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.