Chapter 1: Population-specific HIV/AIDS status report: Women - Introduction

Chapter 1 - Introduction

1.1 Background

Canada’s most marginalized populations continue to be at disproportionate risk for HIV infection. Epidemiological data indicate that the groups most impacted by HIV/AIDS continue to be men who have sex with men, Aboriginal peoples, people who use injection drugs, people from countries where HIV is endemic, and women who are represented in the above groups or who engage in high-risk activities with others in these groups. The proportion of women living with HIV/AIDS has not decreased over the last decade, and women continue to represent approximately one quarter of all new infections in Canada.

Particular groups of women in Canada, such as women involved in sex work, women in prisons, female youth at-risk, women who use injection drugs, Aboriginal women, women from countries where HIV is endemic, and transwomen, are particularly vulnerable to HIV. The distribution of HIV infection among these groups of women reflects the extent to which social inequities and other factors, such as race, culture, class, age, religious affiliation, and sexual orientation, increase women's vulnerability to HIV infection. Thus, in reviewing the available Canadian data and research, the report goes beyond a strict interpretation of sex and gender- based analysis to consider how women’s lives are shaped by the intersections of gender, race, ethnicity, culture, and other determinants of health.

While sex and gender-based analysis is an important tool to help identify and clarify the differences between women and men, intersectionality goes a step further to look at the complex interaction between various forms of oppression [1-4]. Intersectionality is especially important to consider in the context of HIV/AIDS as it sheds light on how HIV prevention, diagnosis and access to care, treatment and support are experienced differently by certain groups of women who are marginalized by society [4;5]. By applying an intersectional perspective, PHAC endeavours to respect the working group’s advice on the importance of highlighting the complexities of women's lives in the context of HIV/AIDS in Canada.

1.2 Methodology

To support the development of this status report, PHAC established a working group composed of community and population representatives, non-governmental organizations, researchers, and policy and program experts. The working group acted as an advisory body, providing guidance and feedback on the report’s progress, themes and drafts. The non-governmental working group members were selected following a stakeholder consultation in November 2005. The working group also included representation from PHAC.

The report is a “scoping review”, developed and adapted for the purpose of mapping out the literature and evidence on women and HIV/AIDS in Canada [6]^{Footnote 5}. The methodology for each chapter was designed to ensure that the most current and relevant evidence was synthesized and presented. Demographic data were extracted from various sources, including Statistics Canada. Epidemiological information and surveillance data were gathered from reports published by PHAC and other existing published data.

Data and information on women’s vulnerability to and resilience against HIV/AIDS were collected from peer-reviewed publications and grey literature. The literature identified for inclusion in the report met the following criteria: focused on HIV/AIDS; published between 2002 and 2010; focused on women in Canada; addressed one or more of the 12 health determinants related to HIV or AIDS, or characterized HIV or AIDS in the context of prevention, care, treatment, support or diagnosis for women populations; and written in English or French. A list of terms and databases searched can be found in Appendix A. Additional information was also included in the report to provide context and/or address gaps identified by the working group.

Information on current research (underway between 2006 and 2009) was gathered from the following organizations: Canadian Institutes of Health Research (CIHR); Canadian Association for HIV Research (CAHR); Canadian Foundation for AIDS Research (CANFAR); Social Sciences and Humanities Research Council of Canada (SSHRC); Ontario HIV Treatment Network (OHTN); and Michael Smith Foundation.

To gather information on the current response to HIV/AIDS among women, including time-limited projects, networks, coalitions, committees, strategies, and policy initiatives in place between 2006 and 2009, information-gathering templates were circulated to federal, provincial and territorial officials through the following mechanisms: Federal/Provincial/Territorial Advisory Committee on AIDS; PHAC national and regional HIV/AIDS program consultants; the Federal/Provincial/Territorial Heads of Corrections Working Group on Health; and Health Canada’s Regional HIV/AIDS Sub-Working Group. Responses were received from all provinces and territories. Projects funded by the Toronto Public Health AIDS Prevention Community Investment Program were also included in the analysis. The expert working group was also instrumental in identifying additional networks, coalitions, strategies and projects for inclusion in the report.

One limitation of the report is that its analysis only considers HIV/AIDS-specific responses that explicitly address women. While many HIV/AIDS-specific programs and services serve female clients in addition to other key populations, only time-limited HIV/AIDS projects that focus on women or target them directly within a broader group are included in this report. A second limitation of this report is that, due to time and methodological constraints, Chapters 5 and 6 focus on HIV/AIDS-specific projects and do not consider projects related to other determinants of health.

1.3 References

[1] Bates LM, Hankivsky O, Springer KW. Gender and health inequities: A comment on the final report of the WHO commission on the social determinants of health. Soc Sci Med 2009; 69: 1002-4.

[2] Hankivsky O, Christoffersen A. Intersectionality and the determinants of health: A Canadian perspective. Crit Pub Health. 2009; 18 (3): 271-83.

[3] Hankivsky O, Cormier R. Intersectionality: mMoving women's health research and policy forward. Vancouver: Women's Health Research Network. 2009.

[4] Fridkin A, Browne A, Varcoe C. Using intersectionality to inform health services for Aboriginal women experiencing marginalization. Paper presented at the NEXUS 6th Annual Spring Institute; 2009 Apr 16-17 [cited 2010 Dec]. Available from: https://circle.ubc.ca/bitstream/handle/2429/15795/Fridkin.pdf?sequence=1.

[5] Hankivsky O, Reid C, Cormier R, Varcoe CClark N, Benoit C., et al. Examining the promises of intersectionality for advancing women's health research. Int JEquity  Health. 2010; 9 (5).

[6] Arksey C & O'Malley S. Scoping studies: Towards a methodological framework. Int JSoc Res Methodol. 2005; 8 (1): 19-32