Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Andrea Krüsi; Flo Ranville; Lulu Gurney; Tara Lyons; Jean Shoveller; Kate Shannon

doi:10.1371/journal.pone.0202776

Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Andrea Krüsi, Flo Ranville, Lulu Gurney, Tara Lyons, Jean Shoveller, Kate Shannon

Résultat de recherche: Article › examen par les pairs

34 Citations (Scopus)

Résumé

While a growing body of research points to the shortcomings of the criminal law in governing HIV transmission, there is limited understanding of how cis and trans women living with HIV (WLWH) negotiate their sexuality and HIV disclosure in a criminalized environment. Given the ongoing criminalization of HIV non-disclosure and prevalence of gender-based violence, there is a critical need to better understand the dynamics of negotiating sexual relationships and HIV disclosure among WLWH. We conducted 64 qualitative interviews with cis and trans WLWH in Vancouver, Canada between 2015 and 2017. The interviews were conducted by three experienced researchers, including a cis and a trans WLWH using a semi-structured interview guide. Drawing on a feminist analytical framework and concepts of structural violence, the analysis sought to characterize the negotiation of sexual relationships and HIV disclosure among WLWH in a criminalized setting. For many participants their HIV diagnosis initially symbolized the end of their sexuality due to fear of rejection and potential legal consequences. WLWH recounted that disclosing their HIV status shifted the power dynamics in sexual relationships and many feared rejection, violence, and being outed as living with HIV. Participants’ narratives also highlighted that male condom refusal was common and WLWH were not only subjected to the gendered interpersonal violence of male condom refusal but also to the structural violence of legislation that requires condom use but fails to account for the gendered power imbalance that shapes condom negotiation. Despite frequently being represented as a law that ‘protects’ women, our findings indicate that the criminalization of HIV non-disclosure constitutes a form of gendered structural violence that exacerbates risk for interpersonal violence among WLWH. In line with recommendations by, the WHO and UNAIDS these findings demonstrate the negative impacts of regulating HIV prevention through the use of criminal law for WLWH.

Langue d'origine	English
Numéro d'article	e0202776
Journal	PLoS One
Volume	13
Numéro de publication	8
DOI	https://doi.org/10.1371/journal.pone.0202776
Statut de publication	Published - août 2018
Publié à l'externe	Oui

Note bibliographique

Funding Information:
This research was supported by the Canadian Institutes of Health Research through a Community-based Research Grant (384667) and a Foundation Grant (FDN-143349). AK is supported through a Michael Smith Foundation for Health Research Scholar Award. KS is partially supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research Scholar Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank all those who contributed their time and expertise to this project, particularly participants, community partners, the SHAWNA Positive Women’s Advisory Board and Community Advisory Board, and the SHAWNA team members: Sarah Moreheart, Erin Seatter, Flo Ranville, Lulu Gurney, and Barbara Borden. We also acknowledge Brittney Udall, Jennifer Morris, Abby Rolston, Peter Vann, Ariel Sernick, and Jenn McDerimd for their research and administrative support. This research was supported by the Canadian Institutes of Health Research (CIHR) CBR 384667 and FDN-143349. AK is supported through a Michael Smith Foundation for Health Research Scholar Award. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research.

Publisher Copyright:
© 2018 Krüsi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ASJC Scopus Subject Areas

General Biochemistry,Genetics and Molecular Biology
General Agricultural and Biological Sciences
General

ODD de l’ONU

Cette action contribue à la réalisation des objectifs de développement durable suivants

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10.1371/journal.pone.0202776

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abstract = "While a growing body of research points to the shortcomings of the criminal law in governing HIV transmission, there is limited understanding of how cis and trans women living with HIV (WLWH) negotiate their sexuality and HIV disclosure in a criminalized environment. Given the ongoing criminalization of HIV non-disclosure and prevalence of gender-based violence, there is a critical need to better understand the dynamics of negotiating sexual relationships and HIV disclosure among WLWH. We conducted 64 qualitative interviews with cis and trans WLWH in Vancouver, Canada between 2015 and 2017. The interviews were conducted by three experienced researchers, including a cis and a trans WLWH using a semi-structured interview guide. Drawing on a feminist analytical framework and concepts of structural violence, the analysis sought to characterize the negotiation of sexual relationships and HIV disclosure among WLWH in a criminalized setting. For many participants their HIV diagnosis initially symbolized the end of their sexuality due to fear of rejection and potential legal consequences. WLWH recounted that disclosing their HIV status shifted the power dynamics in sexual relationships and many feared rejection, violence, and being outed as living with HIV. Participants{\textquoteright} narratives also highlighted that male condom refusal was common and WLWH were not only subjected to the gendered interpersonal violence of male condom refusal but also to the structural violence of legislation that requires condom use but fails to account for the gendered power imbalance that shapes condom negotiation. Despite frequently being represented as a law that {\textquoteleft}protects{\textquoteright} women, our findings indicate that the criminalization of HIV non-disclosure constitutes a form of gendered structural violence that exacerbates risk for interpersonal violence among WLWH. In line with recommendations by, the WHO and UNAIDS these findings demonstrate the negative impacts of regulating HIV prevention through the use of criminal law for WLWH.",

author = "Andrea Kr{\"u}si and Flo Ranville and Lulu Gurney and Tara Lyons and Jean Shoveller and Kate Shannon",

note = "Funding Information: This research was supported by the Canadian Institutes of Health Research through a Community-based Research Grant (384667) and a Foundation Grant (FDN-143349). AK is supported through a Michael Smith Foundation for Health Research Scholar Award. KS is partially supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research Scholar Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank all those who contributed their time and expertise to this project, particularly participants, community partners, the SHAWNA Positive Women{\textquoteright}s Advisory Board and Community Advisory Board, and the SHAWNA team members: Sarah Moreheart, Erin Seatter, Flo Ranville, Lulu Gurney, and Barbara Borden. We also acknowledge Brittney Udall, Jennifer Morris, Abby Rolston, Peter Vann, Ariel Sernick, and Jenn McDerimd for their research and administrative support. This research was supported by the Canadian Institutes of Health Research (CIHR) CBR 384667 and FDN-143349. AK is supported through a Michael Smith Foundation for Health Research Scholar Award. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research. Publisher Copyright: {\textcopyright} 2018 Kr{\"u}si et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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Positive sexuality: HIV disclosure, gender, violence and the law—A qualitative study

Résumé

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ASJC Scopus Subject Areas

ODD de l’ONU

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