Once the silence has been broken

By Mehret Mandefro

Silence is a universal metaphor that explains marginalized human experience. With HIV, the silence that cloaks sexism, the silence that cloaks racism, the silence that cloaks homophobia, the silence that cloaks poverty, is the same silence that fuels the epidemic.

I learned this while caring for HIV positive patients, as their physician, in some of the most silenced communities in the African Diaspora. The women in these settings also taught me these silences are inseparable and that using gender equity as the lens to analyze HIV requires a larger discussion of human rights and health.

I co-founded a non-profit called TruthAIDS out of the experience of women physicians working to prevent and treat HIV in the South Bronx. In that setting, conversations about HIV prevention had to start with love, trust, identity, abuse and support in order to make safe sex a reality for women. This dialogue was missing from traditional teaching and discussions about risk.

Once you ask a woman to break her silence, it is evident that discussions of risk also must move past personal responsibility to environmental factors beyond individual control, such as violence and the destruction of neighborhoods. Too often, whether it is the South Bronx or Ethiopia, there is an experience of trauma, one that starts with the woman, but quickly moves to the people around her and the places they inhabit.

If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life. (R. Virchow, Report on the Typhus Epidemic in Upper Silesia, 1848).

The extremely common acts of violence against women are a “mass disturbance” that is fueling the HIV epidemic across race, class and ethnicity. Ending gender-based violence is a critical human rights issue that must inform HIV prevention for women. This violence is perpetuated by misogyny, and in this hierarchical system, social order determines health status for all.

The nonviolence movement has a long legacy that has much to offer in thinking through these next steps of HIV prevention in women, as does the civil rights movement and the women’s movement. TruthAIDS hopes to connect these discourses across silos, across generations, and across continents through creative partnerships that teach how to move beyond the silence. These partnerships can make the world change.

Women ‘s rights are human rights. Community-based groups around the world are innovating HIV prevention programs that tackle violence, as well as social and economic rights. Their vision of health and human rights is the key to ending all silence.

Dr. Mehret Mandefro is a social medicine physician and Founding Director of TruthAIDS, a preventive health education non-profit. Her primary research interests are the connections between human rights and health, HIV prevention program development and translation efforts targeting marginalized communities. She is currently a Robert Wood Johnson Health and Society Scholar at the University of Pennsylvania where she is advancing film as a method to teach and communicate about societal determinants of health.


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