1. Washington D.C., USA, 22-27 July 2012www.aids2012.org “We Walk With Fear” Experiences of HIV Criminalization and Disclosure Amongst African and Caribbean Migrant Women in Ontario, Canada Presented by: Marvelous Muchenje Women’s Health in Women’s Hands CHC

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org No conflict of Interest

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Roots of Vulnerability to HIV/AIDS for Black Women in Canada Vulnerability is unique and deeply rooted in: –Socio-cultural and structural factors that intersect with - Gender, race, class, political and economic conditions Lack of economic opportunities Deprivation of rights to autonomy and sexual control over their bodies Cultural practices that increase risk of infection Limited educational opportunities

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV Diagnosis Start of the journey…….. Great distress, shock, disorientation, disbelief, denial, devastation, etc Complex experiences of loss: –Feelings of being victimized, regret, sadness, loss of future dreams, hopelessness, fear, withdrawal, isolation, depression, suicidal thoughts, anger, etc –Anxiety and grieving Period of coping, adjustment and acceptance

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV Disclosure

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV Disclosure HIV positive status disclosure is: –an ongoing process –intimately personal and has considerable effects on families and communities Impacts access to information and services Should be a component of support and care services offered for people living with HIV Is a journey involving a number of stages

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org DISCLOSURE Is disclosure necessary? Disclosure Process 1. Acceptance and Empowerment HIV Diagnosis

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org “To Tell or Not to Tell” Confidentiality of medical information Racist experiences with healthcare providers Fear of: accusations of infidelity Partner abandonment Community rejection Stigma and discrimination Violence Withdrawal of immigration sponsorship

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org “To Tell or Not to Tell” Feelings of shame Ideas that if practicing safer sex there is no need to disclose Ramification against family members, community Lack of disclosure skills Information regarding their HIV status used against them in the criminal justice system

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org “HIV is not hurting me, but your ignorance is …………”

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Criminalization of HIV Transmission, Exposure, or Non-Disclosure Lack of clarity of law can adversely impact : –personal, social, behavioral and sexual choices and decision making capacities Aggravates the risk of violence and abuse Reinforces gender inequalities Promotes fear and stigma Creates distrust in relation with health service professionals

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Criminalization of HIV Transmission, Exposure, or Non-Disclosure Criminalization due to overrepresentation of ACB in corrections Institutional racism in justice system Lack of resources and support Knowledge burdens on ASO and other health care providers with no experience providing legal support

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Criminalization of HIV Transmission, Exposure, or Non-Disclosure Lack of awareness and knowledge of the law and how it applies to HIV transmission Lack of awareness of HIV/AIDS transmission, disease progress and prevention Police harassment, coercion and intimidation of people living with HIV e.g. sex workers, homeless Relationship between police and media stakeholders

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org Media coverage

15. Washington D.C., USA, 22-27 July 2012www.aids2012.org Recommendations Building cross-sectoral knowledge capacities around: –HIV transmission, Prevention, Criminalization Further investigation and discussion of alternatives to criminalization –Mediation, Counselling, Restorative justice, Education, Support services Increase emphasis on the responsibilities of those seronegative

16. Washington D.C., USA, 22-27 July 2012www.aids2012.org Recommendation Increased resources for organizations to do targeted outreach to ACB population in their primary language Building relationships amongst: –ASOs, government stakeholders, ethno-specific community leaders/agencies, media stakeholders, legal/justice stakeholders Address the structural barriers: –colonialism, –oppression, –systemic racism and discrimination

17. Washington D.C., USA, 22-27 July 2012www.aids2012.org