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Women Incest Survivors in
Prison
An open letter from a prison
doctor to those who care for women living with HIV
by Anne S. De Groot, M.D.
I have been providing
medical care to HIV infected women who are incarcerated at
a prison in Massachusetts since 1992. Working with the HIV-positive
women at that clinic opened my eyes to their struggles. I
am amazed that they have been able to survive such difficult
lives, and I have been deeply affected by their strength,
their joys and their sorrows. I wrote this short piece on
Friday night, July 28, 1995, after attending HIV clinic at
the prison. Some of the details of this story have been changed,
to protect my patients.
It is Friday night after
HIV clinic. I am lying in bed holding my daughter in my arms.
Her face is moonshaped and turned up to the light coming through
the windows. She is beautiful, she is two, she is a small
but precious vessel of joy. During the day time her joy spills
over and over as she laughs and plays.
I cannot sleep. It is not
because the heat is oppressive, it is not because the sprinklers
outside are turning incessantly, it is not because the trees
make scary shadows on the wall. I cannot sleep because I cannot
forget what X told me about her father today. “When I went
home at Thanksgiving he grabbed my breasts, and my ass” and
“it happened again at Easter.” She told me it started when
she was three “but it was only oral sex” and it continued
until she was 13. She said “he never penetrated me” …except
one time, he almost did, in the toolshed, and she doesn’t
remember exactly what happened, but it stopped after that.
There was a divorce and a custody battle and she ran away
to Florida to live a different kind of life when she was in
her early teens. She returned to her father’s house when she
was seventeen, and one day, when her stepmother and stepsister
had left the house, he tried to get her to do it again. He
walked into the kitchen “you know, like that” (making a gesture
to show a man who had nothing on below his waist). She said
that she laughed nervously and said, “No, Dad, I really don’t
want to do that now” (I wish I could make you hear the voice
that she used to say this last sentence, because it sounded
so childlike and pleading and I felt that I was standing in
the kitchen watching this happen) and he said, “Why not? You
would do it if I paid you.”
In my clinic today, she said
“When I found out I had HIV I was happy, because I thought
he would never touch me again.” She said, “I thought if I
got fat and really ugly, nobody would want to touch me.” She
told her father that she had HIV—she even said she had AIDS,
but it didn’t make a difference at Thanksgiving.
I can’t get this out of my
head tonight. X had just finished a post-incarceration drug
abuse recovery program, and had returned home for Thanksgiving,
when her father touched her again. She had just finished the
program, she felt safer and stronger, she thought she was
protected by her HIV, and he invaded her space anyway. After
Thanksgiving she started eating to keep from using drugs again,
and purging to get clean, and eating and purging. She didn’t
pick up drugging again, even though her self esteem had hit
rock bottom. Her father tried to touch her again at the next
family reunion.
Just a few weeks later she
went along with some friends who had decided to start using
drugs again, and she ended up back in prison, where I saw
her looking huge and not at all HIV-positive but bruised and
ashamed to be back inside. She couldn’t say, at that time,
why she came back (now she says that she was still “too much
inside of it”), even though I tried very hard to learn from
her where the weakness lay in someone I knew to be resolved
to recover and dedicated to avoiding reincarceration. Today,
after she finally told me about her reasons for returning,
she said that she felt a huge weight leave her. I asked her
if I could write it all down, especially this part that just
happened, so that we could use her story as a tool to change
this terrible world.
How do I keep X safe from
her father? How do I repair the damages that have been done
to the women who share their stories with me? Questions fill
my head. How do I keep my children safe from this? How can
I keep it from happening to the child next door, to the child
across the street, to the children in my city? I lie awake
listening for cries and tears around me, feeling powerless
to keep this harm from happening. Tonight, in the heat and
in the dark, the danger to women and children overwhelms me.
I sit down at my computer to write it out, to bring it into
the light, to purge it from me. I don’t know where this writing
will go. This is X’s story, and my own. If we bring our fears
and our wounds out into the light, will writing these stories
make a difference in women’s lives?
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How do I keep X safe
from her father? How do I repair the damages that have been
done to the women who share their stories with me?
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And how did this conversation
with X came about today? Some people think I go dredging for
these stories. In this case, I had asked her to see the dietitian
to talk about her eating disorder. I sent her to the dietitian
for two reasons—to find some way to draw attention to her
bulimia and to get some assistance with it, and also to illustrate
to the prison dietitian the complexity of the dietary issues
involved in caring for HIV seropositive women. Many, too many,
of the women I see in my clinic have eating disorders: how
am I to be sure that they get their HIV medicine if it is
purged with their food? My experience at work confirms what
is known about eating disorders: bulimia has been linked to
childhood sexual abuse.
Today X told me that the
session with the dietitian was helpful, because she actually
confessed that her bulimia was worse during the past winter,
and because she finally realized the connection between her
father’s actions and her reincarceration. To tell me this,
she had to tell me that her father had abused her again, and
that is how the whole story came out. We talked at length,
and she smiled through her tears as she left my clinic. Her
terrible sadness, fear, and anger, remained with me.
So what does all of this
have to do with running an HIV clinic for women? Nothing at
all, if you ask prison officials and prison health care corporations.
Nothing at all, if you ask my medical colleagues who wonder
why I don’t do “my work” and stop seeking answers to my questions.
But I can’t separate listening to these stories and seeking
to understand my patients from my work. If my work is to “take
care” of HIV infected women, then understanding why these
women use drugs, do sex work, don’t go to their HIV clinic
appointments that I set up for them on the outside, and end
up coming back to see me in the HIV clinic at the prison is
part of the work that I have to do. Understanding why my patients
have eating disorders will enable me to intervene effectively,
so that the medications they are taking for their HIV disease
are absorbed. Learning more about my patients helps me set
priorities: is it more important to find safe housing, away
from an abusive spouse, or start a new anti-viral drug? Is
it more important to re-unite them with their families, than
to urge them to move to a city where they might have access
to HIV care? Which intervention will save the life of my patient?
A case in point: Y returned
to prison at the same time as X. Y was also a recent graduate
of the post-incarceration drug recovery program. The story
that she lives with, the story that was untold until she came
to my clinic the first time, is this one: her son is also
her brother. Her relationship to her son/brother has never
been discussed within her family. Is it a surprise that she
left home at an early age and spent many years on the street
drinking, drugging, and doing sex work to support her habit?
Why did she tell me and no one else her story? Because I asked
her why (not how or when) she started using drugs. I have
learned from my experience at the prison that many of my patients
left home as teenagers because of childhood sexual abuse,
turning to drugs for comfort and sex work to support their
drug habits. Unless the cycle of abuse is broken, these women
will never be free to choose a healthier lifestyle—whether
they are already living with HIV or at risk of becoming infected.
Y spent many hours talking
about her son/brother with me at the clinic, and in sessions
with counselors in the drug recovery program. As part of her
drug treatment program after she was released from prison,
she wrote down all of the things her father did to her. She
says now, after returning to prison for using drugs again,
that telling her story at the drug treatment program made
her feel strong enough to go home to see her son, at last.
She thought she might tell him that she was HIV-positive,
but wasn’t sure that she could tell him the truth about their
kinship. He still thought she was his sister, and she didn’t
think that he was ready to learn the truth she had been living
with every day, all 17 years of his life.
When she returned home, she
found that her son had a newborn son, and that she was now
a grandmother and an aunt all at once. Her son had named this
new child after his father, her abuser. She spent many hours
that weekend holding the baby. Then she went off to find her
friends, so that she could get high and forget about the whole
thing.
Another case in point: Z
is 25. Last year, Z moved back to her mother’s house after
her husband died of AIDS, and her mother moved her stepfather
back into her room with her. That was the way they lived when
she left home at 16. She says that she protested, that she
ran out into the yard crying about incest, but they sat her
down at the kitchen table and told her that it couldn’t be
incest because he was not her real father. I try to imagine
this scene in my head—I see the kitchen table, the stepfather,
the mother. How can this be? I ask her why her mother does
this to her. She says her stepfather doesn’t care that she
is HIV-positive, he doesn’t wear a condom when he sleeps with
her, and she thinks that her mother is “getting him back”
this way. She wears her hair long, in two big ponytails set
high on her head like a little girl. She talks in a little-girl
voice and won’t look me in the eye when she tells me that
she has to go home when she gets out, to her mother and stepfather,
because she has no other place to go.
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…we must not tolerate
sexual abuse
of children. There must be no acceptance, no excuse, for
valuing
the lives of women and children less than sexual pleasure.
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For so many of the women I
take care of, there is no safe place to go. X tells me about
“running away” from her father; running from room to room,
and running away from home. Running from the hero of her life.
The stories the women tell are all different but all the same:
The abuser is always the person they love the most. Recovery
involves calling the abuse by its name and losing that love.
For some, this loss is the largest one, bigger even than the
initial loss of trust. And for women who are HIV seropositive,
the urge to return home to find comfort can be heartbreaking.
There is no other place to go, no safe place to find love.
I am told that incest has
been a part of human behavior for a long, long time. Through
my work at the prison, I am learning the terrible consequences
of incest. Women who have been forced to have sex as children,
who have never been able to speak about their experiences,
bear the scars forever. For women who have no access to professional
counseling and psychotherapy, drugs and alcohol numb the pain
and diminish the terror of sexual intimacy. Blame is internalized,
and self-esteem is destroyed. The links to drug use and sex
work are clear; and now HIV has entered the equation. These
links, between childhood losses, failure of support systems,
lack of access to means of recovery from abuse, drug use,
sex work, and HIV infection, are illustrated over and over
again by the women who come sit with me in my HIV clinic at
the prison and speak to me about their lives. Because I ask
them about their lives and because I choose to spend the time
listening, I have learned that every other woman who comes
through my doors at that prison clinic is a survivor of childhood
sexual abuse.
I ask: What comes before?
How does it start? What unhinges that taboo, allows men to
begin to damage their daughters, their granddaughters, their
nieces, and their sisters? I don’t know the answer. What can
we change about our society to prevent this from happening
to women? A student of mine wrote me the one answer that I
think is valid: we must not tolerate sexual abuse of children.
There must be no acceptance, no excuse, for valuing the lives
of women and children less than sexual pleasure. I have come
to know the newest consequence of childhood sexual abuse:
to damaged self esteem and troubled hearts is now added the
burden of HIV. For my child, I don’t know which way the danger
lies, and that is why I sit here writing, wondering if I will
be heard, wondering how I can protect my moonlit daughter,
wondering how I can change women’s lives.
Previously published
in Friends for Life. The stories of patients X, Y,
Z have been changed, to protect their identities. Any resemblance
to any one individual’s life story is coincidental. This work
would not be possible without the support and encouragement
of S. Zierler, CCJ Carpenter, Ken H. Mayer, and APT; and my
directors Joe Cohen and Rochelle Scheib at the Lemuel Shattuck
Hospital, Jamaica Plain, Massachusetts.
Dr. De Groot is Assistant
Professor of Medicine and Community Health at Brown University
AIDS Program Brown University, Providence, Rhode Island and
a member of the HIV/AIDS Program Staff at Lemuel Shattuck
Hospital. She is also an editor of HEPP News. More
information can be found in Anne S. De Groot and Debi Cuccinelli,
“Put her in a cage: Childhood sexual abuse, incarceration,
and HIV infection,” in The Gender Politics of HIV in Women:
Perspectives on the Pandemic in the United States, J. Manlowe
and N.Goldstein, eds., New York University Press. Also see
Jessica Stevens, Sally Zierler, Virginia Cram, Diane Dean,
Ken H. Mayer, and Anne S. De Groot, “Risks for HIV infection
in incarcerated women,” Journal of Women’s Health,
Volume 5 (4) 1-7, 1995.
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