1. The International Community of Women Living with HIV/AIDS “by and for” HIV positive women

2. Background Started in 1992 Run for and by HIV positive women 4500 members in 138 countries – membership is open to HIV positive women and is free and confidential

3. ICW’s vision is: A world where all HIV positive women: Have a respected and meaningful involvement at all political levels, local, national, regional, and international, where decisions that affect our lives are being made; Have full access to care and treatment (ACTS); Enjoy full rights, particularly sexual, reproductive, legal, financial and general health rights; irrespective of our culture, age, religion, sexuality, social or economic status/class and race.

4. VAW Traditional focus of VAW and HIV - increase in vulnerability to HIV infection ICW focus: Link between VAW and HIV positive status Positive prevention and sexual health Broad definition e.g. forced sterilisation and breaches in confidentiality Role of the fear of violence in preventing women protecting and improving their health.

5. VAW and ACTS ICW’s main strategy has been to highlight connections with VAW in our advocacy work: What WHO says: Women and men are accessing ARVs in equal number. Gender is not an issue.’ (Man from WHO) What our members say: ‘Our men refuse to let us go to hospitals because they will ask us to call our husbands to see if they have the infection too.’ ‘’Our husbands or partners tend to force us to give them our ARV dose while he has not tested for HIV and doesn’t know his CD4 count.’ ‘Women were threatened that they will not receive ARVs if they don’t take the contraception.’ ACTS is not only about getting medications. It’s about changing the conditions of women’s lives so we can use those essential treatments successfully.

6. VAW and SRR VAW undermines HIV positive women’s sexual and reproductive health and choices…. “When I was married he forced himself on me. He had an STI and gave it to me. Then when I treated it he asked me where I got it from. He refused to use a condom.” “When I was diagnosed I had a partner. The relationship became more violent – he said I brought a new problem into the family.” “But they do not tell you if you keep it [options] A,B,C is there for you – they don’t give you the option. They sterilize you. You feel obliged to take the option they offer you or you feel you can’t take the immediate service you need.”

7. VAW and HIV testing and disclosure There is not an automatic connection between testing and improved well-being… “In Kenya in May, health workers told me at one clinic they had tested a pregnant woman and found her to be positive. One month later, she had been divorced and thrown out of her husband’s home.” “There is no support for women who lose livelihoods and dignity because of disclosure, so we worry about advocating for disclosure as activists.”

8. VAW and HIV testing and disclosure Disclosure is not always in our control… “In my case the thing that is stigmatised is going to fetch the milk each and every week. It is collected from a particular room and if you go to that room they know you are HIV positive.”

9. Recommendations Policymakers and programmers must understand the possible impact of policies, programmes and services on HIV positive women including increased violence and discrimination; Tackling the double discrimination against HIV positive women needs to be an integral part of all approaches to HIV and VAW.

10. Recommendations Health care workers must understand the context in which women live their lives and therefore how to best support women act on the advice and treatments given; and refer women to sources of support. This includes legal services if their rights are breached.

11. Recommendations HIV positive women have a right to be informed about the SRH services available and the right to make their own choices; Health staff should always protect patients confidentiality and offer non- judgemental treatment and advice.