Journal Articles: Gender

"The prevalence of HIV/AIDS in African and Caribbean communities in Ontario has grown by 85% in the last 5 years and 22-59% of these infections occurred after settlement in Ontario (Remis, 2004)." -Tharao (Page 1)

Authors: Tiffany C. Veinot; Esther Tharao, Notisha Massaquoi, Senait Teclom; Christopher Fulcher and Catherine Kaukinen

The readings this week have given me a lot to think of in terms of my essay and my eventual masters project. I know I’ve said it before, but this is a complicated issue with so many different directions from which to approach it. The readings have yet to become repetitive but there is a definite trend among them, which is that the circumstances of the lives of many black women in Canada make them more vulnerable to contracting HIV/AIDS and makes living with the disease more of a challenge.

What I came to realize while reading the texts this week is that we seem to know the facts surrounding black women and HIV/AIDS. The next step should be asking how we address it and what policy steps may need to be taken to deal with a huge increase in numbers. I think that is where my research project will enter the discussion, with a focus on services related specifically to black people and women.

Two things stood out in the readings this week: the role African and Carribean women play in efforts to address the problem of HIV/AIDS in their community and the shift in the readings in beginning to suggest policy efforts. In the report Women’s Health in Women’s Hands, Tharao writes “All the research respondents agreed that African and Caribbean women were juggling too many priorities to even think about HIV/AIDS.” The women had other priorities in their lives that took precedence. Added to that is that fact that the people working in AIDS services are often not black women. Which means the women are getting care from people who may find it harder to relate to them, as mentioned in the readings last week.

The lack of a community push to address HIV/AIDS among black was also mentioned frequently in the readings. This is in stark contrast to initiatives by some community services and groups that target gay men.

Veinot’s reading, which emphasized the importance of an integrated approach to dealing with HIV/AIDS was especially interesting. She asserts that prevention, support and treatment of the disease are fundamentally intertwined. According to Veinot the three work naturally together and are the most successful when they are approached in conjunction with one another.

Veinot’s integrated approach to HIV/AIDS reminds me in some ways of Collins’ theory of intersectionality, both make sense in the context of the HIV/AIDS epidemic. It is not a simple disease so the answer to dealing with it could never be simple. This integrated approached, while focused on in Veinot’s reading, comes up in almost all four of this week’s texts. In addition the texts all provide policy recommendations on how to turn the theories and ideas they outline into practical policy and action. I think it’s important to do exactly, to explain how a theory can work in the real world and suggest ways to implement the ideas raised.

More than anything right now it seems actions needs to be taken. The issues have been identified, a lot of their root causes have been brought to light, the next step—the one that has yet to be taken—is to do something to change the current statistics. That’ll take black women themselves, AIDS service workers, policy makers and researchers and, most importantly, the will to change.

Journal Articles - Treatment

"'It was appalling to me to see the loss of legacy that is happening in all of these AIDS service organizations and I think that it goes right back to funding.'" - Roy Cain and Sarah Todd (Page 275)

Authors: Sarah Flicker et. al; Roy Cain and Sarah Todd, Cain & Todd; Raisa B. Deber et. al

This set of readings centre around treatment. An interesting theme that emerged almost immediately in all of the articles is how dramatically treatment and services for people with HIV/AIDS has changed in the years since the beginning of the epidemic. The Cain and Todd reading states explicitly that the introduction of highly active anti-retroviral therapy (HAART) drugs changed the landscape of AIDS services organization and the jobs of AIDS services workers. It went from being about palliative care and preparing for death, to dealing with how live with AIDS and the factors that may have lead to clients contracting the disease in the first place (e.g. intravenous drug use).

While none of the readings deal directly with black women, they are all based on studies conducted in Ontario. They create a clear picture of the current treatment landscape from the perspective of the people who work with clients who have HIV/AIDS. To be honest, it all seems somewhat bleak. The first Cain reading discusses how changes to legislation and funding has negatively impacted the quality and type of care that people with HIV/AIDS receive from social service organizations. While it highlights a number of important points, I found myself wondering what exactly were the policy changes that the workers were dealing with. The second one discusses how the introduction of HAART has also changed the way people with HIV/AIDS are treated.

The most interesting point that both Cain/Todd articles highlight is how the changes in the AIDS services landscape have impacted workers who perhaps entered the field because of a link to the community impacted by AIDS and are now dealing with people who are worlds apart from them. It is sad on both sides, for the new types of clients with HIV/AIDS—those dealing with poverty, addictions, abuse and other factors—and the workers who got into the field when many of their clients were gay males who were dying. Now the clients are different, need more support in terms of day-to-day help and rarely die. I couldn’t help but picture poor black women as I read about service workers who had trouble relating to their clients who needed housing and other help.

It is a strange and interesting set of circumstances. It is also very important that these issues have been brought to light by the studies because this disconnect and the challenges social service workers face play a huge role in the quality and type of care that people with HIV/AIDS (including black women) receive from AIDS service organizations. The studies point directly to a problem or challenge, the recognition of which may be the first step in coming up with new solutions and approaches to treatment and care.

At the same time it isn’t all bad news. The studies showed that there are still people working in AIDS service organizations who care and who are trying, despite numerous obstacles to help in the lives of people living with AIDS. They also point to the power of policy and advocacy.

The shift away from advocacy among service workers is probably a huge detriment to improving treatment. Without the people on the front lines (behind those with the disease) fighting for change in policy from governments rather than simply working around the obstacles erected by bureaucrats the chances of effectively combating HIV/AIDS here in Canada is severely compromised. There was a community element or incentive among the first AIDS service workers discussed in the readings that needs to be reignited I think in order to bring about positive change.

Despite the fact that these were all studies with small sample sizes, they were more effective to me than many of the theory based books I’ve read to date because they were based on interviews with real people. They show clearly the challenges and triumphs of dealing with HIV/AIDS and also, in a very human way, show that despite the challenges like funding and red tape, there is a way forward. It’s really a matter of taking that path. Somebody has to choose to challenge and change the status quo. I’m going to be reading reports by AIDS services organizations that focus on helping black women. I hope to find in them the seeds of people attempting to do just that.

This may be naïve of me, but for some reason in spite of it all the readings this week made a solution to the challenges of treating and supporting people with HIV/AIDS seem plausible and definitely possible.

Journal Articles - HIV/AIDS and Black Women

"Recognize where you are within this country and system. Black women we are at the bottom, period. And if you know that then you can operate on a better ground, you can fight your battles differently (under 30 focus group)." -Williams et. al (Page 18)

Authors: Lauren L. Josephs & Eileen Mazur Abel; Peter A. Newman, et. al; Esther Tharao and Notisha Massaquoi; Charmaine C. Williams et. al

The readings this week were, once again, part of a natural progression in understanding what impacts and effects HIV/AIDS has on black women and black communities in Canada. All four were journal articles based on qualitative studies with groups of black women in Canada meant to understand a particular element of how HIV/AIDS affects black women.

All of the studies recognized from the outset the diversity of this group within Canada when it comes to education, immigration status, income and experience. But at the same time they used questionnaires and focus groups to attempt to understand how this diverse group that is so significantly (and at this point somewhat inexplicably) affected by HIV/AIDS conceptualizes the disease and its place in their lives.

The studies began to provide answers and suggest areas for further research. All of the readings date to the early 2000s which seems to be when researchers and healthcare practioners began to notice and address the disportionate rate of infection of HIV/AIDS among women and especially black women in North America.

The readings have now moved away from theory and have begun to focus on the practical and real life impact of HIV/AIDS among black women. I think it is an absolutely necessary step, critical in fact, to begin to talk to the groups impacted by a particular trend once theories have been established about why it may be happening. Theory can only take you so far before you need to actually go out there and try to figure out what is going on—the readings this week represent that step. The authors are mostly social work professors and HIV/AIDS community workers with a direct link to the group of women (black women) discussed in this course and this set of readings.

What I found especially interesting that came from all of the readings is the emphasis the women in the studies put on the need for “culturally competent” treatment and prevention strategies. It’s a smart term that makes more sense to me than "culturally sensitive" in relation to HIV/AIDS strategies for minority women. It becomes less about sensitivity and more about being effective.

The readings all attempt to understand the root causes of the high number of HIV/AIDS diagnoses in black women in Canada. They all come back to what seems to be a triad of reasons that have come up in most of the readings: gender, race and poverty or economic disadvantage. The quotation used above speaks to that and the challenges black women face on a day-to-day and what makes them vulnerable as group.

Josephs et. al’s intimate partner violence study was especially interesting to me because it addresses an issue that has come up a few times in the course, whici is the disadvantage many black women face in relationships and their lack of power when it comes to asserting the use of safe sex strategies. It was also the first, but not the last, of the readings to point out that current HIV/AIDS prevention strategies and campaigns are ineffective in black communities because they were mostly established in the 80s when the disease was socially constructed as a white, male, homosexual disease. Josephs’ study points to the need to move beyond those understandings of HIV/AIDS.

Josephs makes an assertion that rings true for this set of readings and for course itself when he writes, “Understanding the cultural factors that impact the spread of HIV is vital to the developing culturally competent intervention and prevention strategies,” (227). It is a theme that has emerged in the course and is one that seems to point the way for the next step in dealing with HIV/AIDS among black women, which is putting in place prevention strategies that speak directly to the realities of the lives of black women in North America. I’m interested to see if and when that step will be taken by policy makers and AIDS community workers.

African American Women and HIV/AIDS: Critical Responses

“..We are guided by our desire to privilege the voice of African American women, arguably, the most disenfranchised and least understood population in AIDS-related research and literature on women.” – Gilbert and Wright (page xii)

Authors: Dorie J. Gilbert & Ednita M. Wright

This book represents a shift in the readings from talking about the disease and its abstract impact on the lives of people who have it to talking with and about women living with HIV/AIDS, specifically black women in America. It is an important and necessary shift at this point in the course. I have had the chance to get familiar with concepts and theories that surround HIV/AIDS among black women and to develop a better understanding of the disease itself and approaches to dealing with it in both academia and in medicine.

I am more than ready to begin to deal more with what it means for a black woman, a human being, to contract and live with HIV/AIDS. Gilbert and Wright’s book is particularly useful because it not only discusses familiar concepts and ideas surrounding the HIV/AIDS epidemic, but it also speaks directly to African American women and considers solutions that have been sought to the challenge of HIV/AIDS among black women. This reading put a human face, that of a black woman, on this discussion of the disease.

It also highlights the factors that make African American women more vulnerable to contracting the disease. In this part of the discussion the text mirrors many of Collins’ ideas about the intersectionality of race, gender and class and the authors add stigma to the conversation. They even have a section that notes specifically that not enough is known about black sexuality, a lack that Collins’ book begins to address (16).

Many of the sociocultural causes of the spread of HIV/AIDS among African Americans, and women in particular, that the authors point out have come up in other readings and were things that I had figured out on my own. This includes factors like poverty, institutional racism and gender. But Gilbert and Wright also point out other interesting potential roots of the epidemic of HIV/AIDS among black women in America. This includes substance abuse, which has been hinted at in other readings, but Gilbert and Wright go into a detailed discussion about the history and roots of this problem among African American women and men and how it encourages the spread of HIV/AIDS.

The authors also point out disparities in health and mental health care and access as important factors. The gender imbalance among African Americans (more available women than men) is another interesting factor they also discuss. It speaks to the vulnerability argument that Collins’ makes in her book. Because there are less black men to go around, they argue, black women are more willing to accept less from a partner including overlooking infidelity in order to keep them and the security they often represent.

The text also builds on what Triechler introduced in her book about the social construction of HIV/AIDS. They agree that it was first established as a white gay male disease which left little room for other groups being infected with the virus. The authors attribute this initial construction of the disease to why early prevention campaigns targeted to the gay community had little impact among African Americans—they didn’t speak to them culturally.

The reading discusses how a group of nine women interviewed by one of the authors were each coping with having HIV/AIDS and their personal circumstances. Wright describes their situations as “living with dying,” (151). The details provided about the women’s state of mind and how they have lived and dealt with living with this disease is exactly what I’m interested in addressing for my masters project.

My original intent was to read select chapters of this book because I didn’t expect it to be relevant in its entirety to this course, because of its focus on American women. I think I’m right about it not being completely relevant to the course, but its content is important in terms of helping me understand the details of the issue for black women in North America, which is why I will finish the rest of the book for my own personal (and academic) purposes.

Women's Health in Canada: Critical Perspectives on Theory and Policy

“As the pandemic enters its third decade, making useful sense of how to address women’s experiences of HIV/AIDS remains a challenging task.” - Meredith Raimondo

Ed: Marina Morrow

This week’s readings were particularly useful. They helped bring together a lot of concepts that have come up over the course of the readings and put them into a Canadian context. They highlighted the interconnectedness of different elements of both the disease and debates surrounding it. This is particularly true in terms of understandings of gender, which was discussed in the introduction; the role poverty plays in conceptualizations of health in Canada in the Reid chapter and the impact of HIV/AIDS on women in the chapter by Meredith Raimondo.

The introduction of the text addresses the debates around the concepts of gender and sex as social and biological terms. An interesting point made in the reading is the fact that gender refers not only to men and women but also to the relationship between them. Added to that is the placement of transgendered, transsexual and others that exist beyond the binaries of male/female. Women’s health is Canada is not as simple as one might think.

The reading focused on women and HIV/AIDS was especially beneficial. As the quotation above hints at, addressing women’s experiences in the AIDS pandemic is what’s being talked about at this point. The debate is only beginning now in terms of the disease as it relates specifically to women. This means that addressing forms of gendered treatment and prevention may still be overlooked. The same tension I talked about in my earlier posts regarding theory and practice in dealing with HIV/AIDS appears in Raimondo’s discussion of women and the disease.

This reading also supplies some of the statistics to back up what I’ve been inferring about women and HIV/AIDS since the beginning: that women are at risk of HIV/AIDS at an increasing rate. According to the reading there was a 48 percent increase in the number of Canadian women living with HIV from 1996 to 1999 and those numbers have continued to rise (386). The percentage of women among newly reported diagnoses also grew steadily from 2001 to 2003 (386).

The final idea that was introduced in this reading and that I expect to follow up on during my research is the concept of vulnerability. Vulnerability, in the context of women’s health and HIV/AIDS, is based on the idea that the social implications of being female make women uniquely vulnerable to contracting HIV/AIDS. It is essentially a concept of vulnerability as it stems from social factors, it “…emphasizes the social factors shaping the AIDS pandemic,” (390). Raimondo also notes that ethinicity, race, class and age are also important distinctions that shape rates of HIV infection in women.

This highlights an important point that was brought up a number of times in the course of these readings, which is the fact that gender is intertwined with other factors that all work in conjunction to impact women’s health. Raimondo writes that “while genders is clearly a factor in social vulnerability, it is not the only, or in some cases, the most important factor,” (392). She adds, “An attention to vulnerability requires attention to the complex contexts of women’s lives,” (392), this is an important point to make and one that I have tried to remain aware of in the context of this course.

Women, including black women, have specific circumstances in which they live their lives and taking those into account are necessary when trying to understand how a disease like HIV/AIDS impacts them as a group. Life is complex as is this disease, which means while doing research as it relates to women and HIV/AIDS, it is important to always be sensitive to those realities. The challenge of this project will be to keep these in mind throughout the process because it is very easy to oversimplify and gloss over things for the sake of getting to the heart of the story.

Race, Ethnicity and Women’s Health

“Where the type of health care products and services available responds to the needs of a diverse population, progress towards health care equity is possible…” –Shariff et. al (page 125)

Ed: Carol Amarantunga

In the course of these readings I’ve developed an interest in health policy and how theories and research may lead to health care and policy that is sensitive to culture. What I mean by “sensitive to culture” is a type of practical, clinical approach to care at hospitals and family doctors that take into account the potentially different needs of a person from a place like Jamaica, who may prefer a more holistic approach to health care. Or it could mean that a hospital has staff able to translate for non-English or French speakers so that patients are better able to express their concerns and understand their diagnoses. It is a direction in health care policy that I think could and would make a difference in lives of black women living with and at risk of contracting HIV/AIDS.

Based on the reading this week and last week, I’ve chosen my essay topic for this course. Accessibility of health care is especially an issue for new Canadians and is something that affects the quality of life of persons living with AIDS and those at high risk of contracting the disease. Because black women in Canada are often (although not always) immigrants, culturally sensitive health care could play a role in combating the spread of HIV/AIDS in this group or in mitigating the damaging affects of having the disease.

The roles ethnicity and race play in health care, access to health services and policy in Canada directly relate to the issue of HIV/AIDS among black women in Canada, especially when it comes to treatment and care. I don’t have a clear thesis or focus at this point, but these readings have definitely helped me recognize my interests.

The readings this week come from on text on race, ethnicity and women’s health. The chapter I read examines the immigrant experience as it relates to health and health care. I think this was an important topic to address in this course because of the fact that a significant percentage of black women in Canada are immigrants.

I found Wanda Thomas Bernard’s chapter on inclusion especially interesting because it looks at theories based on exclusion and inclusion and addresses them from the practical experiences of immigrant women in Canada.

While the readings are regionally focused and all based on research conducted in the immigrant community in the East, the researchers draw conclusions that add to the larger national discussion of ethnicity and health care. I think they were important for me to read because they gave me a sense of the type of research being conducted around the issues of health care, access, ethnicity and immigration and the questions being asked related to them.

My only concern while reading these chapters was that the research seemed to be there, but there was no evidence that the work actually translated to policy. It’s a question I think I will look into for my own knowledge.

Another important element of this set of readings is the perspective from which the researchers address the issue. The readings this week build on what Bhopal discussed in his text. While Bhopal’s work is based on epidemiology and research affecting policy from the point of view of the researcher, the readings this week approach the issues of race and ethnicity and how they relate to health from the perspective of immigrant or “other” race or ethnicity. They rely on qualitative research conducted in PEI, an admittedly limited pool, to draw conclusions about the female immigrant health experience in Canada.

In these readings the reader gets to hear directly from the people who the research is being conducted based on through quotations and relation of answers in the study. It helped me realize that there is a certain level of validity to this type of qualitative research when it relates to groups that are often marginalized and not given a voice in wider society.

The readings this week felt less personal this week in that I didn’t find myself comparing my experience to those related in the text. But they were just as important as any other I’ve encountered to date because of the broad perspective they offer.

Ethnicity, Race, and Health in Multicultural Societies: Foundations for Better Epidemiology, Public Health, and Health Care

“Race has played a major role in the way societies work and intereact and the cocept has been abused in the past to justify inequalities.” -Raj S. Bhopal (Page 10)

Author: Raj S. Bhopal

This reading is an introduction to a text that focuses on improving health using race and ethnicity in multidisciplinary epidemiological settings. I found it relevant to this course because it directly addresses a key element of the discussion of HIV/AIDS among black women: race. But the author approaches race and also ethnicity from the perspective of an epidemiologist and discusses how taking into account race and ethnicity in research may help or hinder advances in medical research and policy.

This introduction is especially useful because it discusses the concepts of race and ethnicity theoretically, socially and scientifically. It also addresses how human understandings of the two terms have evolved over time. On a more practical level, Bhopal discusses how race and ethinicity may be used as variables in research. This made me wonder how gender and race could be used as variables in HIV/AIDS research.

But at the end of the day, the reasons why HIV/AIDS seems to be affecting black women disportionately to other women and groups are more social than biological. Bhopal’s work speaks to this idea simply because he discusses the power of race and ethnicity in forming prejudices and biases. He also addresses the history of using race based theories to explain the inferiority of some races compared to others and while he sees the benefits of using both race and ethnicity in research he does so with caution all while acknowledging the negative that may come out of it. He writes, “since interest in, and the influence of, research on ethnicity and race is increasing it is important that the conceptual basis of the work is sound,” (9). He seems to be saying that people are going to use the two concepts as variables whether we like it or not, so the next essential step is to clearly define and understand the terms. For that reason Bhopal spends a lot of time explaining and discussing the differences between the two terms.

He goes on to talk about their influence. He writes, “Directly or indirectly, race and ethnicity have a major impact on populations’ health patterns,” (7). The indirect impacts (social results of being from a particular racial group) are what I am most interested in in my research and how ackowldeing them in AIDS related research may help in addressing the spread of HIV among black women. If this type of research would be beneficial or capable of… helping black women deal with the challenge of HIV/AIDS.

Bhopal acknowledges that race is social rather than biological construction but still asserts that is a useful tool for analysis. He devotes an entire section in the reading to discussing the social harm that has been and can be caused by the two concepts. He also makes a good case for the idea of environment as a causal factor in disease, specifically the social conditions of a given group.

I don’t disagree with Bohopal’s assertions, in fact I agree with a lot what he has to say about race and ethinicty. Mainly because he is relying on the facts of social and scientific history in his discussion of race and ethnicity and how the terms have been used and may be used in the future. This is by far the most practical reading I have yet to study because it addresses how these concepts and their use may impact research and then eventually policy.

The policy part is also what I’m interested in. Specifically Bhopal outlines how research using ethnicity or race as variables may influence the development of health services and individual clinical care. Research that looked at treating HIV/AIDS or caring for patients with the virus with a focus on race, so black people, or ethnicity, so a specific cultural group like carribeans, would be beneficial in developing policy and standards of care that could be more considerate of the culutural backdrop of a patient’s experiences and their specific needs.

A large majority of clinical care is focused on the general population, perhaps to the detriment of patients in minority groups. A more targeted approach to care could make a huge difference and research that encourages finding that out I think at least is important.

This is a reading from which real and positive results could be developed from. It is important work for that reason.