Understanding and Addressing Stigma and Attachment Insecurity in HIV-Positive Women Who Experience Intimate Partner Violence: A Model of Medical and Psychosocial Care

Abstract

Low-income women of color who are HIV positive and living in violent relationships are at significant risk for stigma and problems with attachment security. This article explores the ways in which these women may experience internalized stigma from incorporating society's negative views of HIV and domestic violence. It also addresses the ways in which insecure attachment may develop or intensify in this population through violence in their adult intimate relationships and/or living with a life threatening illness. A model of medical and psychosocial care utilized at the Women's HIV Program at the University of California San Francisco is offered as an intervention to reduce stigma and enhance healthy attachment. Clinical examples demonstrate how this system of medical and psychosocial care can help women in this situation establish stability and improve their lives despite the intense challenges they face.

Keywords:

• HIV
• women
• intimate partner violence
• stigma
• attachment
• health care

Acknowledgments

Thank you to Eddy Machtinger, MD and the staff at UCSF WHP for your commitment to providing excellent medical and psychosocial care to HIV-positive women, and thank you to the patients at WHP for your inspiration and courage to heal. I also acknowledge Marsha Pruett, PhD and Kathryn Basham, PhD at Smith SSW for your supportive feedback and guidance.