Chapter 6: Population-specific HIV/AIDS status report: Women - Response

Chapter 6 - Response to HIV/AIDS

As a result of the need to limit the scope of this report, this chapter provides an overview of only those Canadian strategies, coalitions, networks, organizations and projects that focus on HIV/AIDS and women. Note that this chapter does not include an examination of the Canada-wide response to the various determinants of health and their impact on the vulnerability and resilience of the female population to HIV/AIDS.

6.1 Methodology

To obtain information on projects, coalitions, committees, plans and policy initiatives in place between 2006 and 2009 that address HIV/AIDS among women, information-gathering templates were circulated to federal, provincial and territorial officials through the following committees or consultants: Federal/Provincial/Territorial Advisory Committee on AIDS (F/P/T AIDS), PHAC’s national and regional HIV/AIDS program consultants, the Federal/Provincial/Territorial Heads of Corrections Working Group on Health, and Health Canada’s First Nations and Inuit Health Branch Regional HIV/AIDS Sub-Working Group. Responses were received from all provinces and territories. In addition, projects funded by the Toronto Public Health’s AIDS Prevention Community Investment Program, the Québec Programme de soutien aux organismes communautaires (Support Program for Community Organizations) and some organizations from the private sector (identified through key-word searches using Google), were also included in the analysis. 

It is important to note certain limitations of the methodology for this chapter. First, some projects, programs or initiatives, such as health care and social services delivered by provinces and territories, may not have been captured through the information-gathering methodology used in this report. Also, data from some of Québec’s regional health authorities, which manage local community programs, were unavailable. We hope to address this gap in the future. Organizations are invited to contact PHAC’s Centre for Communicable Diseases and Infection Control if they wish to see their work reflected in future status reports.

Second, the number of responses included in this chapter is relatively low because only those projects, coalitions, networks, etc., specifically designed for women or those which target them directly as part of a broader group, are included. Responses that focus on the general population or any other specific population of which women may be part have been excluded from this analysis. The following subsections describe in more detail the reasoning behind the population-specific inclusion/exclusion criteria of certain projects/responses relating to HIV/AIDS among women.

6.1.1 Women as Part of the General Response

As we have seen in previous chapters, women make up 51% of the total Canadian population, and they account for over one quarter of the estimated HIV infections in Canada in 2008 (Chapter 3). Consequently, women are captured as part of the audience for a wide-ranging number of general responses to HIV/AIDS across Canada; however, these responses are not included in the analysis of this chapter as they are not gender-specific.

6.1.2 Women as Part of a Community or Group

Women are identified as a target audience within certain community or cultural group-based responses. Some of these responses focus on the whole community, but also support women-specific activities. For example, the Groupe d’Action pour la prévention de la transmission du VIH et de l’éradication du Sida (Action Group for the Prevention of the Transmission of HIV and the Elimination of AIDS) focuses on the broader Haitian community of Montreal and has developed a female-specific radio program. Because this group targets women specifically, its responses are included in the analysis.

6.1.3 Women as Stand-Alone Categories

Various organizations across Canada have responded to the needs of women by developing projects, coalitions, networks, etc., that are female-centred. This approach is consistent with Health Canada’s Gender-based Analysis Policy, which seeks to identify and clarify the differences between men and women and to demonstrate how their different social realities, life expectations, and economic circumstances affect their health status relating to access to, and interaction with, the health care system. This report recognizes the need for a women-centred approach for looking at HIV/AIDS responses, given that the social and cultural realities of both sexes are distinct.

6.2 Overview

Canada’s response to HIV/AIDS has grown in scope and in complexity since the early days of the infection. Governments, non-governmental and community-based organizations, researchers, health professionals and people living with, and vulnerable to, HIV/AIDS are engaged in addressing the disease and the conditions that sustain it.

Through The Federal Initiative to Address HIV/AIDS in CanadaFootnote 52, the Government of Canada monitors HIV cases through its national surveillance system; develops policies, guidelines and programs; and supports the voluntary sector (composed of national HIV/AIDS organizations, AIDS service organizations and community-based organizations) in the response to HIV/AIDS in communities across the country.

The provinces and territories are engaged in similar activities and, under Canada’s Constitution, are primarily responsible for the provision of health and social services to people living with, or at risk for, HIV/AIDS.

Organizations operate in all provinces and territories to reduce vulnerability to, and the impact of, HIV/AIDS and to provide diagnosis, prevention, care, treatment and support services to those most at risk. These organizations conduct these activities with government and private funding. Depending on the jurisdictions, community-based organizations work through pre-defined structures to determine priorities and allocate resources. Communities and local health authorities, governments, front-line organizations, volunteers and affected populations are uniquely positioned to determine the appropriateness of the response. In addition, the private sector, including corporations, pharmaceutical companies, and churches, is involved in the response to HIV/AIDS in Canada.

6.3 Population-Specific Strategies

This section provides an overview of existing women-specific strategies to address HIV/AIDS at national and provincial/territorial levels. Given that the proportion of incidence of HIV cases among women is increasing (Chapter 3), the provision of women-centred responses is a priority for many national and provincial/territorial governments and organizations across Canada.

The Federal Initiative to Address HIV/AIDS in Canada identifies women as one of eight key populations at risk of, or affected by, HIV/AIDS. This initiative was developed as the Government of Canada’s response to Leading Together: Canada Takes Action on HIV/AIDS, a stakeholder-led document that outlines a coordinated nationwide approach to HIV/AIDS in Canada. Leading Together highlights the importance of community involvement in the response, as well as the need for culture, gender and age appropriate programs and services.

Most Canadian provinces and territories have adopted prenatal HIV testing strategies for pregnant women. Twelve out of the thirteen jurisdictions have formal policies for HIV testing of pregnant women. Seven jurisdictions follow the opt-out approach to HIV testing, while the other five follow the opt-in approach (Chapter 3).

Many provinces and territories have also developed women-specific health strategies. For example, British Columbia has the Women’s and Girl’s Health Strategy, which provides a gender-centred approach to priority conditions, including HIV/AIDS. Manitoba and Saskatchewan support an action plan for women's health, developed by the Prairie Centre of Excellence for Women’s Health, which focuses on programs for women and includes sexual education relating to HIV/AIDS.

With the support of the Ontario Ministry of Health and Long-Term Care, the Women and HIV/AIDS Working Group, consisting of Ministry staff, researchers, community representatives and people infected, and affected by, HIV/AIDS, is developing a strategy to address the growing rates of HIV infection among women in Ontario. The Ontario Women’s Study Research Group, which is associated with the Working Group, is developing a provincial research program that will take into consideration the varied life experiences of women vulnerable to HIV infection. In addition, the Ontario Aboriginal HIV/AIDS Strategy is undertaking Aboriginal women-specific interventions addressing prevention. Although not specific to women, the Ontario Aboriginal HIV/AIDS Strategy plans to prioritize women over the next five years.

In 2009-10, the Ontario Ministry of Health and Long-Term Care established new funding for the Women and HIV/AIDS Initiative, which allowed 15 ASOs to create women’s HIV community development coordinator positions in key communities across Ontario. The Women and HIV/AIDS Initiative (WHAI) adopts a community development approach and involves building the capacity of local community health and social service providers to address women and HIV/AIDS issues in Ontario.

In addition to these strategies, there are also joint culture- and gender-centred strategies. For example, in 2004, the National Aboriginal Health Organization (NAHO) hosted an Aboriginal Women’s Health Roundtable Planning Meeting that attracted 21 representatives from NAHO, the Native Women’s Association of Canada (NWAC), Pauktuutit Inuit Women of Canada, the Métis National Council (MNC), and the Assembly of First Nations (AFN). At the meeting, participants identified the need to focus on various health issues, including HIV/AIDS. The next step was to build the framework for an Aboriginal Women’s Health Action Plan. The following year, in 2005, NAHO hosted a national roundtable meeting on Aboriginal women’s and girl’s health, which drew 70 representatives from First Nations, Inuit and Métis organizations and Health Canada. The goal of the meeting was to discuss priority issues and policy recommendations to improve the health of Aboriginal women and girls. Although there was no specific reference to HIV/AIDS, members agreed that there is a gap in educating Aboriginal females on healthy sexuality.

In recent years, there has been progress toward developing the framework for an Aboriginal Women’s Strategy Action Plan to address Aboriginal women’s HIV/AIDS issues in Canada [1]. The framework, which is the result of several months of consultations with Aboriginal women across the country, will provide for an HIV/AIDS Aboriginal women-specific strategic action plan over the next five years. Two-tier expertise will be established for this framework, including an Aboriginal Women Living with HIV/AIDS Council (AWHA), which will be the primary guiding voice and the Canadian Aboriginal AIDS Network Voices of Women (CAAN VOW) Committee, consisting of key service providers and a core group of AWHA. The following goals will be established in concert with these experts: strengthening the network and support for Aboriginal women in every region; advocating for improving the availability and accessibility of, and care and treatment services for, HIV-positive Aboriginal women; increasing prevention education and awareness on HIV/AIDS for women; and conducting gender-based and women-specific community-based research. The Aboriginal Women’s Strategic Action Plan on HIV/AIDS will serve as a useful resource and guide for Aboriginal AIDS service organizations to design and build their own resources with, and for, Aboriginal women within their respective regions.

6.4 Population-Specific Networks, Coalitions and Advisory Bodies

This section provides an overview of female-specific strategies to address HIV/AIDS on both the national and provincial/territorial levels. Networks, coalitions and advisory bodies undertake a variety of activities, such as providing advice, advocacy, and research. Some of the networks and coalitions listed below also deliver programs. The existence of these organizations and bodies indicates the importance of working in partnership across community, organizational, and government sectors to address HIV/AIDS among women.

In this report, a network or coalition is defined as an organization, which has member organizations and/or individual members formed to represent a group’s interests, goals or objectives at provincial, national or international fora. An advisory body is defined as an organization that provides advice on the development and/or implementation of strategies, policies and programs.

6.4.1 National Networks, Coalitions and Advisory Bodies

The Blueprint for Action on Women and Girls and HIV/AIDS in Canada is a multi-sector coalition consisting of 77 Canadian and international HIV/AIDS organizations and a variety of women’s and reproductive rights groups. This group advocates for improvements to HIV/AIDS prevention, services and supports for women and girls infected with, and affected by, HIV/AIDS in Canada. In addition to advocacy work in support of women’s rights, the members of the coalition have also formed working groups to discuss specific issues that relate to women and HIV/AIDS, including groups related to law, ethics and human rights; research; stigma and discrimination; diagnosis, treatment, care and support; and prevention and education.

Networks on women’s health are also responding to gender and HIV/AIDS in Canada. The Centres of Excellence for Women’s HealthFootnote 53, a multi-disciplinary partnership network of academics, community-based organizations and policy makers, are putting women’s issues high on the research agenda and are working to respond to the specific needs of women relating to HIV/AIDS. In addition to these Centres, the Canadian Women’s Health Network and other working groups and initiatives also address specific policy issues regarding women and HIV/AIDS.

As a result of the high prevalence of STBBIs among women in federal penitentiaries, Correctional Service of Canada (CSC) has developed a social determinant-based strategy entitled, Infectious Disease Strategy for Women Offenders, which offers gender and culturally appropriate infectious disease prevention, care, treatment and support to women in prison. The strategy takes into consideration women’s lived experiences to understand their vulnerability to infection, including decisions on risk behaviours, utilization of harm reduction measures, accessing health services and testing/treatment uptake.

In 2009, planners, decision-makers, service providers and policy analysts met to discuss issues, research, and programming relating to girl’s and women’s substance use in Canada [2]. The goal of the meeting was to further explore harm reduction from a ‘determinants of health affecting women’ perspective, which included a look at determinants such as poverty, sex work, motherhood. Both the British Columbia Centre of Excellence for Women’s Health and the Coalescing on Women and Substance Use sponsored the meeting activities.

6.4.2 Provincial Networks, Coalitions and Advisory Bodies

The Atlantic Centre of Excellence for Women’s Health promotes a gender-based approach to HIV/AIDS policies, programs and research. The Centre, which is member of the Interagency Coalition on AIDS and Development (ICAD) and of the research sub-committee of Blueprint for Action on Women and Girls and HIV/AIDS, conducts policy-oriented research to improve the health status of Canadian women by making the health system more aware of, and responsive to, women’s health needs.

Positive Women’s Network (PWN), a partnership of women living with, and affected by, HIV/AIDS, provides access to support and education and prevention for women in communities throughout British Columbia so that they can make informed choices about HIV/AIDS and their health. In addition, the PWN provides leadership and advocacy around women’s HIV/AIDS health and social issues in national and local health care communities. The PWN is open for membership to anyone living in British Columbia with proof from their healthcare provider of their HIV-positive status.

The Ontario Ministry of Health and Long-Term Care created a working group to address increased rates of HIV among women in that province. As part of this work, the Ministry supported research into best practices in HIV prevention among women to determine where this population is most likely to access health care and social services. The Prenatal Testing Initiative funds a communications campaign to promote awareness of the HIV prenatal testing program among pregnant women, HIV test providers and women considering pregnancy.

In Nova Scotia, the Advisory Council on the Status of Women advises the Minister responsible for the Status of Women and identifies women-specific concerns, including those related to health. In 2003, the Advisory Council produced a gender and HIV/AIDS backgrounder which highlights the various gender-related vulnerabilities to HIV/AIDS.

In Newfoundland and Labrador, a gender/HIV partnership program was created by the AIDS Committee of Newfoundland and Labrador, Oxfam, the Interagency Coalition on AIDS and Development (ICAD), the Canadian International Development Agency and Zimbabwe/Lesotho to address and analyze the issue of men’s violence against women and HIV/AIDS.

As previously discussed in Chapter 4, women involved in sex work and survival sex can experience a multitude of HIV vulnerabilities. In response to the need for sex worker empowerment, several sex worker coalitions have been formed across Canada to develop health education initiatives and promote better working conditions for sex workers. In the Maritimes, the Sex Trade Action Committee, which was initially formed by community police to address issues related to street-based sex work (survival sex) in Saint John, partnered with AIDS Saint John and others (including current and former sex workers) to develop harm reduction, education and rehabilitation projects for sex workers.

Stepping Stone, a sex worker organization based in Halifax, currently staffs many sex workers and has developed partnerships with healthcare providers, counsellors (legal and health), and other community workers (e.g., AIDS Coalition of Nova Scotia) to provide harm reduction and outreach to those involved in sex work, with a particular focus on survival sex.

Québec’s STELLA, which was created in 1995 by sex workers, public health researchers and advocates, is an organization by, and for, sex workers aimed at improving their quality of life and working conditions. The organization aims to provide support and information to sex workers so that they may live in safety and with dignity, to reduce discrimination against sex workers by raising awareness and educating the public about sex work and the realities faced by sex workers, and to promote the decriminalization of sex work.

In Ontario, two sex work organizations have been created, one in Toronto (MAGGIE’s- The Toronto Prostitutes’ Community Project) and the other in Ottawa-Gatineau (POWER- Prostitutes of Ottawa-Gatineau Work, Educate and Resist). Both organizations are run by sex workers to provide health and legal services to this population.

There are several sex work organizations located in British Columbia, including Prostitutes Empowerment Education and Resources Society (PEERS), the Canadian National Coalition of Experiential Women (CNCEW), and the West Coast Cooperative of Sex Industry Professionals of Vancouver (WCCSIP).

PEERS offers programs and services for current and former sex workers, including education and employment transition programs for those wanting to exit the sex trade; access to affordable housing and access to justice (e.g., providing support to parents to help them gain custody of their children); outreach (e.g., offering needle exchange, condoms etc. at mobile drop-in centres); and access to an in-house female doctor.

The CNCEW aims to improve the living and working conditions of female sex workers and focuses on the following key issues: harm reduction (e.g., providing sex workers with appropriate services), law reform (e.g., promoting decriminalization of sex work), public awareness (e.g., fighting discrimination and stigma), social justice, children and youth protection (e.g., recognizing and addressing the issue of youth sex worker exploitation), violence, and human trafficking.

The WCCSIP is a cooperative of current and former sex workers who pay for membership which allows for voting direction or input on profit spending. The following issues are targeted by the WCCSIP: creating labour standards for sex workers; empowering and unifying sex work communities to increase economic security of adult sex workers; developing capacity building to develop policies for the sex industry; engaging allies in addressing the organization’s goals; keeping harm reduction frameworks at the forefront; and working toward social justice and increasing labour conditions and sex workers’ safety.

6.5 Program Analysis

This section provides an analysis of the types of programs and projects identified as part of the data-gathering process to determine whether and how they reflect the realities and needs of women relating to HIV/AIDS. The main objective of the data-gathering process was to identify time-limited projects (active between 2006 and 2009) addressing HIV/AIDS among women in Canada. Projects and the responsible organizations are listed in Appendix C. It is important to note that this analysis does not include those HIV/AIDS programs that have been integrated into regular provincial or territorial health care and social services delivery activities (except for women’s program initiatives implemented by CSC and some provincial prisons which have been integrated into the delivery of health services for women in prisons). Funded projects that are directed at women, have a large women’s component (either in the title or descriptor), or target women directly within a broader group are included for discussion. It should be noted that due to the projects time-limited nature and the time lapse between writing and printing this report, some of the projects may no longer be active.

6.5.1 Projects Addressing Women

Of the 101 projects reviewed, 11 (11%) address women as part of a larger project while 89 target women exclusively (Appendix C). Figure 19 shows that one quarter (25%) of organizations involved in the female HIV/AIDS response are AIDS Service Organizations, followed by Women AIDS Service Organizations (23%), and Specific Populations Service Organizations (20%). The latter two types of organizations target Aboriginals, youth at risk, people from countries where HIV is endemic, sex workers, women who use injection drugs and transgender persons, all of whom are identified at increased risk for HIV.

Figure 19: Distribution of Organizations Involved in the Response to HIV/AIDS among Women in Canada (N = 71)

Figure 19: Distribution of Organizations Involved in the Response to HIV/AIDS among  Women in Canada  (N = 71)

ASO: AIDS Service Organization (open to all populations)

WASO: Women-specific AIDS Service Organization

WSO: Women-specific Service Organization

SPASO: Specific Population AIDS Service Organization

SPSO: Specific Population Service Organization

CS, CH or SHS: Community services, community health, or sexual health services

GO: Governmental organizations

Text Equivalent - Figure 19: Distribution of Organizations Involved in the Response to HIV/AIDS among Women in Canada (N = 71)

Figure 19 is a pie graph with different sized segments. They correspond to the relative distribution of organizations identified in the report as responding to HIV among women in Canada by type of organization. The total number of organizations identified in the report was 71.

AIDS Service Organizations made up 25% of the organizations involved in the HIV/AIDS response among women, compared to 23% which were women-specific AIDS service organizations, 20% which were specific population service organizations, 14% which were specific population AIDS service organizations, 11% which were community services, community health, or sexual health service organizations, 4% which were governmental organizations and 3% which were women-specific service organizations.

The charting of organizations reveals the diversity of organizations responding to the need of women relating to HIV/AIDS. This diversity speaks to the complexities in addressing women’s specific HIV/AIDS needs, particularly given the array of various cross-populations. 

6.5.2 Geographic Distribution of Projects and Distribution by Category

Of the 101 projects reviewed, 36% were located in British Columbia, 5% in Alberta, 4% in Saskatchewan and Manitoba, 21% in Ontario, 23% in Québec, and 4% in the Atlantic Provinces. In the Northern Region, no women-specific projects were identified. This could partly be due to the fact that funding is more likely to be allocated to the general Aboriginal populations (i.e., First Nations, Inuit and Métis), of which women are a part. In addition, eight projects that were national in scope were identified. When considering the proportion of projects in relation to the percentage of the female population within each area, data show that the most populated provinces (i.e., Ontario, Québec and British Columbia) have the largest distribution of women-specific projects.

6.5.3 Different Programmatic Responses for Different Health Needs of Women

As discussed in previous chapters, there are groups of women who, because of social and economic circumstances, are at higher risk of acquiring or transmitting HIV infection. These groups include women from countries where HIV is endemic, women living with HIV, female sex workers, female youth, Aboriginal women, women who use injection drugs, transwomen and women in prisons. These female populations require individual strategies as their health needs and socio-economic realities are distinct.

Figure 20: Distribution of Women-Centred Projects on HIV/AIDS by Category (N = 114)

Figure 20: Distribution of Women-Centred Projects on HIV/AIDS by Category (N = 114)

The (N) total is higher than the actual number of reviewed projects as many projects target more than one population (e.g., HIV-positive Aboriginal youth)

Text Equivalent - Figure 20: Distribution of Women-Centred Projects on HIV/AIDS by Category (N = 114)

Figure 20 is a pie graph with different sized segments. They correspond to the relative distribution of women-centered projects on HIV/AIDS identified in the report by population of focus. The total number of projects was 114.

Among the women-centered projects identified, 21% focused on sex workers, compared to 20% which focused on women from countries where HIV is endemic, 19% which focused on women living with HIV/AIDS, 11% which focused on Aboriginal women, 11% which focused on youth, 9% which focused on women who inject drugs, 7% which focused on women in prisons (7%) and 2% which focused on transwomen.

6.5.4 Female Sex Workers

Female sex workers constitute the most commonly targeted populations among the 101 projects reviewed, representing 25 projects [W11, W18, W22, W23, W24, W27, W33, W48, W54, W57, W61, W63, W75, W76, W77, W78, W86, W91-W96, W98, W101]. Women who engage in survival sex are at high risk of acquiring or transmitting HIV; therefore, a comprehensive response to HIV/AIDS must address this cohort of women. Of these projects, one third (36% or 9) has a target audience of survival sex workers or street-involved females who use injection drugs [W18, W22, W23, W24, W28, W33, W61, W63, W78]. For example, the project femmes de la rue [W78] focuses on ensuring that sex workers have access to appropriate resources, by, for instance, accompanying them to appointments and ensuring the availability of safe injection equipment. In another project called The Rainier Hotel [W18], former sex workers recovering in detox programs are provided access to a range of support with the aim of encouraging them to regain control of their health.  In Québec, the project Cat Woman, which is available in Lac St-Jean/Saguenay [N75], Estrie [N76] and Mauricie [N91], aims to increase safer sex behaviours and develop sex workers’ ability to respond to factors that limit their capacity to protect themselves.

In British Columbia, the project HIV/AIDS and Survival Sex Workers [W22] focuses on developing and distributing culturally relevant, user-friendly HIV/AIDS information. As a result of this project, peers are trained in outreach, meeting and workshop facilitation and coordination skills. Peer support workers are partnered with community health workers when doing outreach. Similar to this project, two other women-specific sex worker projects are culture-specific. The first project targets Aboriginal sex workers [W57] and focuses on increasing their knowledge of HIV prevention, reducing risky behaviour, and improving women’s access to appropriate services (such as AIDS service organizations across Ontario). The second project is developed for Asian women and aims to increase participants’ knowledge of HIV/AIDS [W11].

6.5.5 Women from Countries Where HIV is Endemic

Leading Together and the HIV/AIDS Population-Specific Status Report: People from Countries where HIV is endemic, Black People of African and Caribbean descent living in Canada emphasizes the need for projects that target women from these countries, as this group of women is more likely to experience gender inequality, violence, and isolation. Therefore, projects designed for these women need to address their specific needs. In addition, programs need to reflect the fact that the majority of women from countries where HIV is endemic live in large urban centres (i.e., Toronto, Montreal or Vancouver).

Over one fifth (23 or 21%) of the total projects reviewed identify women from countries where HIV is endemic as a target audience [W10, W11, W17, W30-W32, W39-W44, W50-W52, W55, W62, W64, W71, W72, W73, W74, W83]. These projects were found in four provinces, namely British Columbia, Alberta, Ontario and Québec, which reflects the geographical distribution of this population group.

Over one quarter (6 or 27%) of these projects target HIV-positive females, and most focus on providing support. For example, the project Sahwanya Community Kitchen [W10], developed by, and for, HIV-positive African women from downtown Vancouver, is geared toward easing social isolation by offering an environment conducive to the sharing of experiences. Another project, the Living Room Program [W64] has been created for African and Caribbean women living with HIV in Ottawa so that they can share their life experiences in a confidential space, thereby providing support and breaking the isolation of living with HIV/AIDS.

There are also culturally specific responses, including those for the Somali [W62], Ethiopian [W55], Asian [W11, W50, W51], African and/or Caribbean [W10, W39, W40, W42, W43, W44, W64, W71, W73, W74] and African Muslim communities [W41], representing 16 (72.7%) of the total responses targeting women from countries where HIV is endemic. In two cases, projects target both adult and young women from each community. In fact, both the Somali Immigrant AID Organization [W62] and the Ethiopian Association in the Greater Toronto Area [W55] have provided age-specific workshops to their respective female populations aimed at increasing participants’ knowledge of HIV/AIDS.

Regarding projects targeting Asian populations, one project named The ORCHID project: Outreach and Research in Community Health Initiatives and Development [W11] targets female Asian sex workers employed in massage parlours and escort agencies throughout Vancouver and the British Columbia Lower Mainland. The main objective is to increase the women’s knowledge about HIV transmission and prevention. Two other Asian-specific projects [W50, W51] provide workshops on HIV/AIDS, either with the assistance of South-East and/or East-Asian female volunteers or by reaching women through various cultural venues (e.g., churches, settlement houses, English as a Second Language (ESL) classes, ethnocultural events, etc.).  Both of these projects promote HIV testing among South-Eastern and Eastern female populations, using the media or by translating an HIV testing resource-document into Japanese and distributing it citywide (Toronto). Finally, another project [W40] aims to reach young women from African Caribbean and Continental communities through cultural venues, engaging them in discussing healthy sexual education within a culture-sensitive context.

The other projects that target women from countries where HIV is endemic generally focus on peer-based outreach [W17] and HIV/AIDS prevention [W30, W31, W32, W52, W83].

6.5.6 Women Living with HIV/AIDS

Projects targeting women living with HIV represented 19% (or 21) of all projects reviewed [W10, W13, W19, W28, W35, W37, W42, W44-W47, W49, W52, W64, W65-W68, W74, W86, W89]. In addition to the six projects targeting women living with HIV from countries where HIV is endemic [W10, W42, W44, W52, W64, W74], three focus on HIV seropositive new mothers [W65, W66, and W67]. These latter projects aim to reduce the risk of vertical transmission of HIV, either by offering free infant formula for a period of one year or by providing support, financial and counselling services.

Some of the other projects focus on peer-support [W19, W35, W47, and W68], increasing outreach capacity and access to programs for women living with HIV [W13, W46], and prevention workshops or education [W64]. A project for HIV-positive female youth aims to increase their life and employment skills [W28]. Finally, two other projects aim to empower women to disclose their HIV status to their partners and service providers [W74, W89].

6.5.7 Female Youth

Of the 101 individual projects reviewed, 12 identify female youth as a target audience [W9, W15, W20, W28, W29, W40, W41, W45, W56, W62, W79 and W97]. Of these projects, three are specific to people from countries where HIV is endemic. These provide a gender, culture and age-specific response to HIV/AIDS. One of the projects, Ethiopian Association HIV/AIDS Prevention Project [W55], aims to increase the knowledge among youth on topics such as HIV and the impact of alcohol and drugs on sexual behaviour. Using peer-driven workshops, the target audience is provided information on HIV prevention. In another project, the Somali AID Organization provides workshops to female Somali teens on HIV/AIDS [W62] and diffuses culturally sensitive prevention education through Somali media (e.g., radio, newspaper).

Four youth projects (30.8%) aim to empower young women and girls regarding their sexuality. For example, in British Columbia, the project Girl Power [W9] looks at the association between women’s low self-esteem and risky activity and their connection to HIV. The project focuses on female body image and its portrayal in the media. Another B.C. project, Rights of Passage [W15], aims to educate Aboriginal girls on healthy definitions of themselves and on HIV/AIDS. Similarly, the Sexual Self-Esteem as a HIV Prevention Tool Project [W29], in Alberta, aims to build the self-esteem of girls by helping them feel good about themselves, their bodies and their strengths and abilities to make positive, healthy choices. Education on the risks of HIV is also provided. Finally, a project named “Hey filles, mets tes culottes” [W97] (“Hey girl, stand up for yourself”) is dedicated to prevention and sex education for young women.

6.5.8 Aboriginal Women

Aboriginal women make up nearly half of all new HIV infections among Aboriginal peoples [4] contrasting sharply with non-Aboriginal Canadian women who represent only 20.6% of positive test reports (Chapter 3). Of the 101 projects identified, 14 target Aboriginal females [W1, W2, W3, W6-W8, W14, W15, W26, W36, W57-W59 and W88].

Projects targeting Aboriginal women include those focused on youth [W15], sex workers [W57] and women involved in injection drug use and/or harm reduction [W1, W2, W8, W58, W59]. This latter group consists of the most commonly identified population among the female Aboriginal projects identified, representing 35.7% (5) of these projects. The prevailing focus on female Aboriginals who use injection drugs is congruent with their distribution in the IDU exposure category, which shows that the main exposure category for HIV in Aboriginal women is IDU, representing 66.3% of total positive HIV test reports between 1998 and 2009(Chapter 3, Figure 18. Some of the response focuses on a culture-specific approach to harm reduction. For example, the project named Awakening the Spirit [W59] provides healthcare providers with Aboriginal history and perspectives, as well as harm reduction relating to Aboriginal women at risk. Another culture-specific response, Culturally Appropriate Harm Reduction Program Development [2], aims at reducing harm associated with injection drug use (and other substances) within Aboriginal communities.

In view of the prevalence of violence against Aboriginal women, two projects specifically target this issue [W26, W88] within the context of sexual health. For example, the project named Positive Women, Positive Spaces [W26] aims at addressing the linkages between violence and the risk of HIV infection among Aboriginal women living in Vancouver’s DTES by creating and evaluating a women-only night clinic. The other project [W88] aims at providing sexual health workshops for abused Aboriginal women residing in shelters and training on sexuality for social workers employed by these facilities.

Additionally, the project named Around the Kitchen Table aims at empowering women, especially those living in remote communities, by reinstating their traditional roles and providing them with community network of support and education [W14].

6.5.9 Women Who Use Injection Drugs, Harm Reduction and/or Substance Use

Of the responses reviewed, 10 target females who use injection drugs, harm reduction and/or substance use [W1, W2, W12, W18, W25, W27, W58, W59, W61, and W99]. One project [W12] supports women in Vancouver’s DTES who are affected by HIV/AIDS to access harm reduction, medical services and community resources. Help is provided to women most vulnerable and not connected to services because of discrimination, exclusion and isolation. Another B.C. project Women Care [W27], supports the health, well-being and leadership of vulnerable women, especially street-involved sex workers who use drugs. The project Women’s Harm Reduction in Toronto also addresses women who use illicit drugs and/or who are working in the sex trade [W63]. The program acknowledges challenges and develops responsive, supportive programming. Additionally, the project WIN located in New Brunswick increases women’s use of a needle exchange program, with the goal of decreasing HIV transmission [W99]. It also provides a safe means for needle disposal. Finally, Coverdale Centre for Women Inc., also located in New Brunswick, offers a substance abuse program for women in prisons [W100].

6.5.10 Women in Prisons

Leading Together has called for the implementation of programs for women in prisons designed to reduce the risk of HIV transmission in all correctional facilities in Canada and to give prisoners access to age, gender, and culture-appropriate prevention, harm reduction and treatment tools and services. Eight of the projects reviewed target women in prisons.

The Prisoners with HIV/AIDS Support Action Network (PASAN) women’s program, which is the largest community-based HIV prison program for women in Canada, provides HIV prevention education, support services, release planning and case management specific to the needs of women in prison and recently released women [W60].

The project Wings for Our Future [W92] targets women in prisons, as well as workers in the field of parole eligibility and labour force reintegration. Various workshops, information kiosks and training sessions are planned to enhance HIV and HCV awareness, information, prevention and support both inside and outside of detention centres. Through these activities, it is expected that women in prisons will gain a greater understanding of modes of infection and prevention techniques, while social workers will become more familiar with available resources and be in a better position to provide appropriate referrals. The project’s target clientele consists of about 250 women in prisons (from both provincial and federal Québec prisons) and 90 social workers.

Another project, Prisoners at Federal Prison for Women run HIV/AIDS Education and Support Group [W5], started in 2006 at the Edmonton Institution for Women (CSC Initiative), provided support regarding HIV/AIDS, hepatitis C and harm reduction.

Additionally, the project University Partners with Provincial Prison for Women -- Participatory Action Research Empowers Prisoners [W16], which is peer-driven, contributes to women’s empowerment and ownership of the project. The prisoners guided the research by asking questions, gathering and analyzing the data, presenting new knowledge and designing new policies for change.

The Coverdale Centre for Women Inc. offers many programs, one of which is for women transitioning to the community from the correctional system and for women committed to making a significant life change [W100]. For example, it provides a substance abuse program for women in prisons and a halfway house for women transitioning to the community from prisons.

Finally, the project Sex Worker and HIV-prevention Organization Engages Women Prisoners Through Creative Writing and Art engaged women at Joliette Institution (CSC prison for women in Québec) and Tanguay Correctional Centre (Québec provincial women’s prison) in creative writing workshops [W95]. The goal was to produce a special issue of ConStellation Magazine specifically written, illustrated and designed by sex workers (special edition for women in prisons or affected by law, Vol.10, No.1, 2005).

6.5.11 Other Women-specific Categories

Some of the projects reviewed targeted women from other specific categories, such as women who experience violence, mothers-to-be and current mothers, older women, and transwomen.

a) Violence against Women

Four projects target violence against women in the context of HIV/AIDS: three reside in Québec [W81, W84, and W88] and two specifically target Aboriginal women [W26, W88]. One project named Les femmes et leur santé sexuelle…vers une prise en charge [W81], is intended to increase women’s knowledge and capacity to better manage their sexual well-being and to adopt safer sex practices. Another project, named Positivement femmes [W84], targets women who have experienced abuse, provides them with sexual health prevention skills and aims to increase their knowledge about the risks associated with STBBIs. It also helps them to communicate about sexuality so that they can negotiate safer sex.

b) Mothers-to-be/Mothers

Of the projects reviewed, four focus on mothers-to-be and mothers who are either affected by, or infected with, HIV/AIDS [W25, W65, W66, and W67]. For example, the project named Sheway [W25], located in Vancouver’s DTES, provides health and social service supports to pregnant women and women with infants who are dealing with drug and alcohol issues. Another project, which falls under the Motherisk Program [W67], offers women with free, confidential counselling about the risks of HIV infection and HIV treatment during pregnancy. Finally, The Infant Formula Program [W66] supports new mothers who are HIV positive by offering them free formula for their infants.

c) Older Females

One project named Positive Players: Sexual Health for Women in Their Middle Years [W21] targets women over the age of 40. This British Columbia project also addresses issues unique to post-menopausal women. As the project descriptor states, women over 40 may feel uncomfortable discussing sex practices or drug usage with their health professionals and may associate condom use with birth control only. To address this, HIV prevention resources and information are made available to women through a website. Workshops are also provided. 

d) Transwomen

The review of projects identified two projects for transwomen. The first project, named Asian Women At-risk Education and Outreach Project [W51], aims to increase access to HIV/STI prevention and sexual health messages and services, and includes transwomen among its target audience. The second project named Trans-Positive: Trans HIV/AIDS Community Health Project [W80] addresses HIV prevention and HCV among transsexual and transgender men and women principally from the Montreal area.

6.6 Strategies and Thematic Response

Many of the projects reviewed for this chapter focus on providing targeted HIV prevention messages. Messages are geared to increase women’s awareness or knowledge of HIV/AIDS, but the ways in which this is accomplished varies from project to project. For example, education and information may be provided through media, Internet and awareness campaigns, peer-to-peer workshops, other cultural venues like English as a Second Language courses (ESL) or cultural organizations and through the distribution of HIV/AIDS resource material.

Other projects focus on capacity building objectives by providing training, building knowledge and skills, and forging partnerships through information sharing. In addition, some projects focus on providing support to women most at risk of, or living with, HIV/AIDS, mainly through peer-support or counselling.

Many of the projects discuss a woman’s right to negotiate safer sex and harm reduction associated with injection drug use to reduce the risk of HIV. According to various individuals and organizations, women’s ability to negotiate safer sex is fundamental to HIV/AIDS prevention and acquisition [3;5].

Many of the projects identified in this chapter strive to empower women about their sexual well-being. For example, some of the projects target specific female populations with the following objectives: to increase girls’ self-esteem; promote the sexual well-being of women who experience violence; increase the well-being of women who use injection drugs; increase safer sex behaviours; and develop sex workers’ ability to respond to the factors that limit their capacity to protect their health and well-being. Another program is designed to help women take more effective control of their lives and to feel better about themselves and their families. Empowerment is also fundamental to culturally specific projects. All these projects have the same objective – they seek to empower women with the goal or translating that empowerment into an ability to negotiate safer sex or to reduce the risk of harm. However, it is unclear from the project descriptors of many of these projects whether women are, in fact, more willing or able to negotiate safer sex or reduce harm actually as a result.

Regarding the determinants of health, a number of projects reviewed examine intersecting vulnerabilities among certain groups of women. The effects of intersecting vulnerabilities in women’s lives are addressed to some extent in the Canadian response to HIV/AIDS among those projects that relate to culture (Aboriginal, African and Caribbean communities), age (youth and older women), physical environments (e.g., DTES), social support networks (e.g., violence), personal health practices and coping skills (e.g., substance use, sexual health).

6.7 References

[1] Peltier D. Aboriginal women and leadership. Canadian Aboriginal AIDS Network (CAAN) Newsletter. 2009 Summer; 7 (2): 14-16. 

[2] British Columbia Centre of Excellence for Women's Health. Women-centred harm reduction: Gendering the national framework.  2010 [cited 2010 Aug].  Available from:  http://www.coalescing-vc.org/virtualLearning/section6/documents/Women-centredHarmReduction4.5forweb.pdf.

[3] McWilliam S. HIV prevention in Ontario: Women from Asian and South Asian countries. 2007 [cited 2010 Sept]. Available from:  http://www.health.gov.on.ca/english/providers/pub/aids/factsheets/
hiv_web_fs_women_asian.pdf.

[4] Public Health Agency of Canada. HIV/AIDS in Canada: Surveillance report to December 31, 2009. Ottawa: Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada. 2010.

[5] Scott H, Gillam A, Braxton K. Culturally competent HIV prevention strategies for women of color in the United States. Health Care Women Int. 2005; 26 (1): 17-45.


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