On November 23rd, GSHI Director Dr. Kate Shannon presented at the St. Paul’s Hospital Medicine Grand Rounds on the need for trauma-informed HIV care and gaps in the HIV cascade of care for women living with HIV.
Citing recent evidence from international settings including results from GSHI’s SHAWNA Project, Dr. Shannon highlighted the ongoing impacts of the criminalization of non-disclosure of HIV on women. Canada remains one of the nations with the highest absolute number of criminal convictions for HIV non-disclosure internationally. Health providers and researchers across Canada and beyond have developed consensus statements and guidelines which specifically identify criminalization as a barrier to optimal HIV care.
Research from the SHAWNA Project including the ongoing photovoice have brought to the fore the voices of WLWH and the impact of criminalization on their relationships, personal safety and the many ways in which their lives are negatively impacted by stigma as a result of criminalization. SHAWNA research has also demonstrated strong associations between disclosure without consent (for example, by health care or social service providers) and gender-based violence. A trauma-informed approach to care would centre the experiences of WLWH and could help prevent non-consensual disclosure of status that puts women at risk.
The WHO has released consolidated guidelines for the sexual and reproductive health care of WLWH, which also emphasize the importance of trauma-informed care as well as women-centred care and the need to recognize the increased risk of gender-based violence that is associated with disclosure, especially in the criminalized settings.
In addition, Dr. Shannon reviewed the links between incarceration and interruptions of ART, and resultant impacts on viral load suppression for WLWH. Ongoing qualitative research and consultation with community partners is underway to help identify whether this is related to gaps in prison or post-release care.