Challenges for HIV Health Care Practitioners regarding Domestic Violence in the Border Communities

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Challenges for HIV Health Care Practitioners
regarding Domestic Violence in the Border
Communities

• Gishela Alfaro, MA, LPCI
• Ellen J. Elliston, PhD, LSCW
• Victim Intervention Program / Rape Crisis
• Parkland Health Hospital System

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Introduction to VIP/ Rape Crisis

• Outpatient clinic under Parkland Health
  Hospital System serving residents of Dallas
  County
• 24 hour response for domestic violence and sexual
  assault victims within the hospital
• Follow up case management and counseling related
  to the abuse
• Forensic interviews and expert testimony for
• Domestic violence
• Sexual assault
• Child sexual abuse
• People who have experienced persecution in their
  homes countries and are seeking asylum in the
  U.S.
• Victims of trafficking

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Relevance of Violence to HIV/AIDS

• Underestimated risks
• Presence of domestic violence and/or sexual
  assault are risk factors for exposure to HIV
• Women who are HIV or have AIDS are at increased
  risk for abuse/ violence from their partners or
  past partners
• Since domestic violence and sexual assault are
  both issues that arent openly discussed, we do
  not know the actual number of women who
  experience either or both

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Domestic violence is an under recognized
barrier regular medical care for HIV/AIDS

• Domestic violence is a barrier to health care due
  to
• The abusers interference in
• Keeping medical appointments
• Obtaining or taking medication
• The victims emotional condition related to
  HIV/AIDS and/or being in an abusive relationship
• Posttraumatic Stress Disorder
• Depression
• Shame/ Guilt
• Fear
• Suicidal ideation

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Defining Domestic Violence in relation to HIV /
AIDS

• Domestic violence can be defined as a pattern of
  behavior in any relationship that is used to gain
  or maintain power and control over an intimate
  partner.
• Abuse is physical, sexual, emotional, economic or
  psychological actions or threats of actions that
  influence another person.
• This includes any behaviors that frighten,
  intimidate, terrorize, manipulate, hurt,
  humiliate, blame, injure or wound someone.
• Domestic violence can happen to anyone of any
  race, age, sexual orientation, religion or
  gender. It can happen to couples who are married,
  living together or who are dating.
• Domestic violence affects people of all
  socioeconomic backgrounds and education levels.
• National Domestic Violence www. ndvh.org

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Power and Control in Domestic Violence

• Intimidation
• Emotional Abuse
• Isolation
• Minimizing, Denying Blaming

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Power and Control in Domestic Violence

• Using Children
• Male Privilege
• Economic Abuse
• Coercion Threats

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Increased Vulnerability

• A large percentage of women in the U.S. are more
  vulnerable to exposure to HIV because of
• Abusive/ violent partners or ex-partner
• Childhood sexual abuse
• Sexual assaults from strangers/acquaintances
• Teen date rape and date rape drugs
• Alcohol drug use are associated
  with partner abuse HIV
• Increase in females being trafficked and forced
  to be sex slaves or prostitutes in the U.S.

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Emotional Vulnerability

• When women are abused or sexually assaulted, they
  are emotionally vulnerable. HIV/AIDS increases
  the emotional vulnerability.
• They are trapped, both in their relationships,
  by past experiences, and/or with the disease
• Heightened risk for depression, anxiety, or PTSD
• Suicidal ideation may increase
• They feel helpless to make changes
• Being identified as HIV increases
• their fear of losing their children
• It is hard to follow a medical regimen
• when you feel hopeless.

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Border Environmental Factors Affecting Both
HIV/AIDS and Domestic Violence

• Poverty
• High risk neighborhoods
• Drugs / alcohol use
• Lack of medical options
• Societal attitudes about women
• Power and control /Gender roles
• Lack of information and information provided to
  women

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What Can Service Providers Do?

• Screen
• Support
• Intervene
• Empower through referral

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Screen for Domestic Violence When and Who

• Recommended methods of screening
• Include open ended questions
• Be non-judgmental
• Focus on patients safety
• Sample screening questions
• Do you feel safe?
• Is there anything that goes on at
  home that makes you feel
  afraid?
• Has your partner ever tried to keep
  you from taking your
  medication or from seeking medical help?
• Provide support through counseling,
  referrals to domestic violence
  agencies

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Screen Things to look for

• Minimization of abuse/violence
• Lack of family or social support
• Lack of knowledge about how
  to support herself and children
  
• Inability to function well in the
  American culture
  
• Being homeless or living with others
• Self blame, guilt, depression,
  PTSD or other debilitating
  conditions requiring
  professional intervention
• Intentions to hurt self or others

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Support Avoid Harmful Assumptions

• There are no typical characteristics or profiles
  of abusers or victims. Rather than determining
  whether someone fits a type, determine whether
  warning signs of abuse exist. Care about the
  person.
• AVOID
• Violating confidentiality
• Minimizing the abuse
• Blaming the victim
• Not respecting her autonomy
• Ignoring her need for safety
• Normalizing victimization
• You may encounter
• Silence as a response from victim
• Resistance as a response from victim

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Intervene Steps Techniques

• Assessing the lethality
• Tips for treatment consistency
• Guarding documentation
• Confidentiality in follow up
• Low profile referral information shoe cards,
  nail files with numbers for shelters
• Internet safety

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Why we must respond

• Identifying and intervening in domestic abuse
  and violence is a critical step in the
  treatment and prevention of HIV/AIDS
• Comprehensive integrated health care response is
  the way to break though this under recognized
  barrier to effective HIV/AIDS treatment.

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Empower through referrals Working together

• Referrals for Domestic Violence Agencies
• www.ncadv.org The National Coalition Against
  Domestic Violences website contains current
  information for survivors and those dealing with
  violence.
• www.endabuse.org The Family Violence Prevention
  Fund website provides materials which can be
  ordered, including No Excuse for Abuse
  materials and health care provider brochures.
• www.nrcdv.org The National Resource Center on
  Domestic Violences website features various
  publications and resources for organizations and
  individuals working to end domestic violence.
• www.ncvc.org The National Center for Victims of
  Crime information site includes materials on
  domestic violence, stalking and sexual assault.

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Working Together

• Victim Intervention Center/
• Rape Crisis
• Parkland Health Hospital System
• 4811 Harry Hines
• Dallas, TX
• 214-590-2926
• www.parklandhospital.com

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Conclusion of Presentation

• Questions or Comments