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«2013 Train the Trainer Curriculum The Intersection of Domestic Violence and HIV/AIDS Curriculum is a training tool designed to increase knowledge, ...»

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The phrase domestic violence, also known as intimate partner violence, includes the acts and behaviors commonly understood as domestic violence and dating violence, and means an act or pattern of acts [involving the use or attempted use of physical, sexual, verbal, emotional, economic, or other forms of abusive behavior] used by a person to harm, threaten,

intimidate, harass, coerce, control, isolate, restrain or monitor another person who is:

 A current or former spouse, domestic partner or dating partner of the victim or survivor of domestic violence.

 A person with whom the victim or survivor of domestic violence shares a child in common  A person who is cohabiting with or has cohabited with the victim or survivor of domestic violence as an intimate partner.

 A person with whom the victim or survivor of domestic violence has or has had a social relationship that involves a physical, sexual, or emotional component, regardless of the length of the relationship, or the number of interactions between the individuals involved.

Domestic violence occurs in same sex relationships at the same rate as heterosexual relationships.

INTERSECTION OF DOMESTIC VIOLENCE AND HIV/AIDS

At the core of domestic violence and HIV/AIDS is sexuality. Sexual violence is a common tactic abusers use to control their partners.

The Centers for Disease Control defines sexual violence as “any sexual act that is forced against someone’s will.” “Sexual violence can be verbal, physical, and psychological and includes a completed or attempted sex act, abusive sexual contact, and non-contact sexual abuse, which can include voyeurism, exposure, pornography, sexual harassment, threats of sexual violence, and other acts.” “Globally, nearly one in four women may experience sexual violence by an intimate partner in her lifetime.” (Jewkes, Sen, and Garcia-Moreno, p.157, 2002) One in three women worldwide have been beaten, coerced into sex, or otherwise abused by their partner in their lifetime.

A 2004 study by Dunkle et al of 1,366 South African women in health centers, found that women who are beaten or dominated by their partners were 48% more likely to become HIV infected than women in non-violent relationships. In the December 1999 edition of Population Reports, in a survey of 136 HIV related healthcare providers in the US, 24% of their patients experienced physical violence after disclosing their HIV status and 45% feared such a reaction.

As Peter Piot, executive director of UNAIDS stated in 1999, “Violence against women is not just a cause of the AIDS epidemic, it can also be a consequence of it.” HIV/AIDS and Violence Against Women Panel on Women and Health Speech by Peter Piot, Executive Director (UNAIDS before United Nations on March 3, 1999).

Violence against women is a cause of the AIDS epidemic because of gender based violence in all forms, and specifically because perpetrators of domestic violence use sexual violence to control their intimate partners, thus increasing the risk of contracting HIV, causing an HIV/AIDS epidemic. Domestic violence cannot “cause” HIV infection, but rather there is an increased risk of HIV/AIDS among women who are victims of domestic violence. Being HIV positive is also a significant risk factor for increased violence and control by an abusive partner. Just as women are more vulnerable to interpersonal violence than men, it is likely that they are also more vulnerable to violence following disclosure than men. (Meeting report from WHO ―Violence against Women and HIV/AIDS: Setting the Research Agenda, Oct. 2000) Given these realities, it is paramount that community domestic violence programs and HIV/AIDS programs assess their readiness to address the intersection of domestic violence and HIV/AIDS; develop competency of understanding of the intersection and of the issue that is not their primary service area; enhance skill sets and thus services; build program capacity, including the development of promising practices and policies and procedures; and form collaborative partnerships, exchanging their experiences and expertise and learning from existing initiatives. An understanding of and sensitivity to this intersection by both domestic violence programs and HIV/AIDS programs can affect the physical and emotional safety and well-being of all service participants, whichever provider is the initial point to accessing services.

LANGUAGE AND TERMINOLOGY

In the field of domestic violence, there are terms that may be used interchangeably. One is intimate partner violence. Domestic violence or intimate partner violence is about violence in intimate relationships. An intimate relationship is defined as current spouse, ex-spouse, significant other or partner or ex-significant other, person who cohabitates or has cohabitated in an intimate partner relationship, domestic partner, boyfriend/girlfriend, adults related through blood or marriage, individuals who are dating or have dated (irrelevant of the amount of time spent dating, and a person with whom a child is shared in common) and refers to heterosexual and same sex relationships. Domestic violence occurs in same sex relationships at the same rate as heterosexual relationships. Dating violence includes not just adults but also minors. If the individual or individuals define their relationship as intimate—whether or not there has been a physical or sexual relationship – then it is such.





Victim of domestic violence is another term for which there are other word choices. Victims may prefer the term survivor of domestic violence or victim/survivor.

Those who commit domestic violence are called batterers or abusers. The only difference between these terms is that batterer means the person has physically or sexually hurt the other person while abuser means all forms of violence including physical and sexual. Again these terms are often used interchangeably.

In 2010 the CDC began to use the following language for any person who is infected with HIV, no matter the stage of disease progression: “diagnosis of HIV infection” and “person living with a diagnosis of HIV infection.” Once the person is diagnosed with AIDS, that individual is called a person living with AIDS. Going by CDC’s language recommendation and recognizing that HIV is the virus that leads to AIDS, we will use the term HIV/AIDS throughout this curriculum when talking about individuals living with HIV/AIDS, unless we are talking about HIV or AIDS-specific information.

With regard to transmission of HIV, we will use terminology that addresses high risk behaviors that may lead to HIV exposure and infection. We will avoid the terminology of “risky” sex or behaviors which is subjective to those engaging in sexual activities (what may be considered “risky” sex to some may not be “risky” to others).

Additionally, there are words common to the HIV/AIDS and domestic violence fields. In the HIV/AIDS field, client is a term that is often used for a person diagnosed with HIV or living with AIDS, especially in a medical setting. The same term in the domestic violence field may apply to a survivor who is staying at a domestic violence shelter or who is receiving individual psychological or group psycho-educational services from a domestic violence program. More often, however, domestic violence advocates refer to persons in or leaving a domestic violence relationship as service participants or service recipients.

Those who work in the domestic violence field are usually called domestic violence advocates or counselor/advocates. In the HIV/AIDS field, they are called HIV/AIDS service providers or advocate. An HIV/AIDS service provider can be an individual living with HIV/AIDS who advocates on behalf of other individuals living with HIV/AIDS.

It is important to try and use language that is gender neutral. However, 85% of abusers are male with female victims. There are female abusers with male victims and domestic violence exists in both male and female same sex relationships. Trainers should explain that they may be using he/him for abusers and she/her for survivors, but the trainers should occasionally “switch” terms. The same applies to HIV/AIDS. Not all sex workers are female though they may be the majority.

NOTE: Each trainer needs to use the terms for which she/he and/or the audience has the greatest comfort. The trainer should inform the group which term will be used primarily throughout the training and ask if the term resonates with the audience. Trainers may interchange terms and should inform participants that they will interchange terms throughout the training. For more information, there are basic DV and HIV/AIDS glossaries included in the resources section.

COMPETENCIES

Domestic violence advocates and HIV/AIDS service providers conducting this training are the experts in their respective fields. The curriculum provides the information necessary to understand the intersection of these two fields. However, since the core of the intersection is sexual violence in the context of domestic violence, it is important to include sexual violence advocates in this training.

Both trainers need to realize that there are multiple intersections when dealing with the intersection of domestic violence and HIV/AIDS such as mental health, substance abuse, trafficking, sex workers, teens, poverty and disabilities. These factors impact the different way individuals access, participate and respond to services. However, this is an introductory workshop on the intersection of domestic violence and HIV/AIDS and there is insufficient time to address all these factors in this training. Trainers should remind their audience that individuals seeking their services will have had various experiences and that will make each case unique and all service providers should be sensitive to these issues in their work.

While domestic violence and HIV/AIDS affect all races or ethnicities, Communities of Color are disproportionally affected by both. Communities of Color often face economic barriers, language access and acculturation issues, challenges dealing with the criminal justice system, racism, anti-immigrant sentiment, and barriers to accessing health care, among others. These issues have a disproportionate impact on marginalized racial and ethnic communities and result in additional layers of complexity in reaching and providing assistance to these victims. Too often, historically marginalized racial and ethnic communities have lacked adequate access to effective services. The complexities of addressing violence against women within Communities of Color are vast and cannot be addressed by merely translating brochures or using a “one-size-fits-all” approach.

Partnerships and collaborations with community-based organizations addressing the issues of domestic violence and/or HIV/AIDS in Communities of Color in culturally and linguistically specific ways are important in dealing with the intersection of domestic violence and HIV/AIDS.

Trainers should be sensitive to the stigma, shame, and isolation that are often reflected in the lives of survivors of domestic violence and persons living with HIV/AIDS or persons who live with both in their lives. There may be survivors of domestic violence or persons living with HIV/AIDS in the participant group.

Trainers must be skilled in handling the issues that may arise during the training. These could include resistance to taking on “more work,” issues around sex workers or trafficking and HIV transmission, survivors of domestic violence and their decisions around staying or leaving an abuser. These issues can elicit much discussion, so trainers must be able to effectively deal with discussions and remain mindful of the purpose and focus of the training and time frames of the agenda.

Sexuality is at the core of intersection of domestic violence and HIV/AIDS, so it is important that both trainers are more than comfortable discussing sex and sexuality—terminology, behaviors, beliefs.

Trainers need to be mindful that while there is a connection between domestic violence and HIV/AIDS, it does not mean that every survivor of domestic violence has HIV/AIDS or that every person diagnosed with HIV/AIDS is a survivor of domestic violence. The intersection is a risk not a reality for each individual. Participants should leave the training with this message.

TRAINING OVERVIEW

TRAINING PURPOSE

The main purposes of this training are to:

 Increase the knowledge, understanding, and competencies of domestic violence advocates and HIV/AIDS counselors in addressing the intersection of domestic violence and HIV/AIDS with service participants  Build collaborative partnerships between our organizations to improve service delivery and increase the safety of the people requesting our services By increasing knowledge, understanding, and competencies around these issues and adopting promising practices in both fields, building collaborative partnerships and promoting organization shift to a new way of thinking about advocacy and service-delivery we hope to improve the overall safety of both domestic violence survivors and individuals living with HIV/AIDS.

LEARNING OBJECTIVES

Participants will be able to:

 Build an understanding of the intersection between domestic violence and HIV/AIDS  Gain an understanding of domestic violence as a pattern of power and control tactics of batterers/abusers  Increase knowledge of HIV transmission, disease progression, prevention, and risk reduction  Understand how beliefs and attitudes about domestic violence and/or HIV/AIDS influence service provision  Increase skill and competency in the development of promising practices that enhance safety for individual survivors of domestic violence and HIV/AIDS  Specify advocacy and collaborative strategies for partnerships between community domestic violence programs and HIV/AIDS programs  Highlight the impact of disparities - race, culture, socio-economic factors, geography, gender, sexual identity, disabilities, citizenship/legal status, occupation - on the lives of survivors of domestic violence and/or persons living with a diagnosis of HIV/AIDS

LENGTH OF TRAINING

8 Hours (7 hours with two 15 minute breaks, one 10 minute break and one 45 minute lunch)

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