Presented by: Marvelous Muchenje Women’s Health in Women’s Hands CHC

1. “We Walk With Fear”Experiences of HIV Criminalization and Disclosure Amongst African and Caribbean Migrant Women in Ontario, Canada Presented by: Marvelous Muchenje Women’s Health in Women’s Hands CHC

2. No conflict of Interest

3. Roots of Vulnerability to HIV/AIDS for Black Women in Canada • Vulnerability is unique and deeply rooted in: • Socio-cultural and structural factors that intersect with - Gender, race, class, political and economic conditions • Lack of economic opportunities • Deprivation of rights to autonomy and sexual control over their bodies • Cultural practices that increase risk of infection • Limited educational opportunities

4. HIV Diagnosis Start of the journey…….. Great distress, shock, disorientation, disbelief, denial, devastation, etc Complex experiences of loss: Feelings of being victimized, regret, sadness, loss of future dreams, hopelessness, fear, withdrawal, isolation, depression, suicidal thoughts, anger, etc Anxiety and grieving Period of coping, adjustment and acceptance

5. HIV Disclosure

6. HIV Disclosure HIV positive status disclosure is: an ongoing process intimately personal and has considerable effects on families and communities Impacts access to information and services Should be a component of support and care services offered for people living with HIV Is a journey involving a number of stages

7. HIV Diagnosis Is disclosure necessary? 1. Acceptance and Empowerment Disclosure Process 2. Education and Preparation 5. Accessing Potential Outcomes DISCLOSURE 4. Establishing Motivation for Disclosure • 3. • Evaluating the Disclosure Environment

8. “To Tell or Not to Tell” • Confidentiality of medical information • Racist experiences with healthcare providers • Fear of: • accusations of infidelity • Partner abandonment • Community rejection • Stigma and discrimination • Violence • Withdrawal of immigration sponsorship

9. “To Tell or Not to Tell” Feelings of shame Ideas that if practicing safer sex there is no need to disclose Ramification against family members, community Lack of disclosure skills Information regarding their HIV status used against them in the criminal justice system

10. “HIV is not hurting me, but your ignorance is …………”

11. Criminalization of HIV Transmission, Exposure, or Non-Disclosure • Lack of clarity of law can adversely impact : • personal, social, behavioral and sexual choices and decision making capacities • Aggravates the risk of violence and abuse • Reinforces gender inequalities • Promotes fear and stigma • Creates distrust in relation with health service professionals

12. Criminalization of HIV Transmission, Exposure, or Non-Disclosure • Criminalization due to overrepresentation of ACB in corrections • Institutional racism in justice system • Lack of resources and support • Knowledge burdens on ASO and other health care providers with no experience providing legal support

13. Criminalization of HIV Transmission, Exposure, or Non-Disclosure • Lack of awareness and knowledge of the law and how it applies to HIV transmission • Lack of awareness of HIV/AIDS transmission, disease progress and prevention • Police harassment, coercion and intimidation of people living with HIV e.g. sex workers, homeless • Relationship between police and media stakeholders

14. Media coverage

15. Recommendations Building cross-sectoral knowledge capacities around: HIV transmission, Prevention, Criminalization Further investigation and discussion of alternatives to criminalization Mediation, Counselling, Restorative justice, Education, Support services Increase emphasis on the responsibilities of those seronegative

16. Recommendation • Increased resources for organizations to do targeted outreach to ACB population in their primary language • Building relationships amongst: • ASOs, government stakeholders, ethno-specific community leaders/agencies, media stakeholders, legal/justice stakeholders • Address the structural barriers: • colonialism, • oppression, • systemic racism and discrimination