I. McKeown, S. Reid, S. Turner, P. Orr
Introduction
The incidence of HIV infection among women is growing
steadily, particularly within the Aboriginal community. Although Aboriginal
persons comprise only 2.8% of the general population, they accounted for 5.5%
of all prevalent infections and 8.8% of all new infections in Canada in 1999.
However, few studies directly address the needs of Aboriginal women in Canada.
This project provides a more comprehensive understanding of social factors and
environment on HIV risk behaviours among Manitoba women. Research is needed
to develop a better understanding of why Aboriginal women migrate to urban centres,
how and whether they connect with services upon arrival and how these patterns
are influenced by victimization, substance abuse and reliance on income from
the sex trade. It is within this context that the authors focused on the experience
of violence, economic hardship and relocation/dislocation as they relate to
HIV risk.
The specific objectives of this study were:
- To describe a group of women who are HIV positive in Winnipeg with respect
to age, source of income, education, risk behaviours for HIV infection, ethnicity,
and residence;
- To describe any past experience of violence or threat of violence in the
home and community of HIV positive women in Winnipeg, and how this contributes
to negotiating abilities; and
- To describe the economic circumstances of HIV positive women in Manitoba
and these circumstances contribute to behaviours associated with the acquisition
of HIV; and
- To describe the role of relocation/dislocation of Aboriginal women in the
acquisition and transmission of HIV.
Methodology
The project began by inviting a group of 17 representatives from Winnipeg community
service organizations that provide HIV/AIDS services to women attended a meeting
to share their views on possible research initiatives and research questions which
focus on HIV positive women (See Appendix "A"). The group indicated a strong need
for research that involved the participation of HIV positive women themselves
from the outset.
A focus group was held with the assistance of Kali-Shiva AIDS Services, which
sponsors an HIV positive women's support group in Winnipeg. The participants confirmed
the need for further understanding of issues of violence, alienation and isolation
of women and the role these social factors play in acquiring HIV. An Aboriginal
woman who is HIV positive volunteered to review and provide advice on possible
research questions for the study as part of the research team, provided feedback
on the conceptual framework, recruitment posters and interview questionnaires.
Service organizations that provide community outreach services for men and women
living with HIV and the two hospitals who work with HIV positive women posted
the research advertisement.
Twenty women agreed to participate in the study. In-depth open-ended individual
interviews were conducted at a place chosen by the study participant. The interviews
were transcribed and were coded by the research team. Themes recognized by individual
team members and as a group emerged from the women's stories. This information
was shared with the research participants in a focus group. The purpose of the
focus group was to present and clarify emerging themes and to gather information
from the group regarding prevention strategies based on the findings.
Social Risk Factors Involved in the Acquisition of HIV
in Manitoba Women
The women who participated in the study shared information about their own history
and experiences;
- A majority of participants self-identified as being of Aboriginal ancestry
with the mean grade of education level attained by the participants
was grade 9 with a range of grade 5-12.
- A small number of the participants reported that they acquired the virus
from unprotected sex with a past partner, with the majority reporting
that they likely became HIV positive through IV drug use.
- All the participants at the time of the interviews reported receiving Social
Assistance. Most reported an ability to provide themselves with the
basic necessities of life, but were limited in terms of being able
to obtain adequate housing in Winnipeg.
- The majority of the women in this study reported past involvement in prostitution.
All the women reported having the ability to insist on the use of
a condom if they wanted.
- All the women indicated feelings of isolation and of being unsafe as children,
in their home environment. Reasons for these feelings included sexual
abuse, domestic violence, neglect, and emotional abuse. The reported
age at which the abuse began ranged from five to twelve years.
- Most of the women reported at least one incident of being sexually assaulted
as adults, these events involved past partners, clients and by men
known to them on the streets.
- Of those who reported childhood sexual abuse in the interviews,
half reported they did not talk about these events as they were occurring.
The women cited a number of reasons, for example, a fear of reprisals
from the perpetrator, feelings of shame, guilt and the inability to
realize that talking about the events was a course of action open
to them.
- The majority of participants were young runaways either from foster homes
or from their families or origin; the main reason cited was to escape
sexual abuse.
- As youths, most of the study group participants left home and were involved
in foster care, as parents themselves; they have had CFS involvement
in apprehension and custody of their children.
- Almost half the participants have been in correctional institutions either
as children or as adults, a few citing theft as the reason for their
incarceration and others indicating involvement in violent crimes.
- A majority of the women were from outside an urban center. The mean number
of moves was three the main reason for moving was to escape abusive
relationships.
- Most of the women reported past habitual use of drugs at some point in their
lives, the main drug of choice being heroine and cocaine. The majority
associated the use of IV drugs as a coping mechanism with past and
present emotional issues surrounding their abuse.
- After becoming aware that they were HIV positive, a few women found
support from spiritual beliefs/ religious institutions, more than
half reported support from social programs offered in the community.
- Suppression of memories, suicide attempts, self harm and substance abuse
was identified as a common coping mechanism for past emotional, physical and
sexual abuse.
Discussion
Policy at present has focused on prevention through public advertising campaigns
and the use of condoms in safe sex practices, and by and large has not addressed
the social forces behind engaging in HIV risk behaviours. Women's lower economic
status in society leaves them vulnerable to HIV. The lack of education and limited
skills was the driving force behind entering the sex trade and eventually engaging
in the use of HIV drugs.
The establishment of the Aboriginal AIDS Task Force and programs such as Kali-Shiva's
Women's Support Group begin to recognize the need for a multi-pronged approach
to AIDS prevention. However, resources are required in order to develop and implement
strategies that go further in addressing the complex situation for women.
A concerted effort to include HIV positive women in the design, implementation
and communication strategies in a meaningful way is paramount. Utilizing the experience
and knowledge of HIV positive women themselves in new and beneficial ways will
go a long way in developing appropriate action plans. Strategists must recognize
the role women play in Aboriginal communities and begin to address the violence
women are experiencing as well as the devastating impact of isolation.
Injection drug use and the rate of diagnosed mental health issues among the women
requires further exploration, in particular, the influence this may have on coping
strategies of the women and the impact this may have on prevention strategies
in the future. In conclusion, it appears that there are a number of complex social
factors that are unique to women, which influence engagement in HIV risk behaviour.
The striking similarity of these women's stories underscores the importance of
childhood isolation and lack of support networks. Childhood abuse often results
in the act of running away, the interruption of education, and eventual entry
into prostitution and IV drug use. The recommendations will require support from
government health departments, but also require partnership building with AIDS
service organizations, band councils, community members, educational institutions
and child welfare agencies.
Policy Recommendations
- That Health Canada and Manitoba Health and Manitoba Family Services in partnership
with First Nations communities provide resources to develop and implement
early intervention strategies which address childhood isolation and work to
create support networks. In particular, these strategies should work towards
reducing family violence and providing education in schools regarding childhood
sexual abuse. The strategies must focus on prevention by developing educational
tools for those who work with children at risk of violence in rural and First
Nations communities.
- Parenting must be highlighted as a family and community responsibility
if social risk factors such as poverty and violence are to be eliminated.
Training and resources must be allocated to the development of culturally
appropriate parenting models. While the majority of the women in this study
are single mothers living in marginalized low-income sectors of urban centres,
rural poverty also affects women's ability to raise their families.
- Appropriate agencies develop youth activities and programs that teach and
foster healthy coping strategies, with particular attention and resources
for First Nation communities. These strategies must include mechanisms that
increase children and youths' ability to complete school and provide options
for continuing education. These approaches must be culturally appropriate,
making use of the expertise and knowledge of other members of the community.
- With limited education and options, run-away teenagers are vulnerable to
entrance into the sex trade lifestyle. They need to be able to access appropriate
education and training to develop employable skills. Groups and agencies which
provide assistance for women and girls experiencing violence need sufficient
funding and resources for the critical areas of housing, health, education
and employment training. The allocation of resources to provide transition
housing, affordable secondary housing, "safe houses", support groups and drop-in
centres must be made available to facilitate women and girl's integration
into the urban milieu.
- Current AIDS services workers, and those working with women at risk for
the acquisition of HIV, should be educated on the social risk factors for
Manitoban women and how these factors influence the women's risk-taking behaviour.
Develop and implement flexible and relevant training and education programs
for women in Manitoba that include an understanding of the social factors
that influence their lives. Increase HIV positive women's capacity and opportunities
to educate young girls about the social risk factors based on their own experiences.
- Provide stable and sustained resources to current AIDS service organizations
to develop and implement women-centred and culturally appropriate outreach
programs that address the socio-economic needs of HIV positive women. In particular,
support women's transition from rural to urban communities through mechanisms
that facilitate women's employability and entrance into the legal workforce.
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