ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Challenges in the Care of Refugee Women Living with HIV in a regional setting
Warning: this report deals with torture, trauma and rape/sexual violence so a trigger warning is provided.
Lauren gave a strong, emotionally challenging presentation regarding the setting up of a specific service to cater for the needs of women who are refugees from the Democratic Republic of the Congo.
Wodonga in regional Victoria began receiving refugees via women at Risk Visa 204 of the Humanitarian Refugee Resettlement program in 2015.
Lauren spoke about the history of trauma, torture and rape that these women had experienced in their former lives and how this impacted on the service delivery model established. She spoke of how these women have been unwilling to engage and maintain engagement in care, and strategies used to resolve this situation.
The Democratic Republic of Congo (DRC) is incredibly unstable with wars that have been ongoing for more than 20 years. There are up to 70 separate militia, with internal mini-wars frequently occurring. DRC has the world’s largest UN peacekeeping force and is described as ‘dangerously unstable’.
Traditional cultural values regarding women’s status are vastly different to our own. For example, DRC has legislated that a wife ‘owes obedience to her husband’ and that marital rape is not an offence. Marital rape is common, with 1 in 3 women reporting this. Women have no right to own property or wealth.
Rape has occurred to many of the girls and women of women of the DRC regardless of marital status. The reasons for rape are many reflect both the incredible instability created by war and the powerlessness of the women in the society. These include: punitive rape – to punish or silence; status rape; ceremonial rape; exchange rape as a bargaining tool; theft rape –abduction; and survival rape.
All of the women in the service acquired HIV as a result of rape. Many witnessed the murder of their husband and other family members; kidnapping, rape and loss of their children; were subjected to extreme physical violence and often fled with children other than their own e.g. nieces and nephews. Families fleeing were separated with no knowledge of the whereabouts or outcome of family members.
Attitudes to HIV were very fearful in this community. Fears included disclosure, death, transmission, ostracism and discrimination. Women with HIV are often blamed for the infection. This leads to lack of understanding for reasons both for ongoing monitoring of health but also engagement at all due to fears of being seen at any of the points of care. Some of the strategies to encourage the receiving of healthcare included: not having specific HIV clinics so that clients would not meet each other; flexible walk in model; not noting HIV on medical notes – the generic ‘immunocompromised’ was used instead; and care with interpreters – using only trusted phone interpreters, not using names nor using the term HIV.
Lauren talked about issues around pregnancy; so far they have had one baby born and another baby is due. This involved upskilling of staff – both community health and maternity staff. One GP decided to get her S100 prescribers approval which was a great outcome for the community. However pregnancy and parenting has provided further issues for the women such as questions about why they are bottle feeding, questions about why the child is receiving medication and having blood tests, as well as fears of disclosure during the contact with health workers.
Lauren saw the future as education involving all those involved: Women living with HIV, men from the DRC, the community and healthcare professionals.
I was very keen to attend this presentation as I work in a sexual health service in a nearby town and state, and this service has offered further choice for HIV care in the regional community. I congratulate Gateway Health staff – Lauren, Catherine and Ange on this successful ground-up initiative, which is inherently very difficult to achieve. I look forward to refugee women finding a voice to tell their own stories at future events.