLivesMatter? This NBHAAD, PWN-USA urges ONAP to show its commitment to this reality: by supporting the protection of services tailored for women and youth. By making Black and transgender women a priority, and trauma-informed care a mandate, in moving forward with the National HIV/AIDS Strategy. By striving to improve the real lives – millions of lives – behind the hashtag.

Getting to Zero for Women: Violence is the Fatal Flaw in the National HIV/AIDS Strategy

Getting to Zero for Women: Violence is the Fatal Flaw in the National HIV/AIDS Strategy

FOR IMMEDIATE RELEASE:
CONTACT: Sonia Rastogi, positivewomensnetworkusa@gmail.com, (408) 306-6805

November 28, 2012, Oakland, CA – Data released in 2012 shows a shocking correlation between violence, trauma, and poor health outcomes of women living with HIV in the U.S. HIV-positive women face disproportionate rates of violence and abuse, which too frequently leads to medication failure and death. Yet the National HIV/AIDS Strategy and its accompanying implementation plan failed to articulate goals and objectives to address this fatal health disparity for women.

This World AIDS Day, Positive Women’s Network-United States of America, a national membership body of women living with HIV, calls on the implementers of the National HIV/AIDS Strategy to get to zero HIV-related deaths for women by committing to ending violence and discrimination.

Two months ago, Cicely Bolden was brutally murdered in Dallas, TX, allegedly for disclosing her HIV status to a partner. Earlier this year Brandy Martell was shot to death in downtown Oakland, CA, targeted because of her gender identity.

Data from the Women’s Interagency HIV Study shows that over 80% of women living with HIV in care have experienced trauma in their lifetimes, and a shocking one-fifth have experienced trauma in the past 30 days.

“We see violence against HIV-positive women every day,” says Gina Brown, an HIV-positive woman living in New Orleans, LA. “Some women are literally beaten to death. Others are emotionally or physically abused and, over time, lose the will or ability to take care of themselves, to keep medical appointments, let alone adhere to life-saving medications or eat well.”

“Laws that criminalize people living with HIV may play a role in perpetuating violence against women,” says Vanessa Johnson, JD, founding member of PWN-USA. “These laws, combined with the extreme economic injustice faced by women of color in this country, create an environment where HIV-positive women are not safe even in our own homes. Unfortunately, a woman’s HIV status can thus be used as a tool to manipulate, coerce, or control her.”

Research reveals that HIV-positive women with experiences of violence and trauma show disproportionately high rates of treatment failure, poor health outcomes, and high death rates than women living without HIV.

For instance, women living with HIV experience between two and six times higher rates of various types of child and adult sexual and physical abuse than the general population of women. Recent trauma is associated with over four times the likelihood of failing HIV treatment and almost four times the likelihood of being unable to negotiate or engage in safer sex. Ultimately, violence and trauma lead to higher death rates.

Positive Women’s Network-United States of America, a a national membership body of women living with HIV, demands bold action to end the various forms of violence faced by all women, including physical, emotional, psychological, sexual, institutional, and economic violence, and the trauma that violence leaves in its wake.

The National HIV/AIDS Strategy did not address the devastating impact of violence against women on the health outcomes of women living with HIV. But the Federal Interagency Working Group on HIV, Violence against Women and Girls, and Gender-Related Health Disparities, created by President Obama in a March 2012 memorandum, provides an historic opportunity to rectify this oversight, and President Obama’s Advisory Council on HIV/AIDS (PACHA) also called for action towards this end in May 2012.

The leadership of women living with HIV must be prioritized and centered in every aspect of the work ahead of us. As women living with HIV, the following are our recommendations:

Amending the National HIV/AIDS Strategy: The Office of National AIDS and Infectious Diseases Policy must amend the National HIV/AIDS Strategy to include objectives that integrate and prioritize trauma recovery, violence prevention, and sexual and reproductive health services with HIV care for women.

Service Integration: Trauma recovery services are a gap in current HIV care for women. Trauma, its impact on health outcomes, and existing interventions must be better researched and understood to meaningfully “get to zero” for women.

National Institutes of Health (NIH) must invest in scientific and community-engaged health disparities research that identifies the biological, psychological, and social causal pathways between violence, trauma, and poor health outcomes.

Federal agencies, starting with Health and Human Services (HHS), must fund demonstration projects to identify, inventory, and evaluate best practices for trauma-informed care in clinical settings serving HIV-positive women and homegrown interventions that address violence against women and trauma.

National Anti-HIV Stigma Initiative: The Office of National AIDS and Infectious Diseases Policy must commit to a robust national anti-HIV stigma initiative. Organized national networks of people living with HIV should be involved in designing such an initiative.

Violence is the Fatal Flaw in the National HIV/AIDS Strategy

Getting to Zero for Women: Violence is the Fatal Flaw in the National HIV/AIDS Strategy

FOR IMMEDIATE RELEASE:
CONTACT: Sonia Rastogi, positivewomensnetworkusa@gmail.com, (408) 306-6805

November 28, 2012, Oakland, CA – Data released in 2012 shows a shocking correlation between violence, trauma, and poor health outcomes of women living with HIV in the U.S. HIV-positive women face disproportionate rates of violence and abuse, which too frequently leads to medication failure and death. Yet the National HIV/AIDS Strategy and its accompanying implementation plan failed to articulate goals and objectives to address this fatal health disparity for women.

This World AIDS Day, Positive Women’s Network-United States of America, a national membership body of women living with HIV, calls on the implementers of the National HIV/AIDS Strategy to get to zero HIV-related deaths for women by committing to ending violence and discrimination.

Two months ago, Cicely Bolden was brutally murdered in Dallas, TX, allegedly for disclosing her HIV status to a partner. Earlier this year Brandy Martell was shot to death in downtown Oakland, CA, targeted because of her gender identity.

Data from the Women’s Interagency HIV Study shows that over 80% of women living with HIV in care have experienced trauma in their lifetimes, and a shocking one-fifth have experienced trauma in the past 30 days.

“We see violence against HIV-positive women every day,” says Gina Brown, an HIV-positive woman living in New Orleans, LA. “Some women are literally beaten to death. Others are emotionally or physically abused and, over time, lose the will or ability to take care of themselves, to keep medical appointments, let alone adhere to life-saving medications or eat well.”

“Laws that criminalize people living with HIV may play a role in perpetuating violence against women,” says Vanessa Johnson, JD, founding member of PWN-USA. “These laws, combined with the extreme economic injustice faced by women of color in this country, create an environment where HIV-positive women are not safe even in our own homes. Unfortunately, a woman’s HIV status can thus be used as a tool to manipulate, coerce, or control her.”

Research reveals that HIV-positive women with experiences of violence and trauma show disproportionately high rates of treatment failure, poor health outcomes, and high death rates than women living without HIV.

For instance, women living with HIV experience between two and six times higher rates of various types of child and adult sexual and physical abuse than the general population of women. Recent trauma is associated with over four times the likelihood of failing HIV treatment and almost four times the likelihood of being unable to negotiate or engage in safer sex. Ultimately, violence and trauma lead to higher death rates.

Positive Women’s Network-United States of America, a a national membership body of women living with HIV, demands bold action to end the various forms of violence faced by all women, including physical, emotional, psychological, sexual, institutional, and economic violence, and the trauma that violence leaves in its wake.

The National HIV/AIDS Strategy did not address the devastating impact of violence against women on the health outcomes of women living with HIV. But the Federal Interagency Working Group on HIV, Violence against Women and Girls, and Gender-Related Health Disparities, created by President Obama in a March 2012 memorandum, provides an historic opportunity to rectify this oversight, and President Obama’s Advisory Council on HIV/AIDS (PACHA) also called for action towards this end in May 2012.

The leadership of women living with HIV must be prioritized and centered in every aspect of the work ahead of us. As women living with HIV, the following are our recommendations:

Amend the National HIV/AIDS Strategy: The Office of National AIDS and Infectious Diseases Policy must amend the National HIV/AIDS Strategy to include objectives that integrate and prioritize trauma recovery, violence prevention, and sexual and reproductive health services with HIV care for women.

Service Integration: Trauma recovery services are a gap in current HIV care for women. Trauma, its impact on health outcomes, and existing interventions must be better researched and understood to meaningfully “get to zero” for women.

National Institutes of Health (NIH) must invest in scientific and community-engaged health disparities research that identifies the biological, psychological, and social causal pathways between violence, trauma, and poor health outcomes.

Federal agencies, starting with Health and Human Services (HHS), must fund demonstration projects to identify, inventory, and evaluate best practices for trauma-informed care in clinical settings serving HIV-positive women and homegrown interventions that address violence against women and trauma.

National Anti-HIV Stigma Initiative: The Office of National AIDS and Infectious Diseases Policy must commit to a robust national anti-HIV stigma initiative. Organized national networks of people living with HIV should be involved in designing such an initiative.