Women represent 50% of the population of people living with HIV globally, yet there has been little research or sharing of information about who heterosexual woman acquire the HIV virus from. There is focus on stressors attributing to women living with HIV, including intimate partner violence, gender inequality, unequal power dynamics within relationships, race, ethnicity, poverty, education and various social disparities. Yet, there is little information about men as active participants other than the obvious – men transmit the virus to women.
There is no fact sheet, defining characteristics, risk factors, prevention methods or understanding of the men who transmit HIV to heterosexual women. It appears to be uncharted territory within the research community and a topic that is often discussed quietly among women in private, safe spaces.
Part of me thinks it does not matter how someone contracted HIV. I would never ask someone and do not appreciate when someone asks me. But if we don’t focus on modes of transmission how can we reduce and eliminate HIV transmission?
Along with the stressors mentioned which are characteristics of women living with HIV, here is what we do know: Vertical transmission (mother to child during pregnancy, child birth) is almost nonexistent in the developed world and women living with HIV routinely plan and have families these days.
We know that globally, women are acquiring HIV as a result of child marriages to much older men. We know that acquiring HIV from a woman is less likely than acquiring it from a man but with women representing 50% of the HIV community, explanations about how women acquire HIV tend to be often kind of murky, vague confusing and contradictory with no clear explanation for how women factor into the statistics.
We routinely give explanations about the role of women in HIV as we dispel a myth about HIV belonging solely to the gay community. We go on to explain how although 50% of the HIV community is comprised of women, transmission of HIV by women is low which leaves not only the layperson but me as someone who is informed, rather confused.
"Women remain silent about their partners for fear of being labelled as homophobic when this is not the case. Their silence is often a means of protecting their partner from homophobic backlash."
This status quo where we do not delve further into explaining the role of women and men in the HIV community, creates a space to invite speculation, promote inaccurate information leading to fear, stigma, discrimination and perpetuation of violence in many forms towards women living with HIV as women are viewed as high risk for transmitting HIV.
We need to dare to address the unspoken dynamic of how women acquire HIV.
In safe, informal settings with women, they often explain how they contracted the virus from their husband and or long term partner. Women explain how they did not know at the time or until much later that their partners had been bisexual or gay. Women are often the last person to know about their long term partner’s sexual orientation.
Women do not readily discuss this dynamic and often there is silence in public spaces as they struggle with trying to understand what happened, feelings of being betrayed within the relationship, and confusion about what it means to be bisexual in a heterosexual relationship.
Women remain silent about their partners for fear of being labelled as homophobic when this is not the case. Their silence is often a means of protecting their partner from homophobic backlash. The husbands/partners do not readily share information about their sexual orientation, as they are anonymous about their sexual orientation for a variety of reasons, leading to the conclusion that women contract HIV from heterosexual men.
Heterosexual men and women are then in turn viewed as high risk of transmitting HIV with the added erroneous assumption that heterosexual men contract HIV from women. With the lack of information about bisexual men in heterosexual relationships inaccurate information is perpetuated about how the heterosexual community plays a role in HIV acquisition and transmission.
This uncomfortable issue of how women acquire the virus needs to be examined further if we want to move forward in eradicating the virus and finding a cure. It remains impossible for women to negotiate safer sex with an unspoken or unknown component missing.
Women are often in what they perceive as a long term, stable, heterosexual relationship. After all, someone in a stable, monogamous relationship is not deemed to be at high risk for contracting HIV. Women give the same response almost every time about how they acquired HIV from their partners, yet it is not documented or explored further, with focus on prevention and understanding of transmission of HIV to heterosexual women.
Men are not likely to share information with researchers about their hidden sexuality.
With a missing piece of the puzzle our abilities are hindered as we struggle to: make sense of the statistics, encourage dialogue and more understanding and acceptance about what it means to be bisexual, dispel myths about the composition of the HIV community, move towards supporting the LGBTQI community, address criminalization which vilifies men who transmit HIV, and perpetuate the off limits, taboo topic of bisexuality and heterosexual women, which has proven to be too risky to discuss. How can research be done to further understand this phenomenon when it is not acknowledged?
We need to examine the deeper concern of not being able to openly discuss one’s sexuality with ease as secrets and silence do perpetuate the HIV epidemic. In doing so we need to assure people of a safe space to discuss and unravel the complexities of sexuality.
It all gets down to acceptance of the LGBTQI community and a deeper understanding of gender fluidity. With the situation as it looks globally, with ongoing violence and hatred towards the LGBTQI community, I completely understand why men choose to remain anonymous about their sexuality and feel compelled to label themselves as heterosexual to avoid the backlash of speaking about sexuality as not being so fixed.
This dynamic does demonstrate how the general public fuels the HIV epidemic. I have admiration for those in the LGBTQI community who live openly and take all kinds of risks to their safety and well being on a daily basis. I don’t pretend to have any answers but I do hope one day there will be more data and research to better understand the epidemic.
Until things change we can count on there being silence on the topic of sexuality within relationships, with continued violence and discrimination against women and their partners and in turn, a missing piece to the puzzle of how women play a role in HIV.