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Add to these nuances the fact that intimate partner violence (IPV) is recognized as an important factor in
HIV risk for heterosexual and same-
sex relationships. In the U.S., African Americans bear the greatest burden
of HIV among women. According to
the Center for Disease Control, of new infections in 2010, 64% occurred among African Americans, 18% among whites, and 15% were Hispanics/Latinas. Exposure to IPV can increase women’s risk for HIV infection through forced sex with an infected partner, limited or compromised negotiation of safer sex practices, and increased sexual risk-taking behaviors (Maman, Campbell, Sweat, & Gielen, 2000). For gay males, prevalence in one study sample ranged from nine percent reporting sexual violence to 33% reporting emotional violence. Men who reported they were HIV-positive were significantly more likely to report perpetrating physical violence and to report experiencing sexual violence (Stephenson, Rentsch, Salazar, & Sullivan, 2011).
Positive coping skills have a strong
impact on reducing violence within relationships where at least one partner has HIV. Violence has been found to be related to poor coping styles for both men and women. Studies show support for including partners in treatment,
and reducing IPV has also been shown to help support medication adherence (Lopez, Jones, Villar-Loubet, Arheart,
& Weiss. 2010). To address this need
for positive coping, MFTs have an opportunity to become familiar with factors within these relationships and provide the necessary safe and inclusive space for treatment.
In addition to therapy skills, there are several areas of knowledge therapists should add to their repertoire. The first being an understanding of the historical context and evolution of the HIV and AIDS movement. Understanding the origins,
as well as what the early days were like
for those who are long-term survivors, helps to better situate the present day reality. Secondly, there is also a level of understanding every therapist should have related to HIV transmission, treatment,
prevention and disclosure. It is important to have an understanding of these concepts so you are able to connect from a place
of knowledge rather than anecdotal or outdated ideas, which are often ripe with stigma. As with any marginalized identity, practitioners should also take care to inform themselves and not rely on a client to teach HIV basics. Again, it is important to have connections with practical support. For example, know with whom to connect an individual if they are experiencing treatment, housing or other challenges around acquiring basic necessities. Lastly,
it is imperative you are mindful of the language you use when discussing HIV and those it impacts. Language allows you to build rapport with clients and validate their experiences. We suggest using “people first” language. This means placing the person before their experience (such as, a person living with HIV versus HIV positive person, or person who uses drugs, versus drug user. Developing your
Referrals and resources that MFTs should be ready to provide
As with any person accessing services, it is important to consider an individual’s holistic health. Following is a non-exhaustive list of resources and referrals that may be helpful. Note when making referrals to outside agencies, it is important to know they are committed to anti-oppressive practices and take action to make their space safe for those living with HIV and those facing systemic risk factors for HIV acquisition.
Local AIDS service organization: These agencies often have supports focusing on the needs of persons
living with HIV. This may include social and peer-led groups. They can also be a great resource for
mapping other organizations which are knowledgeable about HIV in order to provide more compassionate connections to care for your clients.
LGBTQ+ organizations: This may be a helpful resource for individuals looking for resources or connections. Though not all individuals living with HIV identify as part of these communities, they are disproportionately affected.
Financial and medical assistance: Many of the drug treatment options for HIV are quite expensive and financial concerns can be a significant barrier to care. Ensure your client can get the treatment he or she needs that will help improve overall health.
Housing: Housing is often a cornerstone in wellness; connecting people with government and community agencies that facilitate affordable housing can be crucial.
Employment services: These organizations provide the support needed to find a job, return to work or build additional skills.
Legal services: Due to ongoing debates over the criminalization of HIV and disclosure, connecting patients to firms and law practitioners who are familiar with the legalities related to HIV and disclosure can provide individuals with their legal rights and obligations surrounding HIV.
Valuable online resources and tools: There is a wide array of exceptional resources related to HIV transmission, disclosure, fertility options and detailed historical information, as well as personal stories and experiences available online. These can be incredibly insightful and inform the work of those who have clients living with HIV, as well as for the clients themselves.
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