Violence
Violence, defined here as physical assault, is common in the United States. Although men are victims of violent crime more often than women are, women are 5 to 8 times more likely to be victims of assault in the context of intimate relationships. Studies indicate that the epidemiology of physical assault within personal relationships mirrors the epidemiology of HIV infection in women. Risk factors include poverty, unemployment, drug use, childhood sexual and physical abuse, being younger than 30 years old, and homelessness (Zierler et al., 1996; Zierler and Krieger, 1997).
Most women living with HIV—as well as those at highest risk for HIV infection—are poor and members of a minority group. They suffer violence throughout their lives that is beyond what women of higher socioeconomic status generally experience. This background of violence, along with poverty, drug use, and the burden of caring for themselves and others, creates a number of potential obstacles or barriers to care for HIV disease and coexisting conditions (Vlahov et al., 1998).
Hate crimes are criminal actions intended to harm or intimidate people because of their race, ethnicity, sexual orientation, religion, or other minority group status (Herek, Gillis, and Cogan, 1998).
The literature indicates that violence and HIV/AIDS may be linked in other ways. Some researchers have suggested that disclosure of HIV positivity may provoke violence in intimate relationships (Gielen et al., 1997; Zierler, 1997).
One study examined the proportion of HIV-positive adults who had been assaulted by a partner or someone important to them since their HIV diagnosis and the extent to which they reported their HIV-positive status as a cause of the violence (Zierler et al., 2000). Participants were a nationally representative probability sample of 2,864 HIV-positive adults who were receiving medical care and were enrolled in the HIV Costs and Service Utilization Study. A total of 20.5 percent of the women, 11.5 percent of the men who reported having sex with men, and 7.5 percent of the heterosexual men said they had experienced physical harm since HIV diagnosis. Nearly half of that group reported HIV seropositive status as a cause of violent episodes. Factors most strongly associated with partner and relationship violence were drug dependence, homelessness, and unemployment. It follows that HIV prevention and treatment programs are appropriate settings for violence assessment and sexual assault counseling services for women and men living with or at risk for HIV infection (Vlahov et al., 1998; Zierler et al., 2000).
HIV-related stigma may contribute to victimization based on sexual orientation. Men are at higher risk for victimization than women, and people who are open about their sexual orientation are at higher risk than people who try to conceal their sexual orientation (Herek et al., 1998). People who identify themselves as gay, lesbian, or bisexual, and others who are at risk for HIV, may experience extreme stigma in the form of hate crimes.
Hate crimes have been defined as criminal actions intended to harm or intimidate people because of their race, ethnicity, sexual orientation, religion, or other minority group status (Herek, Gillis, and Cogan, 1998). Survivors of hate crimes that are based on sexual orientation are more likely than other respondents to regard the world as unsafe. Survivors may also view people as malevolent and may experience personal setbacks.
Research findings support the hypothesis that experiencing hate crimes links the victim’s feelings of vulnerability and powerlessness with his or her sexual orientation and personal identity (Herek, Gillis, and Cogan, 1998). Victims may believe that their sexual orientation puts them at a higher risk for all kinds of negative experiences. Victims of hate crimes based on sexual orientation have been found to suffer greater psychological distress than victims of non-bias-related crimes (Herek et al., 1998).
