For HIV counselor, prevention begins with self-esteem

September 19, 2011

Abusive relationships can lead to infection, new study says

September 19, 2011
Ten years ago, when Evany Turk's doctor entered an examination room to tell her that she'd tested positive for HIV, she was devastated.

"I sat there wondering, 'Why me?'" said Turk, now 34. "I'd been in a committed relationship for three years. We had used a condom the entire time because I was a teen mom and I wanted to be careful. … We had decided to have a baby and I went to the doctor thinking I was feeling sick and fatigued because I was pregnant. But I had HIV."

She said she thought her life was over. Her plan was to leave her doctor's Hyde Park office and drive her car into the brick wall of a bank across the street. But when she got outside, she saw people standing at the bus stop by the building and couldn't put them in harm's way.

Though she decided against ending her life that day, over the next five years she would face a series of other walls: She'd quit her job and move out of state. She'd isolate herself from her friends and family members because she didn't want them to know she had HIV. She'd try suicide two more times and eventually wind up homeless.

She said therapy would help her find her way back.

At the root of all of this, she said, were the shame and the stigma surrounding HIV.

Turk is now a volunteer with the Illinois Alliance for Sound AIDS Policy (IL ASAP), an advocacy group for the AIDS Foundation of Chicago. She also works as a peer advocate for the Living Positively Project at the University of Chicago Comer Children's Hospital.

She helps young women and adolescent girls comb through issues regarding living with HIV and AIDS. Her work takes her into schools and other places where she talks about comprehensive sex education, which includes abstinence, as well as ways to prevent sexually transmitted infections.

I talked to Turk last week about a new study that showed adolescent girls, particularly black girls, were often afraid to demand that their partners wear a condom because the girls feared physical or sexual abuse. This places them more at risk of getting sexually transmitted infections, including HIV.

According to the study, about 12 percent of HIV infections among women in this country have origins in abusive relationships.

Turk said the study reaffirms what she sees every day. Though her story does not involve partner abuse, she said what links hers with those of women and adolescents who face domestic violence are the shame and stigma that often accompany HIV.

"I can't stress this enough," she said. "Yes, many of these women start with low self-esteem. But when it comes to this disease, you don't have to start there. You can be a secure 24-year-old, as I was, and still hit bottom."

Turk said she's currently working with an 18-year-old woman who's been in a violent relationship for three years with a man who's HIV-positive. She also is HIV-positive.

"He's 25 years old, and she told me he's never wanted to use a condom," said Turk. "She's sure that's how she got it.

"She was telling me that he's controlling and he beats her. He tells her, 'I can do whatever I want to you because you're (HIV-positive and) damaged goods.' My work (is to help her) get out of the mind-set that she has to endure that abuse."

Turk said she also works with young girls who worry that if they even broach the subject of using a condom, their partners might think the young women are cheating and become abusive.

"A lot of these young women, especially black girls, have never been told they are worth anything," said Turk. "Many of them are former wards of the state growing up in poverty. They've never had parents to tell them they're wonderful or they're beautiful or they're loved."

She said they don't realize they have a voice and can speak up and protect themselves. For some girls, HIV isn't nearly as big of a threat to them as having to confront their partner about anything, including condom use.

"They perceive men as having so much more power than they have," said Turk.

Anne Teitelman agrees. An assistant professor at the University of Pennsylvania School of Nursing, she's one of the authors of the school's study, which came out this month.

She said there are different types of vulnerabilities and if a girl perceives herself as being "damaged" it makes the coercive strategies some men employ even more effective.

"Partner abuse is the most overt form of what we're talking about. But there are other types of coercion, which is emotional manipulation," Teitelman said. "There is a self-silencing among some younger teens and they don't feel they can speak up about their own sexuality. And if a guy pressures them (about not wearing a condom), he doesn't have to pressure too much."

Both Turk and Teitelman said young women need the skills to negotiate condom use before they're in the throes of a sexual encounter. Then, said Turk, women and adolescents have to be vigilant about not only making sure the condom is on, but remains on during sex. And sometimes, the female condom may be an option.

Teitelman said it's also important to help women and girls define healthy and unhealthy relationships.

"Many don't recognize the qualities," she said. "They don' see the role models and don't know what a healthy relationship is. We give information about HIV and other sexually transmitted infections but we don't say, 'This is what a healthy relationship should look like.'"

Teitelman said young women also need to be able to recognize when the negotiation strategies aren't working and it's time to start devising a safe way to leave the relationship.

Turk said IL ASAP is in a yearlong anti-stigma campaign that asks people — regardless of their HIV status — to wear a T-shirt that says "HIV POSITIVE" and then post photos and stories about the experience on Facebook.

"Stigma fuels HIV," said Turk. "It's why too many people who are infected die because they're afraid to get treatment and support. They isolate themselves and they're so afraid to tell anybody. Sometimes they lose their life not just because of the disease but the silence."

Copyright © 2011, Chicago Tribune,0,1327867.column

Categorized under Prevention.

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